Can medical research happen in a war zone? It can, according to a leading Ukrainian clinician and investigator, but it means working under the constant threat of missile attacks on hospitals and coping with the psychological toll of living with continuous danger.
And the research happens alongside the mission of caring for a surge of patients, many of whom have horrendous wounds, said Roman Fishchuk, MD, MSc, during a recent visit to the University of Colorado Anschutz. An otolaryngologist, Fishchuk is head of the Clinical Trials Department at Central City Clinical Hospital in Ivano-Frankivsk, Ukraine.
“War is happening in Ukraine every day,” Fishchuk said at a Distinguished Leader Seminar organized by CU Anschutz’s Center for Combat Medicine and Battlefield (COMBAT) Research. “People, especially civilians, are dying every day, including children and elderly women. Hospitals are attacked every day.”
To continue research under such conditions, he said, “we try to always focus on being flexible in our approach. The pandemic made us flexible. The war makes us flexible as well, because we have to adjust to many new conditions. We have to be open-minded, because you cannot do things the same way you’re used to. It’s not going to work if you want to survive.”
War has raged in Ukraine since Russia’s full-scale attack in 2022, following its 2014 invasion of Ukraine’s Crimean Peninsula. Since 2022 there have been 53,006 civilian casualties, including 14,534 deaths, according to a November 12, 2025, United Nations report. Civilian casualties through the first 10 months of 2025 were up 27% from the same period a year earlier, the report said.
Ukrainian military casualty numbers are a state secret, but in June the U.S.-based Center for Strategic and International Studies estimated 400,000 Ukrainian soldier casualties, including 60,000 to 100,000 deaths.
At Central City Clinical Hospital, Fishchuk leads a large clinical trial unit established in 2017. Before Russia’s 2022 attack, his hospital in western Ukraine had about 200 patients enrolled in more than 20 trials in areas including COVID-19, asthma, chronic obstructive pulmonary disease, chronic rhinosinusitis, and other clinical indications, many of them backed by international pharmaceutical companies. Dozens of other trials had approval to begin, he said.
But the onset of war caused most international companies to abandon their trials in Ukraine, Fishchuk said, leaving patients without access to innovative medications and creating what he described as a sense of abandonment within the medical community.
“When the full-scale invasion started, pretty much all of these [business-backed] studies just stopped, and companies stopped working in Ukraine,” he said. “And that pretty much continues through this day, unfortunately for us. For international companies, it’s easier to find another country nearby.”
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Photo at top: Ukrainian medical researcher Roman Fishchuk, MD, MSc (second from right) during a visit to the CU Center for Combat Medicine and Battlefield Research in November 2025. With Fishchuk are (from left) Corey Bills, MD; Vik Bebarta, MD; and Adit Ginde, MD, MPH of the CU Anschutz Department of Emergency Medicine.
Central City Clinical Hospital in Ivano-Frankivsk, Ukraine, where Fishchuk leads the Clinical Trials Department. Photo provided by Roman Fishchuk.
But research goes on despite the exit of many international companies, largely through collaboration with universities and agencies outside Ukraine, including in the United States. Fishchuk said he was grateful for continued research partnerships with CU Anschutz.
For example, Fishchuk and his colleagues are collaborating with the COMBAT center and the CU Anschutz Department of Emergency Medicine on an observational study called Antimicrobial Resistance Research to Improve Outcomes of Traumatic Wounds (ARROW), collecting data related to antibiotic-resistant wound infections. Adit Ginde, MD, MPH, and Corey Bills, MD, of the Department of Emergency Medicine, are leaders of the project.
Fishchuk is also collaborating with Ginde on a COVID-19 study funded by the U.S. National Institutes of Health (NIH). Through various collaborations with CU, Fishchuk said, “We’ve developed not only working relationships, but also friendships, and we trust you. We value these relationships a lot.”
Vik Bebarta, MD, founding director of the COMBAT center and chair of emergency medicine, said that federal officials have cited CU’s collaboration with Fishchuk’s team “as one of the best examples globally of how to do clinical trials for the government – and, in this case, under the duress of war.”
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With the war underway, Fishchuk’s hospital has been divided into civilian and military care units.
The nature of injuries has evolved during the conflict from traditional combat bullet wounds to civilian casualties caused by drones and long-range missiles, Fishchuk said, displaying graphic images of civilian injuries for his CU Anschutz audience.
The United Nations estimates that Ukrainian civilian injuries specifically from long-range weapons increased by 75%, to 3,592, in the first 10 months of 2025 from the same period of 2024.
“When you see regular civilians being killed, and children being killed, and you see this on a daily basis, you always have this in the back of your head,” Fishchuk said. “Always, there are air raid sirens. It’s difficult to work under these conditions mentally.”
Medical evacuation from battle areas has become increasingly difficult, he added, with some wounded soldiers unable to be retrieved for days or weeks due to drone surveillance and the threat of attacks.
Ukraine continues to present unique opportunities for medical research, Fishchuk said. Doctors there have accumulated vast experience in modern combat trauma, blast injuries, and mass casualty care.
Fishchuk advocated for more internationally-backed clinical trials in Ukraine in trauma care, prosthetics, traumatic brain injury, hearing loss from blast trauma, mental health interventions, hearing problems and more. Ukraine, he said, has proven its ability to deliver high-quality research data on time, even under the extreme circumstances it faces. “We need more projects in our country,” he said.
Fishchuk noted that clinical trials in Ukraine provide not only research data but also employment, access to innovative treatments, and hope for Ukrainian patients and medical professionals during an extraordinarily difficult time.
He also said that while the skills of Ukraine’s surgeons in dealing with combat trauma have advanced during the war, “we don’t have the capacity to help everyone. That’s why we need humanitarian missions by international surgeons who have the expertise and skills to help these patients.”
In thanking Fishchuk for his visit, Bebarta noted the enormous challenges facing him and his Ukrainian colleagues, several of whom accompanied Fishchuk on his CU Anschutz visit.
“They don’t talk a lot about what goes on every single day,” Bebarta said. “They focus on the work.”
This effort was funded under MTEC solicitation MTEC-24-01-MPAI and is funded by the Combat Casualty Research Program (CCCRP) under the Department of Defense. The views and conclusions contained herein are those of the authors and should not be interpreted as necessarily representing the official policies or endorsements, either expressed or implied, of the U.S. Government.