Ukraine battles back: Stunning progress in battlefield medicine
Since the onset of the full-scale war, Ukraine has reportedly lost a total of 413,000 soldiers, including 43,000 fatalities. These are the official figures released by Kyiv, and the breakdown of these losses provides insight into Ukraine's combat strategies.
Both Russia and Ukraine share limited details about their own losses. This is mainly due to concerns about revealing the true extent of losses to the enemy and, possibly more importantly, concerns about the potential collapse of military and civilian morale.
The Kremlin is particularly known for disseminating information that is completely detached from reality, which even Russians rarely take seriously. How could anyone believe that in 2022, the first year of the full-scale war in Ukraine, only 2,000 Russian soldiers were killed? These are the statistics promoted by Kremlin propaganda.
The administration of President Volodymyr Zelensky, on the other hand, presents the data in a rather general manner. This time, Kyiv reported that 43,000 soldiers have been killed and 370,000 wounded since the war began. This came as a surprise to analysts—not because the numbers differ significantly from Western estimates—based on open sources, the portal UAlosses reported about 60,000 killed and just under 400,000 wounded.
Significant differences
Analysts were perplexed by the high ratio of wounded to killed, which ignited many discussions. Either the Ukrainians have achieved remarkable progress in battlefield medicine and can save nearly every soldier's life, or the category "wounded" includes all soldiers, even those lightly 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? These are soldiers whose injuries prevent them from returning to combat, essentially wartime invalids. President Zelensky assures that about 170,000 are irreversible losses. However, there still appears to be a significant difference between the number 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.
Compared to other conflicts from the early 21st century, during which battlefield medicine has evolved considerably, the proportions differ significantly from the wartime average. During the invasion of Iraq in 2003, the Allies lost 172 killed and 551 wounded in regular combat operations. This results 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 why soldiers suffer such a disparate proportion of losses. What is certain is that Ukrainians have made an incredible leap forward in battlefield medicine.
Saving in war
Eight years ago, Ukrainian soldiers looked enviously at the Polish journalist with an IPMed, an Individual Medical Kit, strapped to their thigh. Envy was evoked by the tactical tourniquet and the knowledge that I had recently completed a battlefield first aid course. They could not count on such luxuries. The level of medical knowledge did not exceed that of Soviet soldiers in Afghanistan. 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 Defence 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 trained at the TCCC course level or Tactical Combat Casualty Care—the battlefield first aid course.
Trained medics are present at the company level. However, due to personnel shortages, companies are stretched and sometimes cover twice as much front as tactical manuals suggest. In such a situation, a trained medic would be invaluable in every platoon. However, that's not feasible. Consequently, trained medics teach their colleagues while under fire. Ukrainians have no other choice.
The method, however, is effective. Reports from the front suggest that the time taken to reach the wounded and evacuate them from the front is so short that Ukrainian soldiers do not perish in the trenches' mud. It's a different story for the Russians. Their system for rescuing the wounded remains at the level of the first Chechen war and has changed little, even during the ongoing conflict.
Unequal losses
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 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 armoured-mechanised units, to assault across open fields. This chosen tactic causes personnel losses to rise at an alarming rate. And they will continue to rise.
Soldiers who gained substantial experience have either been eliminated from further combat or had to be withdrawn for rest. Now, individuals without training 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 wishes, have now exceeded 750,000 killed and wounded. Although Russians still have considerable reserves, necessitating only the declaration of a general mobilisation, which the Kremlin avoids, for Ukrainians, losses of 400,000 are very problematic.