The horrors and dangers of Ukrainian battlefield medicine
Oleksandr Danyliuk is a trauma surgeon. He comes from Zakarpattya (Transcarpathia), studied medicine at Uzhhorod National University and works in Uzhhorod City Clinical Hospital.
He gained experience as a doctor during the escalation of events on the Maidan and the war in Eastern Ukraine. There he first saw the gravely injured, performed complex operations for the first time and saved lives.
We first met him the East in 2015 during the second Patriot Defence Medical Assessment of the Anti-Terrorist Operation zone.
We met Oleksandr the second time a year later in Kyiv, when he completed Patriot Defence’s Ukrainian Trauma Life SupportCourse in order to, in his own words, “finally learn the way it’s supposed to be done.”
We spoke with Oleksandr about his experience, the state of medical affairs and the challenges that Ukrainian doctors face during war.
Photo credit: Patriot Defence
Why did you become a trauma surgeon?
When I was a child, I liked to watch the “Emergency” program on Discovery Channel. I remember seeing how they quickly and effectively treated a bleeding person and saved his life. Then I understood that it was amazing to be a surgeon.
I made it out [east] to the war in the third wave of mobilization. During the first wave in March [of 2014], when I had returned from the Maidan, I immediately went to the military commissariat (I was a reserve army medical officer) and told them that I could leave right away, if necessary. They told me that it wasn’t necessary, but that they’d keep it in mind.
Before Russia attacked us, I was a pacifist, against war, against any armed conflicts. But during the Maidan, I understood that a physical standoff was unavoidable.
You worked in the Maidan medical service?
I arrived on the Maidan on December 1 [of 2013]. As a regular protester. I had just completed my internship. I bought a ticket, got on the train, and called my superior and asked for his support. I told him that my ticket was one-way. Thank God, my colleagues supported me. I joined the [Maidan] medical service on December 9. All we had to treat were colds and bruises, like family doctors. We treated people with simple ailments and minor traumas. Then Hrushevsky Street happened.
I had gone to the Maidan with purpose. So I helped wherever I could. In total, I spent 56 days in three months’ time there. The third time I returned was in January, during the escalation of the conflict on Hrushevsky Street. I arrived when they’d killed Zhysnevsky. He was no longer alive.
I joined the medical staff in the Trade Union Building. I was there with my sister whose first degree is in pharmacy. We were split up. She went to work in the pharmacy of the medical station located in the Parliamentary Library on Hrushevsky Street, while I was made part of the emergency surgical brigade. There were four operating tables, and I worked on one of them.
The mobile medical services brought in the wounded with injuries from explosions and head and cranial injuries. This was the first time I ever had to deal with those types of wounds. Prior to this, I had never seen shrapnel in a body and I had never seen barotrauma-contusions, as we call them. It was shocking.
The Maidan Medical Service. Photo from Oleksandr's FB page
How did you deal with that shock?
We worked as a team that was made up of professionals from across Ukraine, from Donetsk and Luhansk in the east to Uzhhorod in the west. I did my surgical work, other doctors did their work. None of us had experience working as a team, or combat surgery or emergency medicine. Yet we managed to work together fairly well.
Were there any instances when you weren’t able to save someone?
February 20. Unfortunately, four heroes of the Heaven’s Company died while in our care, including the youngest, 17 year-old Nazar Voytovych. It was simply horrific. I will never forget that moment.
Perhaps this is a difficult question, but looking back, did they die because the injuries were fatal, or because the doctors weren’t sufficiently skilled?
One died due to a fatal wound. A second one (Andriy Movchan) died, although he shouldn’t have. If he had received the proper first aid immediately after being wounded, if there had been a person nearby who knew to apply pressure to the bullet wound to slow down the blood loss and then to apply a tourniquet, then his life would have been saved. His wound was not fatal, but by the time they’d carried him to our medical station, he had lost too much blood. He was still conscious, but we weren’t able to save his life.
We had to treat bullet wounds which we hadn’t seen in Zakarpattya at the time. Nobody had experience with that. Nobody had seen a bullet wound, knew the difference between exit and entry wounds and the damage they do to a person. The wounded didn’t want to go to a hospital. They wanted to be treated and return to the Maidan. We treated long term complications and shrapnel wounds. We had to handle all of these. We even administered anesthesia and performed operations on the Maidan. This was done, of course, unofficially. This was all done at our own risk. But why be afraid? We were saving lives.
How did the events on the Maidan influence your professional life?
After the Maidan, in March, I wasn’t sent off [to war] for another four months, despite wanting to go. “We don’t need you,” they said, or “check back in two weeks.” One time they called me up and said “You’ll go to the army on May 26.” Then they canceled my summons. The day I defended my master’s degree was the same day the first residents of Uzhhorod died [in the war].
This was very difficult for me, because I felt that I could have changed something had I already been there. Finally, I was taken in the third wave [of mobilization]. That was the end of July. I underwent a month of training in the army medical unit based in Uzhhorod. But all we were taught was how to shoot a rifle. Nobody taught us battlefield medicine. So we had to teach it to ourselves.
We spent a month teaching soldiers how to use a rubber tourniquet, how to use Butorphanol as an analgesic and dress wounds.We were not prepared. I had no idea what to expect. I checked out a book on battlefield medicine from the library. I read it quickly. This was like taking an express course on military surgery.
Earlier, I did not know that you don’t stitch up bullet wounds. I had no idea. I thought if there was a wound, you automatically stitch it up. At the end of August 2014, we were sent to the front. This was the period of greatest escalation of the entire war.
The Battle of Ilovaisk was underway in a neighboring sector. We arrived in Sector А–that’s Luhansk. Our forces had already been expelled from the Luhansk Airport by intensive bombing, Grad and Smerch rockets. Our brigade ended up by the Siversky Donetsk River. Stanytsia Luhanska. We started covering this sector. My first experience with the wounded came on September 2.
Shock. They were lying en masse across the tops of retreating military vehicles. The soldiers’ eyes were wide and terrified. Nobody was providing them with any first aid; they didn’t even have the equipment to do so. You start doing everything at once: painkiller for this one, change this one’s wound dressing, and so on. Many did not survive, unfortunately.
Then we arrived at the battle positions. These were horrific days and nights, especially the nights. We were being constantly bombed by Grads from Russian territory. Rounds of multiple Grad rockets rained down on us every 40 to 50 minutes. You slept in a bullet-proof vest.
As soon as you saw the sky light up, you ran to the foxhole. Bunkers hadn’t been built yet; there were no engineered structures to shelter a large group of people. So we had to jump into foxholes that were large enough for two, usually for those who didn’t have bullet-proof vests. At the time, there were still people who didn’t have bullet-proof vests.
Oleksandr Danyliuk with Patriot Defence badge. Photo from Oleksandr's FB page
You said that there was no prior training of doctors. But were you supplied with the necessary equipment?
During the month of training [before being deployed], I turned to all my friends, acquaintances, colleagues, etc., [for help.] We came to war zone with practically all the necessary medical supplies. We even had a mobile operating room.
What about the Ministry of Defence?
The Ministry provided us with a Soviet-era mobile OR. If you’re under artillery fire, it’s useless. Two of them were destroyed in a year.
How did you learn?
At first, there was a “ceasefire” and there were no wounded. But then they started again. It so happened that I was asked to temporarily take charge of the medical supplies, the chief medical support officer. For 10 days, they said.
It lasted three-and-a-half months. Not only was I the only surgeon on our team, but I also had to run the entire medical sector. I had to learn in the field. I couldn’t even use a radio transceiver. When my handle was called over the airwaves, I would answer “Hello.” I knew nothing. I learned during battles and from my first interactions with the wounded.
But our team worked well together. We were the primary medical brigade that extracted the wounded from the battlefield, stabilized their conditions and treated them. The wounded were then evacuated to Shchastya, where the doctors of Aidar [volunteer battalion] and local doctors provided them with qualified care. That’s how we worked for three months. Then came Debaltsevo, which was a lot worse.
There were wounded every day. We drove out to get them from the battlefield. Sometimes we had to wait out there for several hours. At first it was frightening. Then it got so frightening, that we grew tired of being frightened. It lasted for so long, that fatigue took over the fright.
Oleksandr (right) during the Ukrainian Trauma Life Support course. Photo from Oleksandr's FB page
Did you lose any of your fellow medics?
Three colleagues from our medical unit died: one feldsher and two drivers. There were 5 or 6 wounded. Thank God, most of their injuries weren’t grave. But one was, unfortunately, severely injured. He lost all four limbs. This is my friend Vadym [Svyrydenko], a feldsher from Kyiv.
On February 16 (Day 7 of the blockade), they started moving towards us in Debaltsevo from their location, so that we’d be able to better defend our position. Vadym was wounded while he was retrieving wounded soldiers. A tank had fired on them, and shrapnel hit Vadym in the leg and hand. He lost a lot of blood, but managed to apply a tourniquet on himself and stop the bleeding. When they brought him to us, he saw me, smiled and lost consciousness due to loss of blood.
We managed to hook him up to anti-shock infusion therapy [IV fluids] in time, operated on him and then sent him off with the other wounded. During evacuation, their transport rode over a mine. He was the only one of the 13 or 14 wounded soldiers that survived. He survived three days lying there wounded, in shell shock at a temperature of minus 20. He lost his limbs to frostbite and anemia. Then he was taken prisoner.
He was quickly returned in a POW exchange after we had come out of the blockade, and both our side and the Russians had many wounded. Due to his critical condition, he was quickly handed over to the Ukrainian side, thank God.
Despite his condition, he was beaten [by the Russians]. They came up to him several times, and learning that he was in Kyiv they’d kick him in the chest. Each one.
In Kyiv he underwent an operation. He remained in septic reanimation for a long time. Now he he’s learning to walk on prosthetics. He underwent rehabilitation in the US. His daughter was born. He’s learning to live anew.
Oleksandr and his college and friend Vadym Svyrydenko. Photo from Oleksandr's FB page
Where did you see the worst trauma?
In Debaltsevo. There we worked for nine days in a bunker. It was a hole in the ground. They brought you wounded with amputated fingers, bones, detached windpipes and detached legs, head injuries, stomach injuries. It was horrific. You’re the only surgeon and you have zero experience. You have no one to consult with. You have to make decisions. Every injury was serious. Even amputating a finger was difficult, let alone dealing with limbs, skulls, necks and stomachs. Essentially without narcotics; our anesthesiologists had to cook up some miracle solutions. My last operation in Debaltsevo lasted four hours. It was an operation on a boy’s liver and pancreas. We managed to save the boy. And that felt good.
After that operation, we began to move out of the blockade. He came out too. Everyone who’d been wounded the previous day survived. It felt good that we managed to save them despite the unhygienic conditions. The bunker: clay, wood, tires and cement are everywhere. Explosions constantly cause stuff to fall into the open wounds. You’re wearing regular gloves. No surgical equipment and you have to work on internal organs. It was something extraordinary.
The patient survived without any infection. This case became legendary not only for me, but for many other doctors who later heard about it.
Are you keeping track of your patients?
You can’t track each one. But all these patients became part of you, your heart, and your mind. You helped them stay alive. You survived their operations with them. Or you died together with them.
I kept track of the most difficult cases. Some of us even became friends. Sashko Tarasiuk and I became friends. We’ve seen each other many times since. Another was a boy in Debaltsevo. He had lost part of his jaw, his fingers and had shrapnel all over his body. I had never operated on a jaw before and it was bleeding profusely. Plus the face. Somehow I restored his face and stopped the bleeding. It was very difficult, but successful in the end. Some eight months after Debaltsevo, we met in person.
The most difficult case was a patient that underwent six operations, one after another, in twelve hours. Liver, intestines, major arteries, veins and thigh. We managed to save him.That was in Stanytsia Luhanska in 2015. It’ll soon be a year since those surgeries. There was great risk involved. In theory, we should have amputated his legs. But we managed to make do with we had and saved his legs. Then the vascular surgeons corrected some issues.
We met later, because he had been unconscious when he came into my care. When he was evacuated, he was on a ventilator and under anesthesia. I didn’t see him again.
In the autumn, after I was demobilized and returned to Uzhhorod, I searched him out. I see a boy walking towards me, speaking to me on the telephone, but he’s walking on both legs and you can’t even tell the horrors his body had been through. And it’s hard to believe that he was once on death’s doorstep.
Photo from Oleksandr's FB page: "Sashko Tarasyuk just came back from the dead. It was the last and the most difficult operation in Debaltsevo"
Were there instances when your own life was in danger? For example, did you have to move the wounded under fire?
There were dozens of instances when I thought I was dead.
These were the times when I arrived on the frontlines: Bal, Chernukhin and so on. When we were ambushed in Vuhledar when we lost Vuhledar. Medics were thrown to places where they shoulnd't have been. I thought that was it. But the fear leaves.
A shock wave hit me in the throat and I had an unpleasant taste in my mouth for a few days. But it all soon passed. In Debaltsevo, a Grad rocket hit our bunker. Thank God it withstood the hit. They regularly shot at medical units with Grads. There’s nothing sacred to the Russians. Zero humanity, unfortunately. The Geneva Conventions do not apply to this war. We came under fire regularly. There was no medical transportation left. None. Nothing.
That final day we worked with the last of our supplies. All that was left were a few vials of fluids, basic instruments and wound dressing materials. All the machines, apparatuses, cars and ambulances had been absolutely destroyed.
We were loading up the wounded for transport, when they fired Grad rockets at us. The truck onto which we were loading the wounded stood between us and where the rockets hit. The driver died and the wounded sustained even graver injuries. We were untouched.
But the explosions were so strong that I thought that I had 15 or 20 seconds left in this life. Next came the breakout that lasted 11 hours, of which 5 to 6 hours were constant battle. This was February 18 and 19, 2015. We left on that truck, unsure of the direction we were heading. Our tires were shot up. Still, we somehow made it out.
“Russki Mir” [the new Russian ideology of “the Russian world”] brought us Russian Roulette. Our column of vehicles was moving. Their tank fires, takes out one of our vehicles, people die. Nobody stops. If you stop, you become the next target.
Every vehicle was on its own. If you got hit, that’s it. No medic will go help you, as no vehicle dares to stop.
Did you have to take care of anyone from the other side? POWs perhaps?
Yes. In 2014. POWs or arrestees, or whatever you want to call them. They were very scared. I purposefully didn’t hide my face from them. I’d say “Look into my eyes. Do I look like a fascist or a person that is carrying out a punitive operation against you?” And they’d say “No. We thought that you’re fascists-banderites.”
In 2015, the POWs in Debaltsevo didn’t require medical attention, at least not surgery. That summer, there was only one in Stanytsia Luhanska who did.
Oleksandr Danuliuk and doctor Ulana Suprun after Ukrainian Trauma Life Support course in June 2016. Photo credit: Patriot Defence
How did the coordination of evacuation occur?
With great difficulty. No communications. No established logistics. No directions or orders.
If there’s someone injured on the battlefield, everyone calls out: “Medic! Medic!” And don’t do anything more. The soldiers are not trained properly. They should know what to do. If you’re woken up in the middle of the night and asked what you’re supposed to do if your arms or legs are injured, your answer should be to apply a tourniquet if at all possible, and not just yell “Medic!”
There were instances when doctors, specialist, anesthesiologists and surgeons were sent to the frontlines to provide first aid, instead of teaching to the soldiers to provide that aid to themselves or one another. They yell “Medic!” and end up dying while waiting for the medic, even though their wounds weren’t fatal. An artery was bleeding. But they were waiting for the medic to come to them…
Did you try influence the situation? Speak with the higher-ups?
What was the result
When we first arrived in 2014, and I became temporarily in charge of the medical service in our unit of 1,000 people, we had a functioning system in place. There were feldshers in the battlefield, “paramedics,” saninstructors [combat medics] and medical vehicles were everywhere.
Every subunit had transport and specialists that provided first aid. We would go and meet the soldiers or the medical brigade would drive out on another ambulance (later we had vehicle with equipment thanks to the volunteers). We were able to provide medical attention en route to the hospital, and in the hospital they would receive qualified care.
There was none of this in Debaltsevo. We were simply thrown out into the battlefield and checkpoints. There were some people who even lived there. I lived in a bunker. I’d go out to gather the wounded, stabilize their condition in the vehicle, arrive at the hospital in Debaltsevo, take off my bulletproof vest, put the patient on the operating table, and operate. I’d finish one patient and go out to get another.
That was my routine for a month-and-a-half. I ran out of the strength and energy to carry on.
I spoke about this time and time again with the other medical officers higher up to no avail. I spoke with some thickheaded people who were essentially still Soviet.
What was the response?
“Yes, yes, yes. Okay.” I tried to show them and told them about my own experience, how it was set up in my sector and how it worked. Let’s do the same thing. We’ll put a doctor’s brigade inside a bomb shelter and provide all the necessary equipment. We had everything we needed. We had professional anesthesiologists, trauma surgeons.We were all sent to different positions, different battalions. But you can’t be a lone soldier. Qualified specialists are supposed to work in medical teams.
This medical military brass you mentioned, are they still a part of the system?
Yes, of course. They’re career military. We returned, they remain. It was after Debaltsevo, in Bakhmut that we met with the volunteer medical workers and the chief medical officers of the Armed Forces. We angrily told them everything. “Do you see the problems you’ve created?” The last half year of work in Stanytsia Luhanska was more or less normal. Once again we had “paramedics,” saninstructors [combat medics] and medical transport in the field. We created a primary reanimation brigade on the basis of the local hospital. It was bombed, destroyed, had no water or power. But we got it up and running and provided medical aid to the military and civilians, to the sick and the wounded.
We worked very well with the local doctors and we had all the equipment necessary. Once again, that was thanks to the volunteers. And the chief medical officers no longer forbade us from taking initiative. He even encouraged it. Delivery times (the so-called golden hour) were adhered to very well. Patients arrived alive who not only had near-fatal wounds, but had been ripped to shreds. They would have died if they had to be driven another 50 to 60 kilometers.
The State is really individual people, not some imaginary substance. Every aspect is represented by a person in a position and their principles and values. Behind every soldier’s saved life there is someone’s hard work, heart and mind.
It’s now the third summer of war. Some people’s inactivity and desire to live in the past continue to threaten Ukrainian lives. Other people continue to work for the cause.
We shall overcome.