Throughout the current Russo-Ukrainian War, Russian forces have consistently targeted Ukrainian medical infrastructure. From February 2022 to January 2025 alone, the World Health Organization recorded at least 2,215 attacks on Ukrainian healthcare, including a significant number of attacks on maternity wards and pediatric centers. Out of 617 national health facilities, 128 are fully damaged, and 280 are now completely non-functional.1 This has extended to medical evacuations – even as far as 40 kilometers from the front, Ukrainian medics and ambulances are targeted, leading to massive delays in evacuation. Medevac can take anywhere from several hours to several days.2
Ukrainian forces have adapted by embracing hardened, underground facilities,3 offering a glimpse of the facilities that American forces may require during a future large-scale combat operation (LSCO). Ukraine initially benefited from a pre-existing network of Cold War tunnels, defense shelters, bunkers, as well as converted civilian infrastructure such as subway stations in populated cities, mines, and even hardened basements.4 However, the Ukrainian military has also partnered with companies such as Metinvest Group, a multinational steel and mining company, that has not only helped to repurpose mines into medical facilities, but has also produced prefabricated steel shelters that allow for rapid construction of hardened facilities.4 Six of these prefabricated shelters, each 7.6 by 2.5 meters, when assembled together, are capable of functioning as a Role 2 MTF and allow up to 4 surgeries to be performed simultaneously.4 Impressively, each of these facilities includes a water supply, drainage, alternative power sources, and defense against electronic warfare.4 While only one of these shelters appears to have been constructed as of September 2025, Ukraine is planning to build over 20 more to act as “stabilization points” near the front line.5
Simultaneously, large-scale construction of underground hospitals has also occurred – one facility is built 6 meters below ground, covering 500 square meters, and including a lab, ICU, multiple operating rooms, and even a kitchen;6 the Ukrainian medical service has claimed that this hospital has saved over 6,000 lives in a single year of service. Reportedly, these structures have been rigorously tested against “live fire, mortars, 120-mm projectiles, and eight-kilogram TNT devices dropped by drones.”1 Even reinforcing the structures with wood has been shown to absorb shrapnel.2
There are many lessons to be learned from the Ukrainian model, as a recent article by Colonel Joseph Serowik attests. Focusing on prolonged field care, using a network of dispersed and hardened medical facilities – taking advantage of both pre-existing infrastructure and prefabricated systems – would serve the American military well, especially in potential future LSCOs in the Indo-Pacific and Europe.4
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