At the Kyiv offices of Initiative E+, many of the tourniquets hanging on the wall are not up to international first-aid standards. Some date back to the Crimean invasion of 2014. But like many on the front lines of the war in Ukraine, these volunteers must make do with what they have.Photography by Anton Skyba/The Globe and Mail
Dr. Volodymyr Sobolevskyy volunteers on the front lines of the Ukraine war to treat wounded soldiers, travelling hundreds of kilometres from his home in Cherkasy to help out as a paramedic. A dentist by profession, he’s witnessed wartime trauma first-hand on several occasions since the war began 18 months ago. But one particular encounter earlier this summer is embedded in his mind.
“This guy should have survived,” Dr. Sobolevskyy said, as he recounted treating an injured soldier at a stabilization point in Orikhove, less than five kilometres from the front line in the Zaporizhzhia region.
Despite the short distance, it took several hours for the soldier to be safely evacuated to the medical post. He arrived with three tourniquets that had been tightly wrapped around his legs by fellow soldiers. One was broken. None of them created enough pressure to prevent blood loss. “Simply put, he bled to death because of these substandard tourniquets,” Dr. Sobolevskyy told The Globe and Mail.
Volunteers like him are accusing Ukrainian authorities of not providing soldiers with adequate medical care on the front lines, which stretch thousands of kilometres along the east and south of the country. They say the lack of quality medical supplies and equipment for the Ukrainian army puts more than one million soldiers at risk. They also warn that the need for medical supplies, ambulances and armoured vehicles to transport wounded troops is becoming more urgent, as the continuing Ukrainian counteroffensive intensifies.
Like the soldier who bled to death, there are many similar cases of woefully inadequate medical care on the front lines, says Masha Nazarova, one of Ukraine’s most well-known paramedics and volunteers who has been working in combat medicine since 2014.
And these shortcomings in care contribute to the number of casualties in the war. Although neither Russian nor Ukrainian authorities disclose official data on battlefield losses and injuries, U.S. officials told The New York Times earlier in August that Ukraine is estimated to have close to 70,000 dead and up to 120,000 wounded.
Valentina Varava heads up Initiative E+, a charitable organization which purchased and delivered 300 evacuation ambulances.
Volunteer groups have been trying to resolve the shortfall of medical supplies by collecting needed goods and bringing them to front lines across Ukraine. One charitable organization, Initiative E+, purchased and delivered more than 300 evacuation ambulances. Its head, Valentina Varava, gave The Globe a tour of the foundation’s head office, which is filled with long tables and shelves stacked with medical supplies donated from Ukraine and abroad.
Getting these supplies to the front lines isn’t the only challenge facing Ms. Varava. Ensuring they meet safety and medical standards is another problem. The Ukrainian army lacks a well-established quality control system for medical tourniquets supplied to hundreds of stabilization points along the front line.
She pointed to a wall where different types of substandard tourniquets have been collecting dust since Russia’s invasion of the Crimean Peninsula in 2014.
“This collection has been gathered for years by our team,” Ms. Varava said. “All of these are fake,” referring to the bad quality of the tourniquets, which don’t meet the criteria for effective first aid established by the Committee of Tactical Combat Casualty Care – an organization of 42 countries, including Canada.
A volunteer from Leleka Foundation packs medical supplies to be sent to militaries.
Ukraine relies on foreign sources for many kinds of life-saving equipment, like these U.S.-made packs for sealing chest wounds.
Volunteer organizations are speaking out now, in a bid to get Ukraine’s Ministry of Defence to dramatically improve first-aid care on the front lines. “We’ve exhausted all avenues to address the matter discreetly,” says Ms. Nazarova.
In an open letter recently published on a popular Ukrainian website, Ukrainska Pravda, dozens of volunteers, NGOs and military doctors alleged that Ukraine’s Defence Ministry and the head of the Ukrainian army’s medical forces command have failed to adequately equip medics and stabilization posts with supplies and armoured vehicles, resulting in evacuations that have endangered the lives of wounded soldiers and doctors alike.
They denounced a lack of quality-control checks for army medical supplies, and a reported ban on military personnel from providing blood transfusions at medical points near the front line. The open letter also expressed concern over personnel shortages and lack of staff training.
These problems have been substantiated by Sergeant Vadim Kholodenko, a combat medic who heads one of the Ukrainian army’s stabilization centres. Currently stationed in Bahkmut, where fighting is extremely volatile, Sgt. Kholodenko oversees a 26-member medical team, including five surgeons, three anesthesiologists and two traumatologists. Dozens of wounded soldiers pass through his medical station daily.
“Eighty per cent of medical supplies and consumables are provided thanks to volunteers, not by the Defence Ministry, granting them the authority to critique the system like no one else,” said Sgt. Kholodenko, who primarily pins the blame on weak management.
On the battlegrounds, the main problem is the absence of quality tourniquets and trained paramedics, according to Sgt. Kholodenko. “During the golden hour, as we call it, the first hour after injury, correctly tamponading the wound and applying a tourniquet can significantly increase survival chances,” he said. However, tourniquets provided are often substandard.
Ukrainian medics treat a wounded serviceman in July near Bakhmut, Donetsk, one of the deadliest conflict zones in the Russian invasion.GENYA SAVILOV/AFP via Getty Images
In response to the accusations and problems raised by volunteers over the lack of adequate first aid on the front lines, Sub-Lieutenant Evgeniya Slivko, a media adviser to the army’s medical forces command, insisted the claims were exaggerated.
“Any head of the medical service of any military unit has the opportunity to inform his commander that he had received medicine of poor quality, and all medicine will be replaced with good ones. We had not received any such statements until July, 2023,” she told The Globe.
Sub-Lt. Slivko claimed concerns of substandard tourniquets were misleading, and she stressed that Ukraine’s medical forces do not have the resources for building facilities to train new combat medics.
The Ukrainian army has received some help in this regard from Operation UNIFIER, the Canadian Armed Forces’ mission to provide critical military training.
Recent programs include the operation of Leopard tanks donated by Ukraine’s allies as well as the provision of combat medicine, according to CAF spokesman Daniel Le Bouthillier.
Operation UNIFIER introduced medical training for Ukrainian soldiers this year. It will continue until at least the end of the year, with the aim of increasing combat survivability and providing advanced life-saving skills to Ukrainian soldiers, Mr. Le Bouthillier said in a statement.
Ukrainian National Guard forces learn to use tourniquets at UNIFIER training in January, 2022, a few weeks before war broke out.
Some progress has been made since the open letter was published.
A special meeting of a parliamentary committee on defence and national security in August urged Major-General Tetyana Ostaschenko, the commander of the Ukrainian army’s medical forces, to address the problem of substandard tourniquets, according to an official Facebook post by the committee. The committee also approved the revision of all first aid kits in the army, and the creation of new positions – sergeants – who will be responsible for the quality of tactical medicine.
In the meantime, Yuiry Kubrushko, co-founder of a non-profit organization focused on helping war casualties, said volunteers will continue to cast a spotlight on the problem until soldiers finally receive proper first-aid care on the front lines.
Leleka Foundation, which provides medical and first-aid supplies to paramedics, emergency crews and hospitals, delivered 18,000 first-aid kits from the start of the full-scale invasion by Russia of Ukraine in February, 2022, Mr. Kubrushko said.
“Medical forces could write the report that they changed everything, so the only resolution is constant public attention to the issue,” he said.
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Anton Skyba