Ukraine's battlefield medics excel amid significant losses

Both Russia and Ukraine provide limited details about their losses. This is primarily due to concerns about revealing the actual extent of enemy losses and, perhaps above all, concerns about the potential collapse of military and civilian morale.

The Kremlin is particularly noted for providing information that is often completely disconnected from reality, which even Russians do not take seriously. For instance, how can one believe that in 2022, the first year of the full-scale war in Ukraine, only 2,000 Russian soldiers were killed? These are the figures disseminated by Kremlin propaganda.

The administration of President Volodymyr Zelensky, on the other hand, presents the data in a general manner. This time, Kyiv reported that 43,000 soldiers had been killed and 370,000 wounded since the beginning of the war. This surprised analysts—not because the numbers significantly differ from Western estimates. Based on open sources, the portal UAlosses reported about 60,000 killed and just under 400,000 wounded.

Analysts were surprised by the high ratio of wounded to killed, which sparked many discussions. Either Ukrainians have achieved incredible advances in battlefield medicine and can save almost every soldier's life, or the category "wounded" includes all soldiers, even those lightly wounded or slightly injured.

However, detailed information is lacking, which is very important from a military perspective. Specifically, how many of these 370,000 wounded soldiers represent irreversible losses, meaning soldiers whose injuries prevent them from returning to combat, essentially wartime invalids? President Zelensky assures that about 170,000 represent irreversible losses. This still suggests a significant difference between those killed and those wounded who cannot return to the battlefield. While total losses might be quite realistic, it can be presumed that Ukrainians may have adjusted the proportions slightly.

The proportions differ significantly from the wartime average when compared to other conflicts from the early 21st century, since battlefield medicine has developed considerably. During the 2003 invasion of Iraq, allies lost 172 killed and 551 wounded in regular combat operations, resulting in a ratio of 1 to 3.2, which does not deviate from the average. Meanwhile, in Ukraine, it is 1 to 9.6.

For now, we can only speculate about the reasons for such a different proportion of losses among soldiers. What is certain is that Ukrainians have taken an incredible step forward regarding battlefield medicine.

Eight years ago, Ukrainian soldiers looked enviously at the Polish journalist with an IPMed, an Individual Medical Kit, strapped to his thigh. The tactical tourniquet and the fact that I had recently completed a battlefield first aid course sparked envy. They could not count on such luxuries. Their level of rescue knowledge did not exceed that of Soviet soldiers in Afghanistan, and their equipment was also decades outdated.

However, they used that time wisely, and by February 2022, most operational troops were equipped with the appropriate medical kits. Many had undergone at least basic medical training. The Territorial Defense soldiers were somewhat less equipped in this regard. However, after another two years, paid with blood, the soldiers developed effective operating methods. Nevertheless, Ukrainians still lack personnel training at the TCCC course level or Tactical Combat Casualty Care—the battlefield first aid course.

Trained medics are at the company level. However, due to personnel shortages, companies are stretched and sometimes occupy twice as much of the front as tactical manuals suggest. In such a situation, a trained medic would be useful in every platoon. However, that's not possible. Therefore, trained medics teach their colleagues while under fire. Ukrainians have no other option.

The method, however, works. Reports from the front indicate that the time taken to reach the wounded and evacuate them from the front is so short that Ukrainian soldiers do not die in the mud of the trenches. It's a different story for the Russians. Their system for rescuing the wounded is stuck at the level of the first Chechen war and has changed little, even during the ongoing war.

Why are Ukrainian losses significantly smaller than Russian ones? It is not a trick or propaganda. The defending side incurs fewer losses than the attacking one. Defenders are usually hidden in various fortified and sheltered positions—trenches, combat shelters, etc. The attackers, meanwhile, must first reach these lines of fortifications.

In the case of the Russians, ever since the fierce battles for Bakhmut, reaching them has meant sending additional infantry groups, with increasingly less support from armored-mechanized units, to assault across open fields. This chosen tactic causes personnel losses to rise alarmingly and continue to rise.

Soldiers who gained significant experience have either been eliminated from further combat or had to be withdrawn for rest. Now, individuals without education and experience lead, burdened with political demands, unable to operate according to military practice.

This primarily accounts for the significant difference between the overall losses of Ukrainians and Russians, which, according to objective estimates, not merely propaganda, have now exceeded 750,000 killed and wounded. Although Russians still have considerable reserves, requiring only the declaration of a general mobilization, which the Kremlin avoids, losses of 400,000 are very problematic for Ukrainians.