Ukraine: Wound Packing and Tourniquet Conversion Example

 The first conversion attempt was unsuccessful. After use of xstat, the second conversion attempt was successful!  -3rd brigade, 2nd mech

Ukraine: First Shoot Down of an Enemy Helicopter by a Maritime Drone

 Ukrainian Defense Intelligence (HUR) announced today the first successful destruction of an aerial target using a marine drone. The drone, a Magura V5, is reported to have shot done one Russian Mi-8 helicopter with a SeaDragon missile, and damaged a second helicopter.

Ukraine: Refugees

 

EU Blocks Telegram Channels that Disseminate Russian Propaganda

MSN: Telegram blocks Russian State-Owned Media Channels in several EU Countries 

Fatalities from Armed Conflict: Three-Decade Trend (includes civilian and military)

Ukraine: Frostbite and Trench Foot Prevention and Treatment

 FROSTBITE AND TRENCH FOOT

Frostbite is injury due to formation of ice crystals within tissues. Adjacent tissues may be damaged by vasoconstriction, thrombosis, and inflammation, 

Determining the severity of a cold injury can be challenging during early phases. Initial signs and symptoms in severe frostbite may appear deceptively benign; conversely, mild cold injuries such as frostnip may present similarly to frostbite.

Prior to rewarming, frostbitten tissues are cold, white, hard, numb, and sometimes blistered. After rewarming, skin becomes blotchy red, swollen, and extremely painful. Blisters tend to appear within 4-6 hours of rewarming. Clear, serum-filled blisters indicate superficial damage, without residual tissue loss. Blood-filled blisters accompany deep tissue damage and likely tissue loss. Longer-term complications can include compartment syndrome, gangrene (usually dry, with a hard black carapace over healthy tissue), need for amputation, and long-term neuropathic symptoms. The full extent of frostbite damage may take several days to several weeks to become clear.

TCCC has four frostbite categories:

First Degree (Superficial): Superficial skin injury, pain on rewarming, numbness, hyperemia, occasionally blue mottling, swelling and superficial desquamation (after ~5 days)

Second Degree (Superficial): Partial thickness injury to skin, in addition to first degree findings, vesiculation of the skin surrounded by erythema and edema (appears around day 2)

Third Degree (Full Thickness): Entire thickness of skin extending into subcutaneous tissue, bluish to black and non-deformable skin, hemorrhagic blisters, vesicles may not be present, eventual ulcerations can be expected, area will likely be surrounded by 1st or 2nd degree injury

Fourth Degree (Full Thickness): Similar to third degree, but full thickness damage including bone. Area may be cold to touch and may feel stiff or woody.

Immersion Foot: Caused by prolonged exposure to moisture. Feet, especially soles, become water-logged, hyperemic, mottled, painful, and edematous, gradually progressing to blistering, hypoperfusion, ulceration, and gangrene if untreated. Treatment is re-warming and drying at room temperature. Pain control and debridement may be required. As with other cold injuries, persistent life-altering symptoms may occur. 

TCCC frostbite treatment protocols are as follows: 

***Treatment protocols in Ukraine will depend on local guidelines*** 

Address major trauma and hypothermia before focusing on frostbitten extremities. 

PREVENTION in patients: Ukraine conflict conditions and injury patterns can predispose patients to cold injuries, in several ways.

Field conditions: Immediately post-injury, it may be necessary to prioritize movement, cover, and returning fire over keeping patients dry and fixing damaged winter clothing systems. In Ukraine at present, Casualty Collection Point and/or field care is generally provided by personnel with auxiliary training, only at the Combat Lifesaver / EMT-Basic level. Due to large numbers of patients, and pervasive drone, artillery, and direct-fire threats, it is common for this Care Under Fire / Tactical Field Care phase to be extremely prolonged. Patients typically spend 6 - 48 hours, or more, on position prior to casevac. 

Nature of Injuries and Medical Interventions: Patients’ mobility, and their ability to protect their own limbs, may be reduced due to injuries and altered mental status (from medication or trauma). Circulation to limbs may be further impaired due to direct trauma, hypotension, shock, global hypothermia, and bleeding control measures. During early care phases, global hypothermia prevention is much more effective against cold injuries than localized hypothermia prevention. Hypothermia is particularly dangerous in trauma patients, as it combines with coagulopathy and acidosis to form a positive feedback loop (“the Lethal Triad”). Climate control systems may be inadequate or absent in transport vehicles and treatment areas (ideally you should be uncomfortably warm in the room where you treat a trauma patient). Preheat chemical blankets, and turn up the heat in the patient compartment while enroute to the AXP. Minimize opening doors and patient transfer time into the ambulance. Even the best care teams may allow a patient to become hypothermic while focused on performing advanced procedures. Remove clothing and blankets from the patient only long enough to perform essential exams and medical interventions. Consider using multiple blankets to “burrito wrap” the patient.

TREATMENT: Hospital / Prolonged Field Care Phase: The core of frostbite treatment is rapidly rewarming the frostbitten area in warm water (37-40 degrees celsius)  This should take 15-30 min if water is kept continuously at 37-40. (TCCC calls for 40-42 degree water; however recent studies have shown this causes additional pain without improving outcomes). The longer the tissue remains frozen, the greater the damage. A general rule of thumb is that if the patient cannot reach a hospital in the next two hours, field rewarming should be undertaken. However, NEVER THAW tissue unless it can be guaranteed that it will not re-freeze. Do not thaw feet if the patient will have to walk on them in the near future; thawed tissue is delicate and susceptible to trauma. Dry heat sources should be avoided; they may burn numb tissue. Avoid the temptation to prematurely end rewarming due to pain; rapid rewarming is more painful but produces better outcomes than slow rewarming. Liberal use of pain medication is highly encouraged during the rewarming process. The patient should move the affected part gently during rewarming.  Do not rub affected areas, or apply snow or oil. Leave blisters intact to prevent infection and deep tissue dessication. Preventing infection is paramount. The hospital may use vasodilators, anticlotting meds, NSAIDs, and elevation to encourage reperfusion.  Patients should avoid vasoconstrictors such as nicotine, and be monitored for electrolyte abnormalities. Acute, persistent pain will generally subside within the first three days, although intermittent nerve pain may continue for an extended period.

Previous Medical Spotlights

Blood Loss and the Lethal Triad

TB and the Ukraine War

Ketamine in War, Including Use in TBI Patients

Crush Injury and Compartment Syndrome

Frostbite

Joke: A Ukrainian Man Goes Before Saint Peter:

Saint Peter asks 'Where were you born?'

The man thinks for a moment and says 'Austria-Hungary, Lemberg.'

'Where did you go to school?'

'Poland, Lwow.'

'Where were you married?'

'The Ukrainian S.S.R., Lviv.'

Surprised, Saint Peter asks 'Where was your first child born?'

'In the German Reich.'

'And where did you die?'

'At home in Lvov, in the Soviet Union.'

Astonished, Saint Peter shouts 'My, you moved around a lot!'

'What are you talking about? I never left the city!'

Ukrainian Musician Plays Shedruk (Carol of the Bells) on a Traditional Bandura, Near the Front Line at Pokrovsk

 

Ukraine: Human Rights Watch Report Summary on Torture of Civilians by Russian Military in Izium

Human Rights Watch Investigators visited Izium in the fall of 2022, after the city was liberated by the Ukrainian counter-offensive. Multiple civilian residents describe being detained and tortured by Russian soldiers in the report.

NEWS ARTICLE: Human Rights Watch Report Summary on Torture of Civilians by Russian Military in Izium

Downing Drones with Radio Waves

 This British Ministry of Defense reports successful testing of its RFDEW. This platform can shoot down drones up to a kilometer away, using radio waves, at the cost of 10 pence per shot.

Ukraine: Incoming Artillery in Donbas

 

 

Ukraine: One of the Longest Armored Movements Behind Enemy Lines in History: The Raid of the 95th Brigade (2014)

 

During the Donbas War, elements of the Ukrainian Army reportedly made a 170km dash behind enemy lines, in order to resupply a cut-off unit. According to Potomoc Institute for Policy Studies historian, Dr, Philip Karber, this was one of the longest armored raids in history.  

Between 19 July and 10 August, units of the Ukrainian 95th Air Assault Brigade, reinforced with elements of the 25th Airborne and 30th and 51st Mechanized Brigades, conducted a 470 km raid, of which 170km was behind Russian and Separatist lines. All those who took part in the operation on the Ukrainian side were volunteers. The raid was successful, allowing for the creation of a safety corridor to evacuate Ukrainian units trapped behind enemy lines at the Russia-Ukraine border. 3,000 troops and over 250 pieces of equipment of the 24th, 72nd Mechanized, and 79th Air Assault Brigades. 

This was the first direct clash between Ukrainian and Russian troops of the Donbas War. The soldiers involved have been praised by military experts and historians for the skill and daring that went into the raid. 

Watch a youtube video from Battle Order, about the raid:

Volunteer Group Platsdarm is bringing fallen soldiers home, from both sides of the Ukraine Conflict

 Oleksii Yukov's volunteer group, Platsdarm, has been working in Eastern Ukraine since 2014. In this time, it has conducted respectful recovery of the remains of over 2,000 fallen soldiers, and returned them to their families in Ukraine and Russia. This provides crucial closure for families of those who went missing in the conflict. Prior to the Donbas war, Mr Yukov worked with groups that recovered remains of soldiers lost in WWI and WWII. 

Link to Voice of America video story on Platsdam:

Ukraine: Christmas Memorial Installation in Kiev

Christmas dinner table with empty chairs and soldiers' uniforms commemorates those who are dead or missing

 

Ukraine: Christmas Message from Dr. John Quinn

"To All of You and cross posting:

You are doing extraordinary work. Keep it up. We face gaps, challenges, and immense headwinds. It is critical that we keep our focus aligned on one shared mission: to reduce preventable morbidity and mortality among the Ukrainian warfighter, the volunteer warfighter, and all volunteers and medical support elements across the FLOT.

We all know the stakes. If we lose focus, people die. People are injured. Projects stall. Partnerships falter. And ultimately, we may lose. The fragmentation I’m seeing as I depart is a direct result of the enemy’s efforts to divide us. Do not let this happen.

Engage. Partner. Support. Do what you do best, what you know is right, and what is needed—always. If in doubt, ask for forgiveness, not permission.

Despite the challenges—financial, relational, and operational—you must persist. Do not give up. Do not surrender. Do not let the enemy win.

Wishing you all a Merry Christmas (whichever one you celebrate), Happy Hanukkah, and Happy Holidays. Stay strong, stay united, and stay focused.

With respect and gratitude, Slava Ukraine! -Quinn"

 -Message from Dr. John Quinn, an American physician who has been going to Ukraine since the start of the Donbas War. He has been instrumental in approval of blood products for prehospital use in Ukraine

Ukraine: Decent Documentary on Izium Occupation

 Documentary by Devin San Luis

Ukraine: Trench Candles and the Palmer Furnace

 Trench warfare and caving... two cold, wet, and dangerous activities, which have both inspired creative ways to stay warm.

Caver and hypothermia expert Jonathan Palmer invented the Palmer Furnace, for use underground. Cavers, especially expedition cavers, often traverse tight, wet passages, in caves which may have an ambient temperature in the 30's or 40's Fahrenheit. This is commonly followed by long periods of inactivity, sitting on cold ground, surveying new passage. This combination can easily result in hypothermia. 

Palmer's invention is a simple combination of a large trash bag and a candle. The person sits with the lit candle between their legs, and covers themselves, legs and all, with the trash bag. A small hole should be cut, so that the face is outside the trash bag, and the top of the head is inside. The bag traps air warmed by the candle, creating a cozy microclimate. Beeswax candles work best, burning for a long time at a high temperature.

In Ukraine, volunteers are making trench candles. This is an old technology, which was also used in WWI and WWII. 

Construction of a trench candle is simple. A tin can (1L paint can, cat food tin, etc) is filled with a spiral of cardboard, cut to the height of the can. A cardboard wick, cut an inch or two taller than the rim, is inserted. Melted was is poured into the tin, until full. The resulting candle will burn for 5-7 hours and produce quite a bit of heat. It can be used for light, warmth, and to heat food and drink. Trench candles with lids can also be boiled in water and used as re-heatable hot packs inside clothing.

Photo from How to Make a Trench Candle at Home

And here's a good video on Youtube, showing the trench candle-making process

News Story: Volunteers in Ukraine Make Trench Candles

Ukraine: Keeping my Helmet Warm

 

Ukrainian Drone hits airbase in Chechnya

 

Ukraine: Successful shoot-down of a Russian Missile during a recent attack on Ukraine's Power Grid

 

Ukraine: 3rd Brigade Interviews a Prisoner of War

 

Ukraine: Russian Submarine Missile Launch

 

This video reportedly shows a submarine missile launch, which targeted Ukraine in December 2024.

Ukraine: Monthly Salary over the Years

Right-hand column shows monthly salary in dollars.

 

Ukraine: The Cost in Dollars of Supporting Ukraine vs Letting Russia Win

 Elaine McCusker, Senior Fellow at the American Enterprise Institute, provides a cost comparison: 

~112 billion:  Cost to the US so far, to support Ukraine with weapons and other equipment (most of this money goes to US arms manufacturers

vs 

~808 billion: Projected additional US defense spending that will be needed over the next 5 years, if Russia wins the Ukraine war, including:

    - $88 billion for 270,000 more US service members

    - $31 billion to harden US facilities

    - $109 billion to increase US air combat capabilities

    - $28 billion for drone development

    - $173 billion in air defenses

    - $63 billion to enhance munitions production capability

    - $50 in shipbuilding

    - $185 in additional training and exercises

    - $33 billion in spare parts stockpiling

    - $10 expanding special operations forces

    - $36 billion expanding space and cyber systems

The full article is available in Foreign Affairs magazine here: The Price of Russian Victory: Why Letting Putin Win Would Cost More than Supporting Ukraine

Ukraine: IAEA vehicle hit by Russian FPV

IAEA Director General Raphael Grossi reported significant damage to the vehicle, and called the strike "unacceptable". There were no injuries. 

Ukraine: Eliminating Enemy Surveillance drones and Shaheds

Over four months in 2024, drones of the 3rd Assault Division aerial defense units brought down dozens of Russian Lancet, Orlan, Zala, Supercam, and other drones. 

Paths of Russian aerial attack assets on 28 Nov 2024. Yellow triangles indicated Shahed drones, other colors are missiles.

 

 

Ukraine: Medical Evacuation Under Fire

 

Ukraine: Soldier survives 24 days with a tourniquet in place

 

This injured Ukrainian soldier was pinned down by enemy fire for 24 days. A tourniquet on his left arm

saved his life. After evacuation to a military hospital, the limb was amputated, and prognosis is good.

Ukraine: Maryinka, Donetsk Oblast, before and after the full-scale invasion

 

"A Testament" - Poem by Borys Humenyuk, MIA

Today we are digging the earth again

This hateful Donetsk earth

This stale, petrified earth

We press ourselves into it

We hide in it

Still alive

We hide behind it

Sit silently in it

Like little children behind their mother’s back

We hear its heart beating

Its weary breath

We are warm and comfortable

Still alive

Tomorrow we will die

Maybe some of us

Maybe all of us

Don’t take us from the earth

Don’t tear us away from our mother

Don’t gather our remains from the field

Don’t try to put us back together again

And — we beg you — don’t erect crosses

Monuments or memorial slabs

We don’t need them

Because it isn’t for us —

You erect these monuments for yourselves.

Don’t engrave our names,

Simply remember:

On this field

In this earth

Ukrainian soldiers lie

And — that is all.

We don’t need funerals

We know where our place is

Simply cover us with earth

And move on

It would be nice if there was a field

Where rye is swaying

A lark flies overhead

And — the sky

The endless sky —

Can you imagine the grain a field

Where warriors are lying will yield?

To remember us, eat the grain from the field

Where we laid down our lives

It would be good if there were meadows there

And many flowers

And a bee under each flower

And lovers who come in the evening

To weave wreaths

To make love till dawn

And during the day, let new parents

Bring their young children

Don’t keep children from coming to us

But this will be tomorrow

Today we are still digging the earth

This cherished Ukrainian earth

This sweet, gentle earth

And with a soldier’s spade we write as one

On its body

The last Ukrainian poem of the last poets

Left alive

- Boris Humenyuk, currently MIA

Click to text excerpt below to link to Luke Harding's full Dec 2023 story in The Guardian:

"A year ago, the poet Borys Humenyuk sent a final message. For 24 hours, he and two fellow Ukrainian soldiers had been under relentless Russian fire. Shells rained down on their trench outside the eastern city of Bakhmut. “We’re running out of ammo. Down to the last bullet,” Humenyuk said over a crackling radio. Those were his last words.

Humenyuk had volunteered to relieve a group of exhausted service personnel at “zero”, the hottest part of the frontline. Now, he explained, he was wounded in the shoulder and unable to drag his injured comrade to safety. “We are stuck,” he reported. By the time an evacuation team reached the trench in the village of Klishchiivka, Humenyuk had disappeared ...." 

-Luke Harding, the Gaurdian

Ukraine: How to Improvise a Nasal Atomizer!

 

From Brown Emergency Medicine Blog

Ukraine: Good Documentary on Modern Trench Warfare from the Daily Mail

 

YEMEN: Super-simple drone made of sticks and a motor

 

Shared on Twitter by CNA Analyst Samuel Bendett

Ukraine: "The Russian Military Medicine Experience in Ukraine" from CNA

 

CNA (the Center for Naval Analyses) is an independent, federally-funded think tank based in Arlington, VA. This November 2024 CNA publication details some very basic analysis of the Russian military medical operations in the Ukraine war. 

"We Need a Medic! The Russian Military Medical Experience in Ukraine"

On his podcast, Samuel Bendett interviews one of the paper's authors here.  Bendett is a CNA analyst, and his podcast usually focuses on drones and technological developments. 

Ukraine: Holodomor Remembrance Day: 23 Nov 2024

 

The text at top reads "Hammer and Sickle - Death and Hunger"

Today Ukraine observes Holodomor Remembrance Day. It's traditional to light a candle at 4pm and put in in the window, to remember to Stalin's engineered famine of 1932-33. An estimated 3-5 million Ukrainians died in the Holodomor.

Countries in blue recognize the Holodomor as genocide.

Ukraine: "Hazelnut": the New Russian Missile

 

On 21 November 2024, Russia hit the city of Dnipro, in E Ukraine, with a new type of missile. The missile traversed the distance from its "Cabbage Canyon" Caspian Sea launch site to Dnipro in 15min. Thirty minutes before launch, Russia used to the ICBM launch protocol to notify the US. Initially, based on flight characteristics and damage assessments, it was mis-identified as an RS-26 Rubezh Intercontinental Ballistic Missile.

Further evidence revealed that it was not a Rubezh, but a new type of missile. The "Oreshnik" ("Hazelnut") is a Russian medium-range missile, capable of carrying a nuclear warhead, but apparently not capable of traveling the 5,000km minimum needed to meet ICBM definition. Various military experts are currently estimating a possible range of 2,000-3,000km. Ukrainian intelligence assessed that the missile traveled at Mach 11, and was equipped with 6 individually-guided conventional warheads, each with 6 submunitions. Putin claims that "there are currently no ways of counteracting this weapon" The same claim was made of the Iskander, which has subsequently been shot down mulitple times by Patriots. So far, Ukraine has intercepted in extraordinary 80% of all missiles fired from Russia. Mach 11, if true, would put the Oreshnik on the upper limit of current hypersonic capabilities- very hard to intercept. On-the-ground reports indicate that explosions persisted in Dnipro for 3 hours after impact. 

The Oreshnik constitutes a significant escalation. It has the potential to negate air defenses around key Ukrainian locations. It is impossible to know the target until moments before impact. It is also impossible to know whether the payload is conventional or nuclear, although Russia already routinely uses nuclear-capable missiles, including Iskanders and KH101s. While the Oreshnik may not have the range to reach the US, Western Europe would be well within range, and is not equipped with commensurate land-based medium-range missiles that could hit launch sites within Russia.

Ukraine: US authorizes use of ATACMs and Storm Shadows on interior Russian targets

 This week has seen the first use of US ATACMs missiles, as well as British Storm Shadows, on non-frontline targets within Russia. 

Prelude to Medic Work In Ukraine, part 4

 

Rule #5:  "Do Not Attack Medical Personnel, Facilities, or Equipment"

- From the United States Marine Corps Common Skills Handbook, Core Principles of the Law of War

14 January 2023, Encrypted text chain:

“Hey there, this is Pete, the Ukraine Country Director. I’d love to chat with you in the next few days when we

both have time. Let me know when you’re available. Hope you’re doing well.”

“Hi Pete, thanks for the text! I’m currently working in a remote village in Africa, with minimal service. I’ll try

to find a hill with enough service for a call and text you back about availability. Thanks!”

“Hey there, I’m outside a remote village in Ukraine for now so maybe we’ll stick to messaging for now lol”

24 January 2023, Encrypted text chain:

“Good evening, I’m in town and will have cell service today and tomorrow if you have time to chat”

“Morning. How about a call in 12-13 hours? I’ll be in and out of service.”

“Sounds good”

“In the meantime if you want to send me pictures of green places I wouldn’t be opposed. Ukraine ia a bit

grey and I live in Alaska.”

“Haha well things are pretty green here, underneath the harmattan dust. Here’s the village we work in”

“That looks gorgeous and humid”

“That reminds me of New England in November... Nice! I see you have a ‘rasputitsya paint job’ going on”

4 February 2023, Africa

My patient is a 25 year-old man, with a complaint of intermittent scrotal swelling for the past two years. The swelling is relatively painless, but he’s concerned that it will prevent him and his wife from having children. It is also beginning to interfere with the annual work rhythm of his West African farm: dry-season harvesting of  beans from the grassy hillsides, machete-clearing and burning brush, fishing and hunting, and the wet season activities of planting rice and vegetables. His daily routine begins with a five-mile pre-dawn walk, down from the hilltop village (sited away from mosquito-laden drainages) to the 5-acre patch of valley farmland, granted to his family by the village chief.

At my request, the patient undressed from the waist down and lay supine on the exam bed. Upon inspection, he had a soft, non-inflamed, volleyball-sized scrotal mass, which was mildly tender when palpated. My differential diagnosis included inguinal hernia, trauma, elephantiasis, undifferentiated hydrocele (fluid accumulation due to various possible causes), and orchitis. Lack of significant pain or obvious inflammation tended to rule out infection, history tended to rule out trauma. Come-and-go swelling could be caused by either hernia or elephantiasis. Hernias are extremely common (in Africa as well as the rest of the world), the man did not come from a known elephantiasis-endemic area. and I was pretty sure I could feel loops of bowel in the patient’s scrotum. I listened with a stethoscope and heard distinct bowel sounds. It was reasonably certain that the patient’s intestines had slid down through a tear in his abdominal wall, along his inguinal canal, and into his scrotum; a classic (though unusually large) inguinal hernia. Because it was painless and non-inflamed, medical direction allowed one attempt at manual reduction.

Hernias can be uncomfortable and unnerving, but are rarely dangerous. A hernia is dangerous if it becomes incarcerated (if the bowel cannot be reduced, i.e. returned to the abdominal cavity) or strangulated (if the blood supply of the herniated portion of bowel is cut off and it begins to die- a medical emergency). Most hernias don’t strangulate. However, because West Africa is a medical desert and hernias are common, many people here live and perform hard labor for years with hernias. This increases the likelihood that people here have both seen a family member experience a strangulated hernia, and that that family member died due to lack of available surgical care. This means that the diagnosis of a hernia causes disproportionate dread in our patients.

I’ll have to include some patient education as I explain the diagnosis and get the patient’s permission to attempt a reduction of his hernia. So, I’m glad to look up see one of our best translators, Aiah, walk into the room. Aiah, a local school headmaster, volunteers almost the entirety of his spare time to the clinic. He has just returned from the local tea house, where the village leadership listens to a shortwave radio broadcast of BBC news, every day at lunchtime. 

Patient consent obtained, I begin to gently push the loops of intestine back through the inguinal canal into the patient's abdomen. It's important to go slowly and gently, and not accidentally push a testicle into the wrong place. As I work, Aiah shares the latest news. Over 20 people have been killed by large wildfires in Chile. A train derailment has caused a hazmat fire in Ohio. China has sent a high-altitude balloon over Montana. An American aid worker has been "shot by Russians" and killed in Ukraine.

The reduction is successful; unfortunately the hernia immediately recurs when the patient stands up. We write the patient a referral; we will transport him by motorbike to a surgical hospital, and pay for his hernia surgery. He is quite happy with this news; the life-changing $30 surgery would otherwise be financially out of reach for him.

It's not until days later, when I travel into the city and get cell data coverage, that I learn who the American from Aiah's shortwave news brief was.

Pete Reed, NGO founder, Ukraine Country Director, non-combatant, and my colleague, was killed on Feb 2 2023, when his ambulance was hit by a Kornet anti-tank missile near Bakhmut. Serious injuries were sustained by other medics on scene. All present were non-combatant medical aid workers, who had stopped to help a civilian injured by artillery fire.

It is a violation of the Geneva Convention to attack medical personnel engaged in the care of patients. This protection also extends to ambulances and medical facilities that are used solely for treatment of the injured (i.e. not for offensive purposes). This applies to civilian facilities, vehicles, and personnel, as well as military ones. So, bombing the military medical unit in the fictional Korean War series M.A.S.H., for example, would have been a war crime. The 2015 American airstrikes that destroyed a civilian Medecins Sans Frontieres hospital in Kunduz, Afghanistan- regardless of whether it was treating civilian or military casualties- were a war crime. When an Austrian shell hit Hemingway's Red Cross ambulance in World War I Italy, that was a war crime. The destruction of Pete Reed's civilian, nonprofit ambulance, staffed by civilian volunteers, treating a civilian casualty, by a Russian antitank missile, was a very clear-cut war crime.

The Kornet antitank missile is fired from a tripod, using a laser targeting system. It has a range of approximately 10km and costs about $26,000. Kornets have a High Explosive Anti-Tank (HEAT) charge, which is designed to penetrate armor. When used on an ambulance, it creates a blast wave, along with a large cloud of sharp-edged and molten-metal shrapnel.

Given that Reed and the other aid workers were attacked only a minute after arriving on scene, it seems probable that the missile crew had their sights lined up on the injured civilians, waiting for medics to arrive. Russia frequently uses such "double-tap" tactics, in order to target and kill first responders.

Incredibly, the event occurred in the presence of Wall Street Journal reporters, and was captured on video. The result is frame-by-frame documentation of a modern war crime.

Due to operational security concerns, and out of respect for Pete Reed and his family, I am going to refrain from discussing details of this event, beyond what is already publicly available from open sources. I hope that full justice will eventually be served for this war crime, along with the many others which continue to be perpetrated in the Ukraine war.

Read more here:

https://www.nytimes.com/2023/02/14/world/europe/russian-attack-aid-worker-video.html frame-by-frame video of Kornet hitting Reed's ambulance and exploding

https://www.wsj.com/articles/the-russian-double-strike-that-killed-a-u-s-medic-in-ukraine-they-had-us-in-sight-442cd058 - Wall Street Journal Article