If war breaks out, civilians will be the first to suffer. A combat medic: And yet, Polish doctors keep asking what to do when it happens

– That’s why it’s so important not to turn a blind eye to Ukraine’s daily suffering. Even from such tragic events, we need to draw conclusions about our own security. Because we don’t know if we’ll be next.

What do Ukrainian soldiers say about Trump’s decision to freeze aid to Ukraine?

– There’s no big politics in the trenches. No one talks about what’s happening in Kyiv, Warsaw, or Washington. But Ukrainians fear a false peace and a frozen conflict. They believe it would serve as a pretext for the West to cut off aid while Russia, just as in the past, pretends to respect agreements – like the Minsk agreements – only to use the time to prepare for another attack.

Signing the Minsk agreements in 2015 was a trap – it froze the conflict in eastern Ukraine and allowed the aggressor to prepare for full-scale war. We cannot go back to that, as President Zelensky keeps repeating. But what do soldiers on the front say now about Trump negotiating with Putin?

– Ukrainians don’t trust the Russians. They don’t believe in any peaceful solution involving them. If the Russians halt or slow down their attacks, for Ukrainians, it will only mean they are preparing for something bigger – something final. They know that even if there’s silence, even if there’s a ceasefire, it will most likely be just a pause before the decisive round.

What’s the mood like in Ukraine now?

– You can see the exhaustion. Morale is dropping. Soldiers don’t get a chance to rest. And those who replace them aren’t well-trained – they simply don’t have enough time. Ukraine’s defensive line is like a taut branch. The question is: when will it snap? I honestly don’t know how much longer they can hold out.

You’re a combat medic, not a doctor.

– A combat medic works directly on the battlefield and doesn't always have a medical degree – the minimum requirement is a specialized course.

So after the right training, you can provide medical aid and save soldiers on the front lines.

– I’m a historian, but my team includes doctors who left Polish hospitals for Ukrainian trenches.

I first went to Ukraine at the turn of 2014 and 2015. The war was already going on back then, though few people remember it today. At the time, I was involved in nationalist-patriotic circles, and to me, that war was just a clash between two enemies—fascist Russia and Banderite Ukraine. I wanted to see it with my own eyes.

And what did you see?

– I saw rockets raining down on Mariupol. I saw people die in front of me. Any illusions I had were gone – I understood that this was a real war, with only one aggressor. And I felt I had to take a stand for freedom.

I saw how deeply Ukrainians longed to be part of a democratic, safe world. They spoke about it, they dreamed about it.

When I returned to Poland, I started studying. I deepened my knowledge of battlefield medicine, which I had learned during military courses. I gathered equipment, found people, and we went to Ukraine – to Kryvyi Rih – to train Ukrainians in first aid.

What inspired you to do that?

– I saw how much they needed it. Ukraine lacked medics and resources. At some point, they said, "Alright, let’s go test what you taught us".

Is that how you ended up on the front lines?

– I found myself under Donetsk airport when it was still barely holding out. That was in 2015 – the first time I experienced intense artillery fire. The first time we helped the wounded and realized how much we were needed. That was our baptism by fire, in the most extreme circumstances. And that’s how my odyssey began – one that has now lasted ten years.

I would return to Poland from time to time, work as a university lecturer and a high school teacher, gather supplies, and then head back to the front. I also went on rescue missions to Syria and Iraq, working with the Kurds fighting ISIS.

In 2022, when the full-scale war broke out, I was working at the Government Center for Security. That made it impossible to be on the front lines in Ukraine. After a few months, I made my decision – I left my safe, civilian life behind, started a foundation, and dedicated myself entirely to frontline medical aid as a combat medic.

How do you operate?

– Our foundation has 50 combat medics, and we are currently preparing six more for the next deployment. We work in rotations, either continuously or on standby duty. Typically, we spend three days in the trenches, followed by three days of rest and combat readiness renewal. However, there have been times when we remained on the front line for an entire month without a break.

That was the case during the Russian assault on Bakhmut. We spent two months without any rest, sheltering in the basements of a city razed to the ground by Russian forces.

We saw firsthand how little regard they had for civilians – destroying everything in their path.

No one in our foundation receives any payment for work on the front lines. We are all volunteers, doing this free of charge. First, to avoid being labeled as mercenaries, and second, because of motivation. When missiles, drones, and everything else designed to kill you are raining down, your reason for being there cannot be money.

Do you coordinate with Ukrainian commanders?

– We are not integrated into their structures, but our cooperation is precisely coordinated with their frontline operations. We take part in direct evacuations, rescue efforts, and assisting wounded soldiers.

Our actions cannot be independent – we must work with the Ukrainian army to ensure effectiveness. We take full responsibility for the patients we fight to keep alive before they reach hospitals.

How do you cope with that responsibility?

– You have to accept that you won’t be able to save everyone. That by going there, you will have patients you simply cannot help due to the severity of their injuries or the limited resources and manpower available. A medic has to get used to this reality – but never become indifferent to it. You have to face it, and when you return home, you must process it. That’s why we have psychologists and therapists supporting us. It’s not easy.

The worst part is losing comrades. When the person you had breakfast with won’t be there for dinner because they went out on a mission and never came back.

As medics, we often transport the dead, not just the living. We retrieve fallen soldiers so their families can give them a proper burial. Sometimes, there are so many casualties that we physically can’t take them all at once. We’re simply too exhausted. But after a few days, we go back for them, even if we have to push for permission from Ukrainian commanders.

Why?

– Because there is no universal rule that fallen soldiers must always be retrieved from the battlefield and returned to their families. Sadly, in some situations, bodies are left behind. The situation is so dire that our priority has to be saving the living. But we believe everyone deserves to come home. If we fall, we want the same – to be brought back to Poland, to our families.

In war, anything can happen at any second. I want to have peace of mind, knowing that no matter what happens, I will return home.

For the Russians, is a civilian just a soldier without a uniform – just another enemy?

– The Russians do not follow international humanitarian law in armed conflicts. There have been many instances where civilians and even medical personnel – who save lives on both sides – have been targeted by Russian forces.

Intentionally?

– They track medical stations and evacuation routes. They see them through drones, they know exactly what they’re looking at, and they still strike at medical transports. Even far behind the front lines, if they detect a medical facility, they destroy it without hesitation. They shoot in cold blood.

It’s outright barbarism, but they have a calculated purpose behind it. The Russians know how much morale suffers when soldiers don’t have medics to rely on. They understand how demoralizing it is when a soldier knows there’s no medical support behind them – no one to treat them if they’re wounded, no one to retrieve their body if they die. That can break a fighter’s will to go on.

What’s been the worst moment so far?

– In August, one of our Polish paramedics was hit by a projectile. He was evacuated back to Poland, and doctors are still fighting for his health. The worst part was that he was one of us. But there have been countless difficult moments. It’s hard to recall them individually because every day in Ukraine is marked by death, pain, and grief.

Maybe what I’ll say now will sound controversial, but it needs to be said. Tragic moments are intertwined with moments of hope, moments of beauty. I don’t want to romanticize war – it is horrific, something that leaves permanent scars on hearts and souls.

But in the midst of tragedy, there are moments of profound humanity and resilience. And it is those moments that give people the strength to carry on.

So what does that mean?

 – It means that on the front lines, there is friendship, selfless help, and a willingness to sacrifice for another person – often a complete stranger. The Russians have no idea how much the Ukrainian nation will emerge from this war strengthened in that regard.

The turning point in my perception of the war in Ukraine – and my emotional breaking point – was Bakhmut. Watching that city in its death throes, I kept seeing images from the Warsaw Uprising Museum in my mind. Walking through the exhibits, looking at the reconstructed graves in gateways and parks, I never imagined that one day I would be the one burying bodies in a pit behind an apartment block, just to keep them from decomposing on the streets. These are things that were once unimaginable to us – yet they are now part of daily life in Ukraine.

It’s crawling from basement to basement like rats, hiding there just to feel a shred of safety.

The Zaporizhzhia counteroffensive was also an immense psychological burden for us. The Ukrainian army sent its soldiers against well-fortified Russian defensive lines, knowing that most of them would not survive – and worse, that their bodies would be left behind.

Russia employs a brutal, merciless strategy of frontal infantry assaults. A soldier is just another weapon, and because they have so many, the Russians don’t care about their lives. The Ukrainians call this approach "meat wave assaults". It leads to massive losses, but at the same time, it allows for slow, grinding advances on the front.

But there were also times when the Ukrainians sacrificed their soldiers' lives, knowing full well that the front lines were impenetrable. We often felt helpless, trying to save Ukrainian soldiers while watching others die before our eyes. Those are some of the hardest moments for medics. Our job is physically demanding – we carry the wounded. But without a strong mental resilience, no one lasts long on the front lines.

Can you still believe that human nature is fundamentally good in a war like this?

– We want to believe it. That’s why we provide medical aid to every wounded person – without exception.

Even to Russians?

– Yes, we treat wounded Russian soldiers as well. And as long as we do that, as long as I don’t feel an internal resistance to saving a life – even if it belongs to the enemy – it’s proof to me that I am still human. That there is still a spark of goodness within me, the very thing we are fighting for, the thing that defines us as people.

I am honestly relieved that I have never witnessed Ukrainian forces executing Russian prisoners. And in all the units we work with, I have never heard of such incidents.

I can personally confirm that while Ukrainians may not be eager to help Russian prisoners, they do it. Russian wounded are placed on the same operating tables and taken to the same hospitals as Ukrainian soldiers. There is also a pragmatic reason for this – captured Russian soldiers can later be exchanged for Ukrainians held in Putin’s prison camps.

It’s no secret, and I’m not saying this as some pro-Ukrainian propaganda, but on the Russian side, it’s the complete opposite. They often just execute prisoners – because, for whatever reason, they find them useless. They simply finish them off. And if prisoners do make it to Russian camps or prisons, medical care is either severely limited or nonexistent.

If war broke out in Poland today, would our soldiers be prepared to provide battlefield medical aid?

– We have serious gaps in comprehensive combat medicine training for individual soldiers. Their knowledge is often limited to applying a tourniquet or a bandage. They don’t know how to handle battlefield injuries – the kinds of wounds that, if untreated, lead to death.

One thing that became immediately clear in Ukraine is that when there’s a low level of self-aid knowledge or basic medical assistance from fellow soldiers, the survival rate of the wounded plummets. A professional combat medic can’t always reach everyone in time.

We are not fully prepared for situations like this. Yes, we are in NATO, and we have more resources than Ukraine, but we need to be ready for the worst-case scenario. I fear that we underestimate our potential adversary and his capabilities. And as the saying goes, pride comes before the fall.

We need to launch mass training programs in battlefield medicine for all military personnel – every soldier.

What needs to change so that our military medics can save as many soldiers and civilians as possible in a real war?

– Right now, our battlefield medicine approach is based on experiences from Afghanistan and Iraq. But those wars didn’t involve mass artillery strikes, air raids, or an enemy that was well-equipped and outnumbered us.

If we ever face a military confrontation with Russia, that’s the reality we will have to deal with. We need to start training accordingly.

Meaning?

– Meaning we need to get out of our comfort zone and train as if we were fighting a real war. That means taking all medical infrastructure underground – because anything left on the surface will be mercilessly destroyed by the enemy. I’ve seen it happen in Ukraine.

Gen. Grzegorz Gielerak, director of the Military Medical Institute in Poland, says that advanced medical facilities, such as field hospitals, may need to be placed entirely underground.

– Absolutely. In Ukraine, field hospitals in containers or tents are simply not an option. That stopped being viable at the very start of this war. And yet, we stubbornly continue to rely on tent-based field hospitals, just as we did in our bases in Iraq and Afghanistan.

Just watch the award-winning documentary 20 Days in Mariupol, filmed by the last international journalists inside the Russian siege of Mariupol, and see how the hospital functioned there – how the entire infrastructure moved underground. The war in Ukraine has proven that there is no other way.

Even now, when we visit hospitals and university medical centers, their directors still ask what they should do in the event of war. How should they prepare? What are the procedures? What kind of training programs should they follow? How should they adapt their infrastructure? There is a great deal of confusion, and many things have yet to be properly organized.

Is Poland’s civilian healthcare system prepared for war – for mass casualty treatment of both soldiers and civilians?

– I don't want to answer that question. I see conflict from the trenches, not through the lens of geopolitics. There is a lot that needs to change. Many decision-makers are beginning to shift their thinking. With the change in political direction, awareness is awakening on many fronts.

Do our doctors know how to treat battlefield injuries?

– On the battlefield itself? No, they are not prepared for that. It’s a completely different reality. Combat medicine is nothing like working in a clean, sterile operating room. The threats are different, the challenges are different – far beyond what our doctors encounter in their daily practice.

The organization and logistics of military healthcare are fundamentally different from those in the civilian world. We cannot approach wartime medical challenges – or even mass-casualty situations like a terrorist attack – through the lens of our experience with well-equipped hospitals in times of peace.

The nature of injuries will be different too, right?

– Yes, battlefield wounds are entirely different and require a completely different approach from what civilian doctors are used to. Most of them have never encountered such injuries before. We’re talking about devastating wounds – massive trauma, multi-organ damage caused by explosions and bullets, people literally torn apart. This isn’t about fearmongering; it’s about making people understand just how drastically different this world is and how doctors will have to face it. There won’t be time for consultations, analyses, or discussions. On the battlefield, every moment is critical – you need to act fast and effectively to save lives.

In Ukraine, medical universities have established military departments. After completing their studies, young doctors also become officers, which gives them a deeper understanding of treating battlefield casualties if the need arises.

That is something Poland lacks, and even creating a Military Medical Academy is not enough.

And then there’s the issue of communication between military and civilian doctors.

– There are deep divisions and conflicting procedures. Peacetime medical laws and regulations slow down and restrict what can be done in a battlefield setting.

Are legal regulations not adapted to wartime conditions? What’s the solution?

– I saw how it worked in Ukraine. Combat medics had to bypass legal red tape to administer treatment and give life-saving medications – despite not having the formal authority to do so. The reason was simple: if they didn’t act, people would die. The wounded wouldn’t survive long enough to reach proper medical facilities.

Civilians don’t understand this reality, do they?

- Exactly. Even those in the civilian medical community don’t always grasp what war truly means and how it changes the way doctors, paramedics, and first responders operate. They fail to understand that when bombs are raining down, many peacetime protocols will be useless.

We’ve lived in a safe country for so long that we take stability for granted. But war changes everything. That doesn’t mean there are no rules or laws – civilized nations must still uphold certain principles, even in war. The point is understanding that battlefield medicine is neither sterile nor academic.

Civilians often cite international humanitarian law, believing it guarantees freedom of action and protection for medical personnel on the front lines. But Ukraine has shown that this is a fiction – it simply doesn’t work. The reality for medical personnel will change the moment war breaks out. It’s time for civilians – including doctors – to finally understand that.

Can this be changed?

– Everything can be changed if politicians decide to act. Worse, if we face the threat first and only then begin to change the rules.

These changes take years of work, and in Ukraine’s case – liters of blood. Some procedures and legal regulations have already been revised there after certified training programs approved by the Ukrainian Ministry of Health. For example, individuals without medical education are now permitted to administer blood transfusions on the battlefield and to administer certain medications. I know that Poland’s military healthcare sector has been knocking on the doors of the Ministry of Health and reaching out to key decision-makers responsible for these changes.

But there is significant resistance from the civilian medical community, which does not want these changes.

Yet, emergency medicine also applies to military medics – the very people who would be providing aid in times of armed conflict.

Is the real issue that combat medics – who aren’t always doctors – are stepping into the domain of civilian physicians?

–  The issue is the legal roadblocks that prevent properly trained non-medical personnel from performing certain medical procedures on the battlefield. With prolonged evacuation times and extended care required for wounded soldiers in combat, battlefield medics must be able to administer select medications and carry out specific medical procedures. Otherwise, wounded soldiers simply won’t make it to the medical personnel waiting for them in hospitals. This requires both openness from civilians and changes to our legal system.

Could it also be a matter of professional pride? Do civilian doctors feel superior?

– When we talk in Poland about the need to amend the law – strictly in wartime, of course, because no one is advocating for some "healer-plus" program – we are met with resistance.

When we bring this up with decision-makers or in medical chambers, the response is often: "If you want to practice medicine, go to medical school".

This shows a complete lack of understanding of the potential reality we may face.

Do Ukrainian soldiers hope for a ceasefire, for any kind of peace agreement?

– Some are just waiting for it all to be over. There are also those who want peace – but not at any cost. Even after losing loved ones, they remain determined to fight to the very end. I’m talking about military units where morale is exceptionally high. Their stance is clear: it's complete victory or nothing – negotiations and ceasefires are off the table.

How will Ukraine and its soldiers deal with the urge for revenge against Russia?

– From what I see, there is no way that the Ukrainian and Russian nations will ever again view each other as brotherly. The idea of friendship between them is simply gone.

The tragedy and trauma of war – the sheer scale of the suffering inflicted on Ukrainians – has, in my opinion, permanently severed any mental or emotional closeness between these two nations.

Lt. Res. Damian Duda, president of the "W Międzyczasie" Foundation, is a Polish medic who volunteers on the Ukrainian front. A university lecturer awarded the Cross of Merit by the President of Poland and the Order of Merit by the President of Ukraine. Since 2014, he has gained experience in battles in Mariupol, Donetsk airport, Soledar, Bakhmut, and Zaporizhzhia, as well as in Syria and Iraq.

*The "W Międzyczasie" [eng. "In the Meantime"] Foundation was established in 2023 as a non-profit organization with the mission of providing humanitarian and emergency aid to war victims in Ukraine, particularly in areas affected by active combat.

Translation: Patrycja Eiduka