Ukraine's medical advancements shift battlefield survival rates

Both Russia and Ukraine provide 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, fearing a potential collapse in military and civilian morale.

The Kremlin is mainly known for providing information completely disconnected from reality to the extent that even Russians do not take it seriously. 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 propagated by Kremlin propaganda.

The administration of President Volodymyr Zelensky, on the other hand, presents the data quite generally. This time, Kyiv reported that 43,000 soldiers have 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 remarkable 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 are irreversible losses. This still seems like 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.

Compared to other conflicts from the early 21st century, since battlefield medicine has developed 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 the reason for such a different proportion of losses among soldiers. What is certain is that Ukrainians have taken incredible steps 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. Envy was sparked by the tactical tourniquet and the information that I had recently completed a battlefield first aid course. They could not count on such luxuries. The level of rescue knowledge did not exceed that which Soviet soldiers had in Afghanistan. Their equipment was also decades outdated.

However, they used that time wisely, and in 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 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 cover twice as much of the front as tactical manuals advise. 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's 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 armoured-mechanized 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 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 wishes, 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.