For Lieutenant Colonel Roman Kuziv, the decision to literally bury the field hospital under six meters of soil was a logical consequence of the statistics: the Russians had bombed another medical center in the same area 16 times.
"We have accepted that Russia repeatedly ignores the Geneva Convention and we will never regain the protection that medical facilities once had," he says, as his vehicle descends the ramp leading underground.
There, the visitor discovers a modern facility of 400 square meters, divided into six cubicles of thick assembled metal which, according to military nomenclature, meets the highest expectations required of these centers.
"It is a Role 4 hospital," explains Kuziv, referring to that classification. "There are two operating rooms and an Intensive Care Unit. We have a well that supplies us with water and two independent generator systems," he adds, while touring the various levels of the facility.
"They told me I was crazy, but hospitals are a clear target. On February 1st, I ordered the evacuation of the Pokrovsk hospital at 8:00 p.m. I evacuated dozens of employees. Two hours later, the Russians dropped seven CAB bombs [of 500 kilos]," recalls the person in charge of military health centers in the eastern part of the country.
The cylindrical containers are manufactured in the Metinvest factories, which have also transformed their production policy to assist the Ukrainian army. "The first underground hospital entered service last year and now another one is under construction. Initially, we wanted to make small modules that could be joined with screws, but the soldiers told us they didn't have time for that, so we decided to make them larger," explains Oleksandr Myronenko, CEO of the company, at the facilities where the containers are produced.
Engineers who participated in the tests to certify the facilities used live fire and explosives to check their resistance: from 120-millimeter projectiles to mortars or eight-kilo TNT devices, which were launched with drones onto the structure.
"Unfortunately, Ukraine is now a laboratory where the future of military strategy is being experimented," Kuziv opines.
The transfer of medical centers underground confirms the regression witnessed in terms of respect for the laws that were supposed to govern conflicts, established after the Second World War, where precisely underground hospitals were almost the norm due to the indiscriminate attacks they suffered from all parties involved.
Although medical facilities continued to be targeted in conflicts such as those in Korea or Vietnam, the Geneva Convention in 1949 and the protocol added in 1977 attempted to define a legal framework for the protection of these buildings intended to assist victims of conflicts. However, systematic violations of humanitarian law have led to field hospitals -popularized by the series M*A*S*H- being on the verge of becoming history due to the risk they pose.
According to a report by the Ukrainian Ministry of Health in early May, Russia has destroyed more than 300 medical facilities and damaged another 2,000 since launching its general invasion in February 2022.
On July 8th of last year, a Russian rocket partially devastated the country's largest children's hospital, the Okhmatdyt in Kiev, killing two adults. The Ukrainian army reported that Moscow fired a cruise missile, known for its effectiveness in targeting designated objectives.
According to Pavlo Kovtoniuk, author of a report on the recurrent armed attacks by Russian troops on health facilities, Moscow "has already used this murderous tactic in Chechnya and Syria without assuming responsibility. If Russia avoids punishment, the destruction of hospitals will become a weapon of war. Unpunished evil never stops growing." This practice is far from being an exclusive attribution of the Russian armed forces. In Gaza, Israeli attacks on health centers have been a constant since October 2023.
According to the organization Perspective on Insecurity, as of April 28th, medical institutions in the Strip had been attacked 359 times. The Israelis killed 645 healthcare workers and arrested another 354.
Data summarized bluntly by the World Health Organization: "At least 94% of Gaza's hospitals have been damaged or destroyed."
Gaza tops this sad ranking, which, however, reflects a tactic increasingly integrated into the military strategy of numerous countries.
In 2016, Doctors Without Borders launched a campaign warning about the proliferation of these assaults, considered a war crime under the slogan Not a Target. Two years later, the prestigious journal The Lancet questioned in its editorial whether "humanitarian principles, as defined today, are still relevant for a constantly evolving war strategy."
Located 12 kilometers from the front, the hospital designed by Kuziv was visited by the Ukrainian President, Volodymyr Zelensky, last December, who highlighted the innovative nature of the center. The pioneering project is giving way to a whole policy of building medical facilities underground, sponsored by the local government. For example, Kiev plans to build a large 12,000-square-meter hospital in the Kharkiv region, with a capacity for 2,000 people.
In Kherson, in the south of the country, local authorities have already implemented three underground departments in three medical facilities. One of them was set up as a maternity ward since January of this year.
"The building has received two direct hits and two very close ones so far this year," explains Volodymer Gobachevsky, 58, one of the facility's managers.
Four women remain hospitalized, either waiting to give birth or recovering from childbirth. Natalia Mokrakova, 36, is one of them. Just a few hours ago, she gave birth to little Nikita. For her, being a mother under the perpetual threat of war is not even an added value.