October 15, 2025: The invasion of Ukraine led to unexpectedly high Russian casualties. Russia had to conscript more medical personnel to provide their troops with adequate care, at least by low Russian standards. The unexpected conscription of medical personnel caused many to leave the country, as they can earn a better living in the West after recertifying their licenses to Western standards. The Russian government tried to address the exodus of medical personnel, but between the relatively low pay in Russia, government efforts to transfer medical personnel to rural provinces with minimal medical services, and the increased medical needs of the military, a growing number of Russian medical personnel have been leaving their homeland.

Some things never change in Russia, and one is inadequate medical care. Russia has never established a nationwide healthcare system or a military health system comparable to those in the West. This was especially noticeable in the military. Russian medical care in combat units, particularly during combat, has never been effective and is often unavailable.

In the combat zone, medical treatment for the wounded was poor or nonexistent. The same applied to diseases that broke out among troops. At one point, Russian troops in Ukraine suffered from what was called "mouse fever" and received little treatment. This meant a growing number of Russian troops were disabled by the fever, which Russian military medical personnel were slow to address. In part, this is because it is a new ailment, and the Russian medical community has not yet found an effective way to cope.

It's a different situation with Ukrainian troops, where the army has been quick to adopt Western military practices. The traditional Ukrainian military feldsher, or medic with practical but no formal medical training, received more training and better equipment than their Russian counterparts. The results have been dramatic.

About 40 percent of Russian casualties die compared to only 20 percent of Ukrainian casualties because Russians in this war often receive no battlefield medical treatment whatsoever. The Ukrainians eagerly adopted Western combat medical practices, which were above average during World War II and continued to improve afterward. Western forces now provide at least minimal battlefield treatment, largely by evacuating the wounded to be treated by medics and eventually sent to field hospitals where surgery and other emergency treatments are available. It has long been known that wounded soldiers in freezing conditions die of exposure or shock within about an hour unless they are carried to shelter, but this was not happening for Russian soldiers in this war, even though it was done to some extent during World War II. Soviet field medics then were generally women with no medical training whose primary job was to crawl out onto battlefields with groundsheets and roll wounded soldiers onto them.

One of the more remarkable, and underreported, aspects of the wars in Iraq and Afghanistan is the dramatically lower American casualty rates compared to Vietnam and earlier 20th-century wars. The casualty rate in Iraq was a third of what it was in Vietnam. It was even lower in Afghanistan and subsequent conflicts. Medical care has become much better, quicker, and more accessible. Not only are procedures more effective, but severely wounded soldiers reach the operating table more quickly. Field medics now have capabilities that, during Vietnam, only surgeons possessed. This is one reason why the ratio of wounded to killed was 6:1 in Vietnam, compared to 7.3:1 in Iraq. In Ukraine, Ukrainian troops benefit from these advancements, while their Russian adversaries do not.

The fighting in Iraq and Afghanistan brought about a major change in how the United States handled combat casualties. The result was that over 90 percent of wounded troops survived their injuries—the highest rate in history. Several factors contributed to this. The primary one is that medics and troops themselves are trained to deliver more complex and effective first aid more quickly. Military doctors now talk of the "platinum 10 minutes," meaning that if a wounded soldier, especially one who is severely injured, can be kept alive for ten minutes, their chances of survival increase significantly. Previously, the goal was the "golden hour," which reduced deaths among wounded troops, but the ten-minute goal has reduced the death rate to an even greater extent.

Medics are now equipped and trained to perform procedures previously done only by physicians, while troops are trained to handle procedures previously managed only by medics. This skill upgrade is made possible by several factors.

First, over the last few decades, there has been continuous development in methods and equipment for emergency medicine practiced by ambulance crews and emergency room staff. These practices were initially slow to be adopted by the military. However, because of the fighting in Iraq, nearly all have now been adopted by military medical personnel. This was often due to medics in reserve units who had full-time jobs as emergency medical personnel.

Although combat deaths have been reduced by more than half in the last decade, some types of wounds still lack effective battlefield treatment, meaning the victim will die before more extensive treatment can be obtained. Chief among these are abdominal wounds, particularly when the abdominal aorta is severed. When that happens, the victim bleeds to death in minutes. Now, there is a solution in the form of a belt placed on the abdomen and activated. A bladder inflates, applying sufficient pressure to the abdominal aorta to stop or reduce bleeding enough to allow the casualty to reach a surgeon.

While tourniquets have been used for thousands of years, these devices only work on limbs. Preventing death from most other rapid blood loss situations was achieved in the last decade with the development and widespread use of powders and granules that quickly stop bleeding. First came special bandages like the Chitosan Hemostatic Dressing, more commonly called HemCon. This was essentially a freeze-dried substance that caused rapid blood clotting and was incorporated into what otherwise looked like a typical battlefield bandage. It significantly reduced bleeding, which had become the most common cause of death among wounded American troops. This device was a major breakthrough in bandage technology. Over 95 percent of the time, HemCon bandages stopped bleeding, particularly in areas where a tourniquet could not be applied. However, they were less effective for abdominal aorta injuries. HemCon was followed by WoundStat powder to address some bleeding that HemCon could not handle.

WoundStat was one of many new medical tools for battlefield medicine that greatly increased the effectiveness of immediate (within minutes or seconds) medical care for troops. This effort consisted of three programs. First, new medical tools and treatments were developed that troops could quickly and safely be taught to use, such as HemCon. Then, medics—about one for every 30 combat troops—were equipped with more powerful tools to reduce the likelihood of troops bleeding to death or suffocating from certain types of wounds that are not fatal if treated quickly. Finally, the Combat Lifesaver program more than tripled the number of medics by training selected soldiers in a 40-hour Combat Lifesaver (CLS) course covering the most common medical procedures for the most dangerous types of wounds. These CLS-trained soldiers are not medics but make a significant difference.

During the last two centuries, major wars have driven significant improvements in medical care. This has accelerated dramatically in the past decade. For example, since September 11, 2001, over two million American troops went to war, and about two percent were killed or wounded. Only 12 percent of the 57,000 combat zone wounds were fatal—the lowest percentage in military history. This was largely due to major improvements in managing rapid blood loss, such as when a major artery is severed, and the increased speed of delivering complex medical care to wounded troops. New medical technologies also made it possible to detect injuries like brain trauma, which was previously difficult to diagnose and treat. More of these improvements reached wounded Ukrainian troops than their Russian adversaries.

The Combat Lifesaver course teaches troops how to perform procedures like inserting breathing tubes and other emergency surgical interventions to restore breathing. CLS troops have skills most likely to be needed in life-saving situations when a medic is not available. The additional emergency medical training and new first-aid gear, such as the CLS bag, have saved hundreds of lives and reduced the severity of many wounds. Enough troops have taken CLS training so that there is one CLS-trained soldier for every 10-15 combat troops and one for every 20 or so support troops on convoy or security duty.

Another advantage is the high intelligence and skill levels of the volunteer military. High enlistment standards have largely gone unnoticed by the public, but within the military, it is well known that combat troops are much brighter than at any time in the past and can handle more complex equipment and techniques. Getting combat troops to learn these techniques is not a problem because, for them, it could be a matter of life and death.

Another factor is that medical teams capable of performing complex surgery are closer to the combat zone. These teams, like medics and troops, have more powerful tools and techniques. This includes telemedicine, where video conferences with expert doctors in the U.S. help save patients.

This is part of a century-long trend. During World War II, the "golden hour" standard of getting wounded troops to an operating table was developed. Antibiotics were also developed around the same time, along with the helicopter, whose first combat mission in 1945 Burma was to recover injured troops. These developments are not exotic.

Finally, the military medical community has a track record of success that the troops know about. Everyone realizes that if they pitch in, the chances of survival are good—and they are. In Ukraine, the results were striking because wounded Ukrainian troops received better battlefield medical treatment and were quickly moved to hospital-level care. This is another reason Ukrainian troops have higher morale and combat capability than their Russian counterparts. Russian wounded troops often receive no professional medical care from medics or even feldshers, while Ukrainians do. Russian wounded troops who are captured are allowed to inform their families they are alive but injured. Eventually, these Russian troops can tell their families they received much better medical care from the Ukrainians than the Russian military could provide.

Russia also tries to hide these realities from the public. Last year, Vladimir Putin ordered Médecins Sans Frontières (MSF), or Doctors Without Borders, to leave Russia—an unpopular decision with most Russians. MSF had worked in Russia since the 1990s, when the Soviet Union’s collapse lifted its ban on such international organizations. Putin’s ban on MSF revived a Soviet-era policy. He gave no reason for the ban, and MSF left. The Russians working with MSF continue operating in the medical programs MSF began or enhanced. Putin can now claim this progress as Russian, rather than the result of international cooperation.

Another reason for Putin’s decision was to prevent NGOs from manipulating the media as part of their private international diplomacy. NGOs have become a powerful force in the diplomatic arena, developing and promoting their own foreign policies. This is not the case in Russia, a highly centralized nation that needs more help delivering better medical care to its citizens.

Putin feared that MSF’s good work would reflect poorly on his government, which has struggled to address public health problems. Part of the issue is that many medical resources have been diverted from general healthcare to treat nearly a million soldiers wounded or sickened while serving in Ukraine. Many medical personnel have been persuaded to go to Ukraine to provide treatment in the combat zone. Western militaries, especially the United States, have shown that prompt medical aid close to the fighting saves lives. Putin claims his reinvention of this practice is a Russian idea, and the presence of MSF contradicts claims that medical improvements are solely Russian efforts.

Putin has previously expelled foreign non-governmental organizations, many of which did not provide medical aid but addressed problems the corrupt Russian government could not handle. Putin did not want foreigners providing firsthand accounts of how dire healthcare and other situations are in Russia.