As the number of Russian casualties in the so-called “special military operation” (“SMO”) increases, military hospitals find themselves unable to handle the influx of the wounded. As a result, injured military personnel are increasingly being redirected to regular civilian hospitals.
A year ago, Putin ordered the healthcare system to adapt to military needs. It was revealed in late May that civilian hospitals in eleven regions must allocate 5,000 beds for the treatment of soldiers.
This decision has made life hell for healthcare workers and patients alike, while exacerbating existing chronic problems of Russian medicine, which never recovered from earlier austerity measures and overload during the covid pandemic.
A doctor who works in a hospital in one of the affected Russian regions shared her insights about the disruptions to medical facilities brought on by the war, on the condition of anonymity.
“The wounded just lie on the floor”
— When did you start admitting wounded soldiers? How many have there been and where have they been coming from?
— The first time we received wounded soldiers was in July. Some other hospitals in our region started receiving massive influxes of military personnel in May or June.
During the summer and fall, a hundred beds were allocated for such patients. Those beds are distributed across regular wards, intermixed with civilians.
Recently we were told that we have to increase [the number of beds allocated for the military] to 300 starting in January, all the while maintaining standard levels of care for the civilian population.
The wounded come from the regions where active combat is occurring. Lately there has been a dramatic surge in the number of convoys. A month ago we were promised that there would be only a few wounded soldiers coming in before the new year, but now I have information that a hundred more are coming in a matter of days.
— How well are civilian hospitals prepared to treat wounded soldiers?
— Our facilities were never meant to admit patients injured in combat; ours is a general hospital. Soldiers are distributed across various wards. Even gynecologists have to treat “difficult cases.”
Even during normal times we lack doctors and nurses to help conventional civilian patients. After we started admitting combatants from the “special military operation,” we never reassessed our performance targets for treating civilians. It hasn’t even been a matter of discussion. As a result, emotional and physical pressure on the staff has increased.
Our hospital hasn’t received a ruble since July, and neither has another hospital in the region that’s also a part of this program. We have no extra means to buy medications. We haven’t built a single new operating room or dressing ward; we haven’t hired a single staff member.
— Is there enough room for all the wounded?
— Now that we’ve installed more beds, including some in the hallways, we have enough patient capacity for the time being. But in some hospitals being repurposed for military needs, the wounded just lie on the floor. These are mostly the central hospitals, the biggest institutions situated in Moscow. We know that from the patients themselves, some of whom spent a week or a couple of weeks at such hospitals.
“These people think of themselves as heroes who can do whatever they want”
— Your new patients, who are they?
— All participants of the “SMO” — drafted and contract soldiers, and former fighters of the Wagner group, representing various levels of their hierarchy.
— How would you describe their physical and mental state?
— In terms of physical, most of our patients come for aftercare. They get first aid and specialized aid at frontline hospitals or on the battlefield. We mostly get patients with shell fragments who need minor surgeries or reparative surgery before they are discharged from the army.
As for the patients’ psychological states, many of them are very aggressive, probably as a result of their current occupation. Most have concussion-related conditions or post-traumatic disorders leading to a certain psychological instability.
— Are they armed?
— I can’t be certain, but it is likely. Unlike civilians, who only have minimal outerwear with them when they’re admitted, the military come fully equipped with their giant packs. We can’t control it or store their things, so everything stays in the wards.
Even more importantly, at a civilian hospital they’re allowed to come and go freely. Weapons have been brought in from the outside on a few occasions already. No firearms yet, but there have been pneumatic and bladed weapons.
— What problems does the presence of military personnel pose to doctors, nurses, and regular patients?
— We face a constant risk of being beaten up or injured, as well as constant grumbling and rudeness. [Many of] these people think of themselves as heroes who can do whatever they want. It isn’t 100% of them, of course, but 20 or 30% is quite enough. As a result, the atmosphere in the wards is emotionally tense, and physical fights every couple of days are par for the course.
— Is drinking a big issue?
— We barely do anything about “quiet” drinking. We’re incapable of confiscating alcohol. A nurse weighing 50 kilograms is powerless against even a regular army private, let alone a stormtrooper.
— Any instances of violence against women?
— During the nights, nurses stay in the wards all on their own. And then anything can happen. Very few of the patients are bed-ridden. So sexual advances and harassment are routine — it happens every other night. It’s good if the girls don’t get scared and start screaming. Then usually some other fighters come up from neighboring wards and things don’t get dramatic. But still… It’s not normal for girls to go to work knowing that they face a real risk of rape every shift.
— Is it former convicts who make the most trouble?
— I wouldn’t say that it’s only former Wagner fighters who engage in this kind of behavior. In fact, senior members of Wagner tend to be very civil and help us with restoring order.
— Are your superiors, the Ministry of Defense, or other law enforcement officials doing anything to protect people?
— We can keep a bold face all we want, but the truth is that hospitals aren’t protected [from this kind of behavior]. We simply do not have the means to hire additional security and proper guards. Who works as security guards in hospitals? Grannies and grandpas. All we can do is hide out and wait for the storm to pass.
Our superiors have responded by churning out instructions on what to do in risky situations, and nothing else. Their proposed solutions all come down to making an emergency call. Do they really think that a phone call has ever protected a woman from rape, assault, emotional distress or any other injury?
The military police will agree to take action only if a patient is drunk or under the influence of drugs. If an apparently sober patient is making trouble, they won’t show up. On the last few occasions it took the military police up to two hours to arrive.
As soon as there is some commotion in a ward or a hallway, we call the Rosgvardia [National Guard]. They arrive in five or ten minutes. But the only thing they can do is take a patient off the premises. And no one will stop him from coming back and making more trouble.
“Protesting is forbidden. That is why people are protesting with their feet”
— What do your superiors say about the situation?
— The superiors don’t find it necessary to comment. Everyone pretends it’s how it should be. In their opinion, it is our duty [to treat the wounded]. This is what we were ordered to do. However, we have yet to see a written order.
We never signed any supplementary agreements, any contracts, anything. It has all been presented to us as a matter of course.
There are only verbal agreements that we are accepting active military personnel. Officially, these patients do not exist.
— Do you get compensated for treating the wounded?
— About three months ago we received vague assurances that we would get paid for this work, without specifying when or how much.
The way things are going, it seems that endless reproofs and criticisms are the only things we’re going to get for working with the wounded. For instance, we weren’t paid our New Year’s bonuses. What’s more, we were reprimanded at a meeting before the New Year for not meeting the targets for admitting regular civilian patients. But no normal doctor or ward supervisor is willing to risk their own life, while civilians are sharing wards with fighters who can stir up trouble at any moment. Morally, we cannot afford it.
— Were there any protests from the medical staff or individual doctors?
— Protesting on such a subject is absolutely forbidden in our country. That is why people are protesting with their feet: they walk away and leave the job. We have a huge need for junior and middle medical personnel in our region. Therefore, having received New Year’s salaries far below the amount they had hoped for, many people will quit their jobs. In January we will have a huge outflow of nursing staff.
Doctors don’t want to stick around either, and they don’t want to work Saturdays for free. We’re not military doctors. We are now being forced to do things we never intended to do in the first place.
“We were just recovering from the covid crisis — only to face a new kind of ‘plague’”
— What consequences do you envision for such a situation?
— The consequences may prove truly dreadful. First, we are guaranteed to see an outflow of civilian patients. Patients want to be treated, not to undergo additional terrible stress, both physical and moral.
Secondly, there will be an inevitable outflow of employees who are simply unable to work under such conditions. We were just recovering from the covid crisis — only to face a new kind of “plague” where you are forced to treat combat injuries of whatever kind, regardless of your specialty.
Finally, there is no money allocated to fund care for these new patients. Which makes this a misuse of funds. Accordingly, chief physicians and other superiors, at the very least, may find themselves in debt to those in power, and hospitals will have accounts payable to the Ministry of Health and the MHIF [Fund for Compulsory Medical Insurance]. As they say, you can’t make seven hats out of one fur.
— In your opinion, how could the problem be solved?
— First of all, it is necessary to make all this official. Sign contracts with the staff. Fund the situation in an honest and straightforward manner. The staff and the hospitals need the means for medications and security. We need legal protection as well. But all of this, of course, is not going to happen.
