A group of Ukrainian Army soldiers pierced by Russian grenades and mortar shells arrived at a hospital recently in need of surgery. It would have been a familiar scene from the bloody war grinding on in Ukraine, except for two crucial differences: Most of the wounded soldiers were American, and so was the hospital — the U.S. Army’s flagship medical center in Germany.
The Army has quietly started to treat wounded Americans and other fighters evacuated from Ukraine at its Landstuhl Regional Medical Center. Though the number so far is small — currently 14 — it marks a notable new step in the United States’ deepening involvement in the conflict.
When the war erupted in 2022, hundreds of Americans — many of them military veterans — rushed to help defend Ukraine. Nineteen months later, perhaps a few hundred are still there, volunteering for local militias or serving under contract with the Ukrainian national army.
An unknown number of them have been shot, hit by artillery, blown up by mines or otherwise injured in combat. About 20 have been killed. Most of the wounded have had to rely on a patchwork of Ukrainian hospitals and Western charities for help. Now, though, the Pentagon has stepped in to offer some of them the same care it gives to American active-duty troops.
The hospital at Landstuhl is authorized to do so under a Defense Department policy, which began last summer, that allows the hospital to treat up to 18 wounded members of the Ukrainian forces at a time, the Pentagon confirmed in a statement. The fact that most of the Ukrainian troops at Landstuhl are Americans illustrates how the war has progressed in unexpected ways.
The Biden administration vowed at the start of the war that it would not put American troops on the ground in Ukraine, and it warned Americans not to get involved. Now it finds itself treating those it told to stay away.
Marcy Sanchez, a spokesman for the hospital, said that all the wounded fighters there were currently in good condition, but he declined to offer any specific details about the patients.
Asked about the development by The New York Times, a Defense Department official who is regularly briefed on Ukraine-Russia matters expressed surprise, and said that leaders at the Pentagon were unaware that Landstuhl was regularly treating wounded American volunteers, but added that the leaders were not concerned about it.
The official, who spoke on condition of anonymity to discuss internal deliberations, noted that while the administration strongly discourages American citizens from going to Ukraine to fight, it is obvious that some go anyway, and if they become wounded and end up at Landstuhl, the military is not going to turn them away.
The 65-bed facility, a Level II trauma center, is the largest American military hospital outside the United States, and served for years as a way station for thousands of wounded American troops evacuated from conflicts in Iraq or Afghanistan. After those wars wound down, Landstuhl’s beds and expertise often went unused.
Several members of Congress, including Representative Jason Crow, Democrat of Colorado, have been pushing the military to open the hospital to wounded Ukrainians.
“It’s an obvious way to help,” Mr. Crow, a former Army Ranger, said in an interview. “Landstuhl is one of the pre-eminent medical facilities in the military. The doctors and nurses there have unique capabilities to treat battlefield wounds.”
He said treating only 18 casualties at a time was too limited, and that the U.S. military should do more.
The patients now at Landstuhl are mostly from the United States, but also from Canada, Britain, New Zealand and Ukraine. Several of them said in phone interviews from their beds that they were receiving excellent care.
“We’re blessed to be here,” said an American veteran who underwent surgery this month to remove shrapnel from an arm and both legs. The veteran, who previously served in the U.S. Air Force, asked not to be identified because he feared reprisal by Russia.
He and others from a company of English-speaking fighters were hit during an assault on a village near the Russian-held city of Donetsk. More than two dozen soldiers were wounded, and two were killed. Over the next few days, the wounded were moved among Ukrainian evacuation points and hospitals, first near the front lines and then in Kyiv, the capital.
The fighters who were interviewed said Ukraine’s hospitals were under tremendous strain, and medical care in their Soviet-era wards could be spotty. Wound care was spartan, and sanitation and antibiotics were below U.S. standards, they said; surgery was at times reserved for only the most serious cases.
“I was evacuated in a wheelbarrow,” the Air Force veteran recalled. “I woke up during surgery because I didn’t get enough anesthesia.” He sighed, then added, “The Ukrainians, they do the best they can, but there are so many wounded.”
Some of his wounds had been open for two weeks when he arrived at Landstuhl, he said. Surgeons quickly operated to remove rusty metal fragments left by a grenade. While he was being interviewed, a member of the Landstuhl staff stopped in to ask how his pain was, and offered him graham crackers.
“Man, we are so thankful” to be at the hospital, said another American veteran, who was hit by shrapnel in his legs, arm and neck. He, too, asked not to be named. “I was wounded in Ukraine three weeks before they told me it would be a month before I got surgery. In Germany, they did it in two days.”
Marcy Sanchez, a spokesman for the hospital, declined to offer specific details about the patients from Ukraine, but said that all were currently in good condition.
Although Landstuhl has been authorized to treat combat casualties from Ukraine for more than a year, it saw almost none until August, when a former Green Beret medic named David Bramlette began bringing patients to the hospital.
Mr. Bramlette, who had deployed to Iraq and Afghanistan, went to Ukraine to fight shortly after Russia invaded. For several months, he led a small assault team on the front lines near Kharkiv and Izium. When shrapnel pierced the eyes and brain of a comrade, Mr. Bramlette said, he became painfully aware that as volunteers in Ukraine, American veterans had little of the support they relied on when they were in the U.S. military.
“The helicopter isn’t coming for evac,” he said in an interview from Kyiv. “If you are wounded, it might be days before you get to a hospital in Kyiv. We were scrounging to find care.”
Mr. Bramlette left the fighting in December and began working for the R.T. Weatherman Foundation, which provides humanitarian aid and works to bring home wounded Americans and the remains of those killed in combat.
For months, he said, he struggled to find civilian hospitals in Europe that would take the wounded. In August, after more than two dozen foreign volunteer fighters were injured, he contacted a European government agency called the Multinational Medical Coordination Center, hoping it might help find civilian hospital beds for them. Instead, it told him to send patients to Landstuhl.
“It was one of the best days I’ve ever had in Ukraine,” he said.
Patients were soon in ambulances, paid for by the foundation, for a 30-hour drive through Poland and across Germany to the hospital, which is near the French border. Since then, three more groups of wounded have joined them.
Mr. Sanchez, the spokesman for Landstuhl, said the hospital was prepared to treat more wounded, and “remains postured and ready to support U.S. Armed Forces, NATO member countries and other allies and partners as directed.”
Mr. Bramlette says there are benefits all around: The wounded get top-level care, while American military doctors get experience treating complex wounds that the U.S. military might encounter in a future conflict.
But the arrangement is not without risks. Russia has repeatedly warned that any increase in U.S. involvement could spark a broader war. It would not take a particularly creative Russian propagandist to portray the American volunteers, wielding American weapons and being treated at an American Army hospital, as de facto U.S. troops on the ground.
But worries about an angry Russian response may be overblown, according to William B. Taylor, the U.S. ambassador to Ukraine during the Bush and Obama administrations and chargé d’affaires during the Trump administration.
“For years, there was fear that providing certain types of aid would provoke Russia,” said Mr. Taylor, who now oversees Europe for the United States Institute of Peace in Washington. “It turns out, they didn’t need to be provoked.”
The United States has crossed numerous so-called red lines in the last year, by providing Ukraine with rocket artillery, tanks and pilot training, Mr. Taylor said, and Russia has not responded by escalating the conflict. President Vladimir V. Putin already blames Russia’s setbacks on the battlefield on United States involvement, he added, and caring for few wounded American foot soldiers was unlikely to be a tipping point.
“Big picture, it’s in our interest for Ukraine to win,” he said. “To achieve that, we should be doing whatever we can. Part of that is weapons. Part of that is financial support. And part of that is taking care of wounded.”