Ukraine is teaching British medics how to prepare for war

A wounded solider is treated by medics at a field hospital
Ukrainian military medics treat a wounded comrade at the field hospital near Bakhmut - Evgeniy Maloletka/AP

Britain’s medics are rewriting their plans for a full-scale war as they learn lessons from the conflict in Ukraine, a leading NHS trauma surgeon has said.

Evolutions in drone warfare and a return of First World War-style superbugs have presented new challenges as Western countries take steps to put their health systems on a war-footing, according to Dr Shehan Hettiaratchy.

Dr Hettiaratchy, the lead trauma surgeon at Imperial College Healthcare, suggested the NHS would have to be all but shut down to only deal with war casualties if Britain was to be dragged into a full-scale conflict.

He warned the health service would also be worse off compared to its European counterparts because it lacks the same headroom to expand, unlike France and Germany.

ADVERTISEMENT

Last year, General Sir Roland Walker, the head of the Army, warned Britain must be ready to fight a war against Russia in three years.

“I think it’s really hard to prepare… I’m going to say it’s not possible to prepare, because the Ukrainians weren’t prepared and the Ukrainian military clearly had spent a lot of time thinking hard about if there was to be an invasion from Belarus, from Russia,” Dr Hettiaratchy said on the fringes of a DGA Group event with the UK and Ukrainian governments in support of Kyiv’s healthcare system.

“If we get to a scenario where we are having that level of casualties and that kind of war-fighting, the health system would be only doing that. That’s where we’re scaled at now,” he added.

“If you look at us compared to other European countries – Covid showed it – we have less capacity, less redundancy in our health system compared to other European partners.”

Injured soldiers are treated in a hospital bus in Donetsk
Injured soldiers are treated in a hospital bus in Donetsk. Experts say Ukraine was not ready to handle the number of casualties despite having time to prepare - Anadolu/Getty

The event held at the British ambassador’s residence called for governments to do more work with private businesses to support Ukraine’s war-stricken healthcare system.

ADVERTISEMENT

Dr Hettiaratchy has been working to train Ukrainian surgeons since the start of Russia’s full-scale invasion in February 2022.

He said the challenges faced by his Ukrainian counterparts were entirely different to those faced by Western medics in Afghanistan, where he served as a combat surgeon with the British military.

The sheer number of Russian drones and Ukraine’s lack of air superiority means Kyiv’s combat medics don’t enjoy the same luxuries experienced by Nato armies in the Middle East.

Western troops knew that in order to save as many of the injured as possible they had to get the casualties back to the field hospital at Camp Bastion within the “Golden Hour”.

“That is great if you’ve got a helicopter which can fly you back to a hospital, back to a surgeon, back to someone like me,” Dr Hettiaratchy said.

ADVERTISEMENT

“The problem you have in Ukraine is you don’t have that scenario because of the lack of air superiority, because of drone warfare.”

The number of drones and a lack of armoured personnel carriers mean Ukrainian medics are often unable to evacuate wounded troops from the frontlines for hours.

This has led to a rise in the number of amputations carried out on casualties who were strapped up with tourniquets, which are used to stop life-threatening bleeding.

“These people have tourniquets on for five, 12, 24 hours, because they can’t be moved back to the next line of medical support, which means they are having a high level of amputation,” Dr Hettiaratchy said.

Health risks change in line with new weapons

The use of tourniquets has triggered a long-term challenge for Ukrainians who survive an initial attack. This is because when the blood circulation is cut off by the medical device, the wounded muscle starts to die and releases poison into the rest of the body.

ADVERTISEMENT

“They’re having a much higher rate than we would have seen before of kidney injuries, and this is how warfare changes,” the surgeon added.

Keir Starmer visits a hospital in Ukraine
Keir Starmer visits a hospital in Ukraine in January to shore up support for Kyiv three years after the war started - CARL COURT/AFP

Dr Hettiaratchy has been training Ukrainian surgeons in London as well as travelling to Western Ukraine to help improve their skills.

“It’s amazing to see how they have responded and developed and grown their capabilities and their capacity to meet the challenge,” he said.

“The number of casualties they’ve got coming through, the types of casualties, the challenges they are facing are things we’ve not seen – because we haven’t had this kind of peer-on-peer fighting between two equally matched military powers going at it – since the Second World War.”

Despite offering his contemporaries high praise, Dr Hettiaratchy said Ukraine’s healthcare system has “critical gaps” which need addressing, including a lack of types of surgeons, nurses, therapists and infection control.

Antibiotic-resistant superbugs

He said Western planners would have to consult First World War history books to adapt to the emergence of superbugs that are resistant to antibiotics.

“They’ve got bugs that are not cured by antibiotics. What they are describing is going back almost to the First World War, pre-antibiotic-era of surgery,” he added.

“These people now have wounds that are uncontrolled, infections are uncontrolled and uncontrollable with antibiotics, and you have to revert to First World War techniques.”

Speaking before Britain unveiled £100 million in funding for Ukraine’s health system, Dr Hettiaratchy urged Western governments to improve their offerings of non-lethal aid for Ukraine.

Volodymyr Zelensky, the president of Ukraine, revealed in December that almost 400,000 Ukrainian troops had been wounded since the start of the war.

The surgeon warned these would become a generational burden on the Ukrainian state if more isn’t done to pick up the mantle of almost three years of brutal conflict.

“There is an absolute economic society component to make sure society functions afterwards, because the volume is so high,” he said.

“It’s really important that Ukrainian society picks up the mantle of dealing with the consequences of their years of war, fighting, which are going to be human costs as well as other infrastructure costs… the human cost is the one that kind of almost endures and probably has the most consequence, because it’s a lifetime burden.”

This support must come from foreign governments and private companies, Dr Hettiaratchy said.

One of the ways businesses could help is by innovating production techniques of creating prosthetics with 3D printers to manufacture them much faster to meet demand, he added.

At least 50,000 Ukrainians have lost limbs in nearly three years of war according to the country’s health ministry.

Dr Hettiaratchy concluded: “Clearly, no one has the experience that Ukraine has in terms of volume and how wide it’s affected, but there are things we can do to help them understand how to tackle the problem. In many ways, they can’t afford to mess this up, because the scale is so large if they get it wrong.”