Medics aren't seeing many gunshot wounds in Ukraine. It's blast and shrapnel injuries in a 'war of remote destruction.'

• In Ukraine, the most common injuries are blast and fragmentation, often caused by drones.
• US veterans in Ukraine and a local medic said their gear is mostly for those injuries, not gunshot wounds.
• This is a "war of remote destruction," the medic said.

The war in Ukraine is one of blast and shrapnel injuries, not gunshot wounds, a local medic and US veterans providing medical care in front-line areastold Business Insider.

Russia's invasion of Ukraine is characterized by fighting in extensive trench networks, where grenades continue to prove their worth, intense artillery fire, missile barrages, and drone attacks. Land mines also continue to be a problem.

Gunfights, however, are becoming less common.

US veterans and a Ukrainian medic told Business Insider that most combat injuries are caused by fragmentation and burns and that amputations are often necessary.

These injuries are not unusual for industrial, artillery-heavy conflicts, or more modern kinds of warfare, for that matter, but they are being exacerbated by new technology, such as exploding one-way attack drones and others that drop grenades and other deadly explosives.

"This is not a war of direct small-arms contact," the medic shared, "but a war of remote destruction."

Explosions, shrapnel, and amputations

Katerina Zirka, the Ukrainian combat medic, said that she increasingly sees injuries that affect multiple parts of the body at once, often without a single identifiable "entry wound," but instead dozens of micro-injuries from blasts and shrapnel. The medical equipment she carries has changed as a result.

Medics are also seeing internal blast injuries that don't come with external wounds, such as concussions, ruptured eardrums, and lung injuries from rapid changes in pressure, she said.

Soldiers fighting in Ukraine have told Business Insider about being injured by exploding drones, mines, and falling debris when buildings are hit. Mortars, artillery, and rockets have also done their fair share of damage.

A US veteran who fought in Ukraine and served as a combat medic for his unit previously told Business Insider that he saw a significant number of injuries from explosions, like burns, concussions, traumatic brain injuries, and wounds from shrapnel that resulted in amputations.

"Artillery is fucking everywhere out there. You go anywhere near the front, it's just artillery shell, artillery shell, artillery artillery," he said, speaking to BI on the condition of anonymity for operational security reasons.

The threats, however, are far more than artillery.

Jeffrey Wells, a US Navy veteran with experience in Afghanistan and Iraq, is involved in medical training for front-line Ukrainian civilians through a nonprofit organization, Task Force Antal, that also provides supplies and evacuation assistance. He shared details about the kinds of injuries he's seen in this role.

"Mostly people aren't being shot, even on the front lines," he explained. "It's injuries that come from a missile, a drone, or a glide bomb."

Mark Antal, the co-founder of Task Force Antal and a veteran of the elite US special operations unit Delta Force, told Business Insider that he had to tell some of his group's medics that "the soldiers on the front line, less than 2% of them are being shot. All of the wounds are from drones, from shrapnel."

And with civilians, "it's crush injuries, it's blast injuries."

Christine Quinn Antal, a US Army veteran and former national security advisor who co-founded the nonprofit, said that with other injuries being significantly more prevalent, members have taken "things like chest seals," tools used for gunshot wounds, out of their medical kits. "We've moved away from that," she said.

A war of remote explosions

Away from the cities, out on the front lines, drones dominate warfare, but even in the close-quarters fighting, explosives, not necessarily guns, are key. There is still a role for guns in this war, but drones and other new tech are taking over classic combat roles, even the precision strike role of snipers.

Drones are used in this war more than in any other conflict in history, and have fundamentally changed the shape of the war. Their ubiquity is shown by Ukraine's own stats. Its commander in chief said in November that drones were responsible for around 60% of all Russian targets hit.

Drones direct traditional weapons but also engage targets as well. They are deadly tools readily available in large quantities at low costs, making them increasingly desirable tools as the war drags on.

Zirka said that injuries have changed because now, "most engagements actually take place in the air through the use of drones. As a result, gunshot wounds are encountered much less frequently." Soldiers have told BI that drones have created a roughly 10-kilometer kill zone at the front.

Guns are not gone from Ukraine, far from it, but it is a different kind of fighting. Soldiers carry and are trained on various guns for different missions, some of which sometimes actually lead to injuries that aren't gunshots.

Soldiers often arm themselves against the ever-present threat of drones with electronic warfare tools and shotguns, among other systems. Shooting down drones, like the fiber-optic drones resistant to jamming, can generate dangerous shrapnel that can pierce or shred the skin.

Troops also carry guns into trench warfare, which has been a prominent part of this fight.

But much of that fight also relies on other weapons, such as explosives like grenades and mines. These weapons are used to booby trap trenches and to try to clear them. The trenches can be so tight that it can make using firearms like assault rifles difficult.

Drones are also used in trench battles, including by dropping grenades into enemy trenches or diving down on soldiers and exploding.

Likewise, explosives are often used to clear bunkers as well. Charging into one for an extremely close-quarters firefight is exceptionally dangerous. A grenade, on the other hand, lowers the risk.

Ukraine has mounted machine guns and other weapons on its uncrewed ground robots, creating new ways to fire on the Russians using guns without putting its troops at risk, but these weapons are still quite limited for the time being. The same is true for the automated gun turrets.

As Zirka indicated, this war is more of a remote-explosive fight than a gunfight.

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