I just returned from eastern Ukraine as one of the few volunteer surgeons to spend several weeks on call in the war zone, observing and training doctors. The Ukrainian medics I met there are extraordinary, but I return with a cautionary tale. I’ve never seen the sheer number of complex and horrifying injuries Ukrainians are suffering. What’s happening in Europe should alert us to the toll of a potential conflict with Russia, China or North Korea. It would be magnitudes greater than anything America has seen in 70 years. Pray that the U.S. doesn’t have such a war.
It isn’t that I doubt the U.S. military would prevail. America would win. The problem is that the U.S. healthcare system—including the Health and Human Services Department, the Pentagon and the Veterans Affairs Department—isn’t ready to handle large numbers of catastrophically wounded civilians and soldiers injured by artillery, drones, hypersonics and glide bombs.
I have volunteered in several conflicts and disasters. Over the years I’ve worked in Afghanistan, the Soviet Union, Cambodia, Yugoslavia, Iraq, Somalia, Sudan, Sierra Leone, South Sudan, Libya, Central America, Syria, Jordan, Armenia, Pakistan and elsewhere. At one point I was the only surgeon in southern Rwanda during the genocide that killed nearly a million people. But war in 2024 is worse than it used to be—especially for civilians.
Mechnikov Hospital in the Ukrainian city of Dnipro is similar to a major American university hospital that handles big cases such as breast cancer and stroke. Since the Russian invasion in February 2022, every new war casualty gets a number written on his left arm in magic marker. While I was there, that number hit 28,000. In
20 years of the war in Afghanistan, 20,149 Americans were wounded and 2,354 killed in action.
Consider another comparison. Rand
estimates that roughly 34,000 people are admitted to hospitals in the U.S. with gunshot wounds annually. Imagine if you took every major shooting victim in the U.S. west of the Mississippi and sent them all to one hospital. Mechnikov is it.
These aren’t flesh wounds or simple broken legs. Patients are brought in with combinations of brain, face, chest and abdominal wounds. Many require amputations. I am on call almost 300 days a year for complex craniofacial/plastics trauma at three major trauma centers. We see everything. Fortunately we get only a few of the most severe facial mutilations—where someone loses his entire face and survives. In Ukraine, I saw 12. I saw golf-ball-size shrapnel and 3-inch pieces of protective Kevlar armor pulled from lungs and brains.
The chief of neurosurgery at Mechnikov shared with me the hospital’s experience with vertebral artery injuries. (These are two arteries in the spine that feed the brain.) Because of the violent force that causes such injuries, most patients die before reaching the hospital. The typical neurosurgeon will see two or three patients with such terrible injuries over the course of a career. The U.S. military, with incredible evacuation resources, treated 18 vertebral artery injuries during 20 years in Iraq. Mechnikov has treated 91 in two years.
Of Mechnikov’s roughly 1,700 patients, 120 are in intensive care. Patients on ventilators line the hallways. Several times a week doctors load up dozens of patients and ship them eight hours by train to Kyiv, only to have their beds refilled the next night.
The wounds in Afghanistan and Iraq were largely caused by standard rifle rounds or improvised explosive devices—sometimes a Claymore mine strapped to a paint can full of bolts. The wounds in Ukraine are worse for several reasons.
First, military-grade rifles use bullets that yaw when they hit a body, often in clusters of two or three rounds. The yaw blows out bone and soft tissue in clumps the size of your fist.
Second, Russian artillery has fired more than six million shells, each with a fatal radius of 40 yards. Ukraine has fired only two million back. The U.S. hasn’t been involved in artillery duels like this since the Korean War, when modern medical techniques were nascent. Injuries suffered during an artillery barrage require multiple operations, complex wound care and significant rehabilitation for years.
Third, drones are revolutionizing the battlefield in Ukraine, much as the machine gun did during World War I. Small drones, such as a modified quadcopter with explosives attached, create wounds that cascade from head to toe. The U.S. military has never had to deal with this before.
Finally, glide bombs and hypersonics have replaced the dumb bomb. These munitions plow through trenches and sophisticated concrete structures, leaving a trail of devastation in the blink of an eye. The Russian Kinzhal missile, a hypersonic launched from the air, can wipe out an entire city block.
During the U.S. Civil War, the world was aghast at the death toll from the new Gatling gun. Today we are witnessing a new revolution in the destructiveness of conventional warfare. It’s happening in real time, and the U.S. isn’t prepared.
