For some foreigners who rushed to Ukraine in the early days of the war, what might happen if they were wounded in battle was a question they’d figure out later. 

“A lot of times we didn’t even know where the stabilization point was,” said David Bramlette, a former U.S. Army Green Beret who led a small team of foreign soldiers in Ukraine last year after leaving his graduate-level studies at Johns Hopkins.

The situation has since improved. Bramlette works for one of several foundations that are helping to evacuate wounded foreign soldiers for medical treatment outside Ukraine, allowing them to see English-speaking doctors and get faster access to specialized care. 

Even so, the heavy involvement of private foundations highlights how the U.S. and friendly governments remain relatively hands-off when it comes to medical support for Ukraine’s military, even as they provide tactical training and weapons worth billions.

Shortly after Russia launched its full-scale invasion of Ukraine in February 2022, foreigners rushed to volunteer for Ukraine. Some ultimately served in Kyiv’s International Legion, an all-foreign unit within Ukraine’s army, while others found themselves serving within regular Ukrainian military units. 

“One thing we’ve noticed since we started doing the wounded evacuations is that there are foreigners serving in every unit,” said Bramlette, who works for the R.T. Weatherman Foundation. 

Nor are they stationed far from the lines, added Nathan Chan, who works with Bramlette in Kyiv: “They’re either in trenches or on the assault.” 

If wounded, such foreign soldiers can expect to spend time recovering from their wounds in Ukrainian hospitals, either near the frontline or evacuated towards Kyiv. 

Many volunteers, however, speak neither of Ukraine’s most common languages— Ukrainian and Russian—leaving them isolated within their medical wards, Bramlette said. 

“It’s really hard to do good pain management” across a language barrier, he said. 

Patients can use Google Translate to communicate that they’re in pain, but describing the intensity and location of the pain becomes a challenge. While Ukrainian hospitals can provide the specialized care they need, moreover, the pressure of war has strained the medical system overall. 

In July 2022, the Defense Department approved the treatment of Ukrainian soldiers at Landstuhl Regional Medical Center, a U.S. military hospital in Germany. In 2023, the Weatherman Foundation began sending wounded soldiers there.

So far the group has transported 21 soldiers, and are arranging transport for four more. The troops have included Ukrainians, Americans, Canadians, New Zealanders, and French, all legally soldiers in Ukraine’s army. 

Once a decision has been made to move a soldier to Landstuhl, Bramlette, Chan, and Ukrainian assistants prepare the necessary paperwork to allow the soldiers to leave the country. Wounded soldiers are driven by ambulance to the Ukrainian border with Poland. 

If a soldier’s condition permits it, they can be transported by ambulance all the way to Germany for around 3,500 euros. More seriously wounded soldiers will be transferred to an air-ambulance service in Poland, which costs up to 21,000 euros. Costs for the transportation are borne by the Weatherman Foundation. A spokesperson for the U.S. Army in Europe confirmed that the U.S. government does not pay the costs for transporting Ukrainian soldiers to Landstuhl.

Once in Landstuhl, American doctors grapple with complex battlefield wounds that U.S. soldiers have rarely faced in the last decade. 

Many of the soldiers helped by the Weatherman Foundation have suffered extreme injuries, typically caused by loitering munitions, artillery shells, or landmines. Such weapons can lacerate a body with multiple wounds. “You’re talking about guys with 20, 30 pieces of shrapnel in them,” said Bramlette. “That’s pretty standard.” 

One medical report based on observations of Ukraine found that trauma surgeons often deal with multiple types of injuries in a single casualty, including life-threatening wounds, blunt-force trauma from being thrown, and traumatic brain injuries.

After their wounds are treated, the majority of soldiers then return to Ukraine, including for rehabilitation in physical therapy centers. 

Bramlette and Chan are now looking to expand the number of European hospitals taking in foreign-born and Ukrainian national soldiers. Doing so will allow for treatment of wounds that Landstuhl can’t handle, as well as reduce pressure on Ukraine’s own medical system. Of Landstuhl’s 65 beds, 18 are currently allocated to soldiers in Ukraine’s army. 

“I think Europe can sort of function as sort of a pressure valve,” said Chan. 

Increasing their work would mean gathering more funds, though, a sentiment reflecting the general importance of bootstrapped volunteer organizations in Ukraine. 

“Our needs are outpacing our resources,” said Bramlette. “We could do so much more.”