CNN accesses hospital train rescuing wounded soldiers in Ukraine

Olga is running around the intensive care unit, constantly checking her patients’ oxygen levels, adjusting their medications, and taking their vital signs.

She works quickly, but even in the busiest moments, the nurse anesthetist doesn’t hesitate to stop to adjust a pillow or blanket, ensuring that the wounded soldiers under her care are as comfortable as possible despite the constant rocking and rumbling.

A sergeant in the Ukrainian army, she treats some of the most critically ill patients. It’s intense work – and she does it on a speeding train.

THE CNN was given exclusive access to a medical evacuation train used by the Ukrainian army to transport the wounded from near the front lines to hospitals across the country.

This hospital on wheels – one of several crisscrossing the nation – is now a crucial part of Ukraine’s healthcare system, which has been severely weakened by Russia’s brutal two-and-a-half-year war. It is operated in complete secrecy, which is why the CNN is not revealing the route or identifying the team by their full names.

Most cities in eastern Ukraine are struggling to find enough hospital beds to accommodate the near-constant flow of casualties from the front lines. But freeing up space requires even the most seriously ill patients, many of them unconscious, to be transferred to distant locations, often hundreds of miles away.

Long ambulance rides are too risky for people in critical condition, and using helicopters is too dangerous given Russia’s air superiority over Ukrainian skies. The train is a lifesaver.

“We can do almost anything here. It’s a full-fledged intensive care unit,” Oleksandr, a captain in the Ukrainian Medical Forces and the train’s chief resident, told CNN .

He explained that his field of work — combat medicine — primarily involves stabilizing and evacuating patients to safety, rather than providing treatment. His work on the train is just one part of a medical chain that begins the moment a soldier is injured.

“The hardest part is evacuating the front line,” he said. “Combat medics working on the front line are dying just like soldiers.”

Running an intensive care unit on a moving train is a herculean task involving dozens of people and presenting a unique set of challenges.

Oleksandr said the vast majority of his patients, about 90 percent, have suffered multiple shrapnel injuries. Many have undergone amputations, and several are intubated, alive thanks to ventilators and other life-support machines. All have numbers written on their hands indicating which carriage of the long evacuation train they should travel in.

“Our capabilities here are very limited. If something happens, I can’t call in an outside consultant,” he said. “We can do minor surgeries, to stop bleeding. We can’t do abdominal or chest surgeries. We have to be very careful when selecting patients,” he added.

Yevgeniy was seriously injured in a drone strike just two days before he was selected for evacuation into the train’s intensive care unit. He suffered multiple shrapnel wounds. His head was bandaged and two huge scars on his chest and stomach were covered with fresh bandages.

Breathing with the help of an oxygen nasal cannula, Yevgeniy told CNN that he was lucky, being the only survivor of the attack near Bakhmut in eastern Ukraine. He said he would not tell his family about his injuries until he felt better.

The most important train in Ukraine

The hospital train is an example of the kind of Ukrainian ingenuity that impressed the world in the early months of this conflict.

Oleksandr Pertsovskyi, CEO of passenger operations at Ukrainian Railways, told CNN that Ukraine had no medical wagons when Russia launched its full-scale invasion of the country in February 2022.

“We saw that wounded soldiers were being physically forced out of the windows (of regular trains). And we said something had to be done and we started adapting our regular carriages, which in peacetime took tourists to the Carpathian Mountains,” he told CNN after supervising the arrival of one of the medical trains.

To limit swaying, the vehicle travels at about 80 kilometers per hour, half the speed of a normal train. It also has priority over all others – including VIP trains carrying foreign dignitaries.

Even so, the intensive care unit is constantly rocking. Every piece of equipment, every bed and every beeping machine needs to be anchored to the floor, and staff must take extra care when working with patients.

Ambulance trains were first used during the Crimean War in the 1850s, but they have come a long way since then. Modern Ukrainian versions come equipped with ventilators, life-support machines, ultrasound scanners and portable air conditioning that help maintain stable temperatures even on the hottest days.

Each carriage is a self-sufficient unit powered by generators – an important safety feature given the frequency of Russian attacks on Ukraine’s energy infrastructure, Pertsovskyi said.

But it’s the little touches that make these trains truly special. Children’s drawings and Ukrainian flags are displayed in each carriage, offering some comfort to injured passengers. The blinds on each window are shaped like a trident, the country’s national symbol, deliberately placed in plain view of soldiers lying in their beds.

A tale of two mobilizations

The train offers a small glimpse into the brutal cost of war. Seasoned warriors and new recruits travel together, united by pain and injury.

Sitting silently on his bed, Oleksandr looked tired even before the long journey began. He told the CNN who was injured in a Russian drone strike. “They dropped a grenade. I was stunned. I have shrapnel in my hands, shoulders and back,” he said, adding that the shockwave had damaged his hearing.

An electrician and father of two, the 35-year-old was mobilised 18 months ago and was serving as an anti-tank gunner in an infantry battalion in the Donetsk region. In all that time, he spent just 45 days away from the front line.

“Morale is high, but people are very tired,” he said with a blank look as the train rolled on. “There comes a point when you realize it’s all up to God. Or luck. When the bombs fall, there’s not much you can do.”

It was a sober assessment from a man codenamed “Positive.”

Ukraine’s President Volodymyr Zelensky has long admitted that the army is struggling to replenish its ranks, leaving exhausted soldiers with no chance to rest.

At a news conference last month, Zelensky said the effort to recruit more troops was gaining momentum. “Some rotations have started. I can’t call them fundamental rotations yet, to be honest. But it’s a start, and that’s very important,” he said.

Fatigue is affecting frontline morale. CNN recently spoke with several Ukrainian commanders and officers who said desertion and insubordination are becoming a growing problem, especially among new recruits.

Sitting just a few beds away from Oleksandr was Stanislav, who had voluntarily enlisted just three months ago. He too had been injured by a drone that crashed into his trench, leaving him with a punctured lung, broken ribs and other injuries.

Yet Stanislav seemed to be in a completely different frame of mind than Oleksandr. “After I was injured, my spirits didn’t drop. I became more motivated,” he told CNN with a smile.

Wearing a sports shirt and shorts, he was convinced that Ukraine would win the war despite being outnumbered and outgunned by Russia.

“They use quantity, and we use quality,” he said.

The incredible price of war

Almost nine hours into its journey, the hospital train finally stopped at a railway station in one of Ukraine’s cities. In the dark of night, a long line of ambulances awaited the patients. The train’s journey was over, but their road to recovery was just beginning. Some will probably never fully recover.

Olga, the ICU nurse, was preparing to hand over her patients to the doctors on the platform. Her work was done for the day.

She joined the army as a civilian nurse in 2015, a year after the conflict between Russia-backed separatists and Ukraine began in the eastern parts of the country, and after Crimea was illegally annexed by the Kremlin. She enlisted in the army in 2016 and – apart from a brief hiatus in 2022 – has served ever since.

After finishing her shift, she told the CNN that seeing seriously ill patients coming from the front lines is the hardest part of their job.

“But we have the opportunity to provide much-needed help to our defenders 24/7, and that’s the best part.”

As the ambulances left and the train pulled out of the station, Pertsovskyi, the railway chief, could finally breathe a sigh of relief. The hospital train is considered a major target for Moscow, and there have been several attacks recently targeting nearby railway stations and other infrastructure.

Standing on the platform, just hours after watching a train full of new recruits heading in the opposite direction, he reflected on the brutality of the conflict.

“In the morning, I see these kids saying goodbye to their parents who are going to the front lines,” he said. “Then to see these same guys coming back unconscious or with amputations, it seems like the toll of war is incredible. It’s an assembly line.”

*With information from Victoria Butenko and Olha Konovalova, from CNN.

This content was originally published in CNN accesses hospital train that saves wounded soldiers in Ukraine on the CNN Brasil website.

Source: CNN Brasil