Secret medical trains were a lifesaver for countless wounded Ukrainian soldiers on the front lines, helping them escape death.
Olga barely rests in the intensive care unit (ICU), constantly checking patients’ oxygen levels, adjusting medications, and recording vital signs. She is always busy and works at a fast pace, but she does not hesitate to stop to adjust patients’ bedding and make sure the wounded are as comfortable as possible.
As a sergeant in the Ukrainian army, she is caring for the sickest patients on a special train.
A soldier works on Ukraine’s secret hospital train. Photo: CNN
This is a medical evacuation train used by the Ukrainian military to transport wounded soldiers from areas near the front lines to hospitals across the country. The mobile clinic, operated in complete secrecy, is a vital part of Ukraine’s health system, which has been severely weakened by two and a half years of conflict.
Most cities in eastern Ukraine are struggling to find enough hospital beds to take in wounded soldiers from the front lines, and are having to transfer patients for treatment to more remote locations, often hundreds of kilometers away.
Moving by ambulance is too dangerous for people in critical condition, while transporting by helicopter is also unsafe as they are easy targets for the Russian air force.
The medical trains were a lifesaver in this case. “We can do almost everything on board. It’s a full-fledged intensive care unit,” said Oleksandr, a Ukrainian military medical captain and head of the ship’s medical team..
Oleksandr explained that he specializes in combat medicine, which focuses on stabilizing injuries and moving patients to safety, rather than treating injuries on the spot. The work Oleksandr does on the ship is just one part of the medical chain that begins as soon as a soldier is injured.
“The most difficult part is the evacuation from the front line. Frontline medics are losing their lives every day just like other soldiers,” the Ukrainian captain added.
Operating an intensive care unit on a moving train is an incredibly difficult task, involving dozens of people and posing unimaginable challenges.
About 90 percent of Oleksandr’s patients suffered multiple shrapnel wounds. Many had amputations, and some were intubated and kept alive by ventilators and other life-support machines. All had numbers written on their hands to determine which car to take on the evacuation train.
“Our response capacity here is very limited. If something happens, I cannot call in outside consultants. We can do minor procedures to stop the bleeding, but we cannot operate on the abdomen or chest. We have to be very careful when selecting patients,” said Oleksandr.
Yevgeni was seriously injured in a drone strike and was admitted to the ship’s intensive care unit two days later. He said he was lucky to be the sole survivor of the Russian raid near the stronghold of Bakhmut in Donetsk province. Yevgeni refused to tell his family about his injuries until he felt better.
The railway hospital is a prime example of Ukraine’s ability to improvise during conflict.
Oleksandr Pertsovsky, chief executive of the passenger transport department of the state railway company Ukrzaliznytsia, said the company did not have any medical carriages when Russia launched its campaign in February 2022.
“We saw wounded soldiers crammed onto regular trains and said something had to be done. We started renovating train cars that were normally used to carry tourists,” he said.
To minimize shaking, the train travels at 80 km/h, half the normal speed. It also has priority over other trains, including VIP trains carrying foreign dignitaries. Still, shaking is inevitable. In the ICU, all equipment, beds, and machines are anchored to the floor. Staff must be extremely careful when working with patients.
Each Ukrainian ambulance train has its own generator, is equipped with a ventilator, life support machine, ultrasound machine and air conditioning, which helps stabilize the temperature even on the hottest days.
Oleksandr, a wounded Ukrainian soldier, is evacuated from the front line on a hospital train. Photo: CNN
Drawings by Ukrainian children and the national flag are displayed in every carriage, providing a sense of comfort for passengers. The curtain brackets on every window are shaped like a trident, the national symbol of Ukraine, and are located at the soldiers’ eye level.
Sitting quietly on his bed, Oleksandr looked tired even before the long journey began. He had been injured in a Russian drone attack.
“They dropped a grenade. I was stunned, shrapnel hit my arm, shoulder and back,” Oleksandr said, adding that the force of the explosion damaged his hearing.
An electrician, the 35-year-old father was drafted 18 months ago and served as an anti-tank gunner on the Donetsk front. Since then, he has only been away from the frontline for 45 days.
“The fighting spirit was still high but everyone was very tired. At this point you realize that everything is not up to you but in God’s hands or luck. When the bombs fall, there is not much you can do,” he said, looking dazed as the train moved.
President Volodymyr Zelensky has long acknowledged that Ukraine’s military is struggling to replenish its ranks, which are so short that exhausted soldiers are not given the opportunity to change gears and rest.
Sitting a few beds away from Oleksandr was Stanislav, who had volunteered for the army three months earlier. A drone crashed into a trench, puncturing his lung, breaking his ribs, and causing other injuries.
Stanislav, however, is in a completely different state of mind to Oleksandr. “After my injury, my morale did not drop. I got more motivation,” he said with a smile, confident that Ukraine would win despite being outnumbered and outgunned. “They have the numbers and we have the quality,” he said.
After nearly nine hours of travel, the hospital train stopped at a train station in one of Ukraine’s cities. A long line of ambulances awaited the patients in the darkness. The trip was over, but the soldiers’ road to recovery was just beginning. Some may never fully recover.
Olga, a nurse working on a Ukrainian hospital train. Photo: CNN
Olga, a nurse in the ICU, is preparing to hand over a patient to medical staff on the platform.
She joined the army as a civilian nurse in 2015. Olga joined the army in 2016 and has been serving almost continuously since. After her shift ends, Olga says seeing patients return from the front lines in critical condition is the hardest part of her job.
As the ambulance left and the train rolled out of the station, Director Pertsovsky breathed a sigh of relief. Standing on the platform, just hours after seeing a train full of recruits heading in the opposite direction, he reflected on the brutality of the fighting.
“Every morning, I saw young men say goodbye to their fathers and go to the front lines. When they returned unconscious or with missing limbs, I saw the cost of conflict beyond imagination,” he said.