Undisclosed, Ukraine: It looks like an ordinary train waiting to depart an ordinary station, but through its fogged windows, a Ukrainian serviceman with face injuries lies stretched out on a gurney.
All of the other blue-and-yellow carriages of this train operated by the military are carrying wounded soldiers to hospitals away from the precarious front line.
Nearly three years after Russian forces invaded Ukraine, many medical facilities in war-battered eastern Ukraine have been damaged or destroyed, while those left untouched are overcrowded.
For Oleksandr, the army doctor overseeing the evacuation, there are clear benefits to rail: many people can be moved at once and it is safer than transporting wounded soldiers by helicopter, given Russian superiority in Ukraine’s airspace.
But there are risks too.
“Our adversary in the war does not distinguish between what’s medical and military, so we take certain security measures,” the 46-year-old said.
AFP was recently granted rare media access to the train, whose points of departure and arrival are not being disclosed for security reasons.
Inside the secret train
Ambulances arrived at the station carrying dozens of wounded troops who were then hauled onto the train on stretchers and settled on beds with floral-patterned sheets.
Ukrainian flags and hand-drawn pictures by children annotated with patriotic messages lined the walls inside the train.
The carriages resemble a hospital until the train rolls away from the platform and gently rocks patients and staff — and everything else inside — as it crawls farther from the front.
“We do everything on the move, everything. Starting from the usual intravenous injections, ending with incubations,” said Viktorya, a nurse dressed in khaki and wearing blue medical gloves.
“We get dizzy afterwards,” the 25-year-old said, standing in front of a window, the sweeping Ukrainian landscape rolling by.
The journeys to and from the front, where Ukraine is coming under increasing pressure, have given Viktorya a painful insight into the cost of the conflict grinding through its third year.
“I understand the number of wounded now. It’s very hard to see it every day,” she said.
Kyiv — like Moscow — is tight-lipped about its soldier casualty count.
President Volodymyr Zelensky in February said the number of Ukrainian servicemen confirmed killed was around 31,000 — a figure observers say is likely an underestimate — but the number of missing and wounded has never been disclosed.
Severe injuries
Most of those wounded were struck in artillery or drone attacks, staff explained, and many have had arms or legs amputated or were unconscious.
One carriage is designated for patients who have been in intensive care and doctors can even operate on patients in case of “force majeure,” doctor Oleksandr said.
Things can go wrong and mass bleeding — an unpredictable and rapid killer — is a major concern for staff.
“Staff are always near the patient,” Oleksandr explained, adding that they take turns using the toilet or eating.
Despite the logistical issues around caregiving on moving trains, the wounded soldiers’ preoccupations lie elsewhere.
“Their psychological state is not good,” Olena, a medical staff worker, told AFP.
“They’re not worried about losing a limb or whatever else. What depresses them is how their comrades are and how their family is,” Olena added.
Tales of war
One Ukrainian serviceman on the train was being treated for a gunshot wound after being caught in a Russian ambush that also killed one of his fellow soldiers.
“Four of us left but not all of us returned,” the 28-year-old who identified himself as Murchyk said.
But he was already gauging when he might be able to make his way back to the front, where Ukraine’s outnumbered forces have been ceding ground to determined Russian advances.
Whether Murchyk can return to combat will be decided by a medical commission, but he said he was clear-eyed about his wish.
“I’d like to go back,” he told AFP.
The train evacuations in Ukraine began when the war did, in February 2022.
It revives a process used in World War II, with several refitted trains now taking wounded troops from the front.
When Oleksandr’s train arrives at its destination, ambulances are already waiting for the patients to be loaded off and taken onwards to hospital.
“It is of course very stressful and yes, you breathe a sigh of relief when you arrive and unload,” he said, “when you see that all the ambulances have left, when the platform is empty and the train is empty.”

TOKYO: Japan’s Prime Minister Shigeru Ishiba vowed Monday to stay in office despite his gamble of snap elections backfiring, with the ruling party’s worst result in 15 years.
Ishiba, 67, called Sunday’s election days after taking office on October 1, but voters angry at a slush fund scandal punished his Liberal Democratic Party (LDP), which has governed Japan almost non-stop since 1955.
With projections suggesting the LDP-led coalition would lose its ruling majority, Ishiba vowed to stay in office, saying he would not allow a “political vacuum.”
“I want to fulfill my duty by protecting people’s lives, protecting Japan,” Ishiba told reporters.
He said the biggest election factor was “people’s suspicion, mistrust and anger” over a scandal, which saw LDP figures pocket money from fund-raising events and which helped sink his predecessor Fumio Kishida.
“I will enact fundamental reform regarding the issue of money and politics,” Ishiba told reporters, repeating that voters had delivered a “severe judgment” on the party.
The yen hit a three-month low, sliding more than one percent against the dollar, as exit polls and results reported by national broadcaster NHK and other media showed the worst result for the LDP and its junior coalition partner Komeito in 15 years.
They were projected to fall short of Ishiba’s stated goal of winning at least 233 seats — a majority in the 456-member lower house.
The LDP won 191 seats, down from 259 at the last election in 2021, and Komeito 24, according to NHK tallies. Official results were expected later Monday.
Ahead of the election, Japanese media had speculated that if this happened, Ishiba could potentially quit, becoming the nation’s shortest-serving prime minister in the post-war period.
On Monday the LDP’s election committee chief, former premier Junichiro Koizumi’s son Shinjiro Koizumi, resigned.
The most likely next step is that Ishiba will now seek to head a minority government, with the divided opposition seen as probably incapable of forming a coalition of their own, analysts said.
Ishiba said Monday he was not considering a broader coalition “at this point.”
“Lawmakers aligned with (former prime minister Shinzo) Abe were cold-shouldered under Ishiba, so they could potentially pounce on the opportunity to take their revenge,” Yu Uchiyama, political science professor at the University of Tokyo, told AFP.
“But at the same time, with the number of LDP seats reduced so much, they might take the high road and support Ishiba for now, thinking it’s not the time for infighting,” he said.
A big winner was former premier Yoshihiko Noda’s opposition Constitutional Democratic Party (CDP) which increased its projected seat tally to 148 from 96 at the last election.
Ishiba had promised to not actively support LDP politicians caught up in the funding scandal.
But the opposition jumped on media reports that the party has provided 20 million yen ($132,000) each to district offices headed by these figures, who were still standing in the election.
“Voters chose which party would be the best fit to push for political reforms,” Noda said late Sunday, adding that the “LDP-Komeito administration cannot continue.”
Mirroring elections elsewhere, fringe parties did well, with Reiwa Shinsengumi, founded by a former actor, tripling its seats to nine after promising to abolish sales tax and boost pensions.
The anti-immigration and traditionalist Conservative Party of Japan, established in 2023 by nationalist writer Naoki Hyakuta, won its first three seats.
The number of women lawmakers meanwhile reached a record high at 73, according to NHK, but still representing less than 16 percent of the legislature.
“As long as our own lives don’t improve, I think everyone has given up on the idea that we can expect anything from politicians,” restaurant worker Masakazu Ikeuchi, 44, told AFP on Monday in rainy Tokyo.
“I think the outcome was a result of people across Japan wanting to change the current situation,” said fellow voter Takako Sasaki, 44.