The battle is never-ending for medics on the front line

Russia’s Donbas offensive is driven by its artillery ... which means a steady flow of traumatic blast wounds

Field ambulances disgorge their passengers in order. First come the walking wounded: cigarettes hanging from grey lips, faces vacant, camouflage stained dark red.

Many of them cannot actually walk: they are too stunned to do anything but stumble into a trauma ward between two comrades.

Then come the stretcher cases: four civilians this time, all with the same stunned faces as the soldiers.

There is someone whose head is almost entirely bound in white bandages. A man whose leg is bound with ripped cloth to an improvised splint; an elderly woman, already on a drip, the pillow on which she lies bloody; another woman, under a foil shock blanket, still conscious, asking someone to call her relatives.

Volodymyr Zelensky, the Ukrainian president, said on Sunday that Ukraine was losing “50 to 100 people a day” in the battle for eastern Donbas.

That is a high figure that likely reflects the worst days rather than a rolling average – but also the sheer violence of a war fought predominantly by high explosive ordnance.

Neither side in the fighting here likes to talk about its own losses.

Vladimir Putin obliquely acknowledged Russia’s own on Victory Day, when he promised state aid to the wounded and families of the dead.

But official casualty figures have not been updated since March 25, when Moscow’s defence ministry said 1,351 Russian soldiers had been killed and 3,825 injured. That is well below Western assessments.

British defence intelligence said on Monday that Russia has probably “suffered a similar death toll to that experienced by the Soviet Union during its nine-year war in Afghanistan”, which would put the figure closer to 15,000.

The Ukrainians, who keep a rolling score of Russian soldiers and kit which they claim to have killed and destroyed, also treat their own casualty figures as secret information.

Military and civil officials are under strict orders not to discuss numbers or details of losses.

That makes it difficult to assess the human cost of the war. But the current battle here is probably taking a heavy toll on both sides.

Russian forces trying to surround Severodonetsk, the last Ukrainian foothold in the Luhansk region, are making full use of massed artillery to drive the Ukrainians back.

The Ukrainians are trying to hold them off with the same weapons. Last week, their guns destroyed a Russian battalion tactical group trying to cross the Siverskyi Donets river.

The result is a storm of shrapnel and blast waves working its way through towns and villages on either side of a frontline.

“We are taking 20 to 25 civilian casualties a day from Bakhmut, Severodonetsk, Lisichansk and Popasna,” said a civilian trauma surgeon who spoke on condition of anonymity. “They are almost all shrapnel and blast wounds.”

“We stabilise them, drain the chest, do the head wounds, and send them on to Dnipro. Nine out of 10 who reach the hospital survive,” he added. “We have lot of experience with these kinds of wounds. We’ve been treating them since 2014.”

He insisted that the facility was not overburdened by the constant stream of trauma cases, brushing aside his own obvious sleep deprivation as part of the job. “I don’t have a choice,” he said. “We are managing and we have enough supplies.”

The trauma surgeon refused to comment on the numbers or details of military casualties.

But soldier or civilian, Russian or Ukrainian, the wounds are the same: punctures from flying shrapnel that can cut any organ, at any angle; and respiratory shock from blast waves that can wreck the lungs.

Sergeant Sergei Sanders, a combat medic with a Ukrainian airborne unit, has seen them all. He also risks becoming a casualty himself every time he responds to a call.

“The zombies are crazy today,” he said on one recent afternoon as he summed up the morning’s Russian shelling.

The sergeant was operating on a combination of adrenaline and deep swigs of a high-caffeine energy drink.

It was barely lunchtime, and he had already run three medivacs out of Soledar, a small city in the path of the Russian effort to cut the last road to Severodonetsk.

Those rescue missions could be some of the last on that route: Russian forces were reported to have reached the outskirts of that city yesterday afternoon.

Only soldiers handle the high-risk evacuations on those roads. Foreign volunteers including Médecins Sans Frontières are confined to transporting casualties further west once they are stabilised.

But it is an effort highly reliant on foreign assistance.

Sgt Sanders’s current ride is a well-equipped Swiss ambulance, “with love from Zurich” scrawled in German on the door. He is extremely pleased with it, but it is unarmoured, and the roads he uses have been under Russian artillery fire for some weeks.

“Civilian ambulance. You just have to drive very fast,” he said.

There are other shortages, of both trained combat medics and equipment.

“My partners with whom I work, we take money, and buy, buy, buy, because not enough,” he said. “Specifically, we don’t have enough blood plasma. My friend searched for maybe two weeks, but there was not enough. Because all the plasma goes to the hospitals. And there are not enough tourniquets.”

In a war defined by limb and artery-severing explosions, that is a serious problem.

Although many Ukrainian soldiers now carry modern combat-application tourniquets on their body armour, some still rely on the old Soviet solution: a rubber band wound around a rifle stock.

Others are using a version that is 3D printed by Ukrainian volunteers, but with disappointing results that the sergeant demonstrated on his own leg.

“It doesn’t stop the bleeding,” he said, winding it until the plastic windlass broke. “People want to help, but I keep saying: ‘don’t make tourniquets’. Only use certified ones.”

As the sergeant leaves to prepare his ambulance for its next possible call, there is a lull in the flow of casualties and the yard falls quiet.

With the latest civilians and soldiers handed over to the hospital staff, the ambulance crews and medics pause for cigarettes and a quiet chat about the road.

It is a brief respite. A humourless officer soon orders them to move their ambulance out of the way.

The guns are still working at the front. More of their victims will be arriving before the day is out.