Though Russian state media outlets have only just begun speaking openly of a “looming epidemic” of disease on the frontlines, chronic illnesses have long been a part of everyday life in the Russian military. In order not to miss out on the lucrative enlistment bonuses they are owed by the state, soldiers often conceal their diagnoses, while infection rates in the trenches continue to rise and military hospitals lack basic medications and even sterile syringes.

How did Russia’s war in Ukraine become a breeding ground for epidemics, the consequences of which will be felt far beyond the battlefield?

An epidemic in the making

The tactics being adopted by the Russian military appear to have been borrowed from the notorious Wagner mercenary organisation, which would group soldiers with serious health conditions together into separate units, according to Russian journalist and political commentator Anastasia Kashevarova.

Kashevarova, who is known for her controversial and unapologetically pro-Putin posts on Telegram, said that soldiers with serious medical conditions including HIV, cancer, hepatitis, and tuberculosis will be assigned to separate units in the Russian military, and claimed that many soldiers suffering from such conditions had enlisted in the army using falsified medical documents in order to qualify from the financial benefits on offer, while others were diagnosed after deployment.

At least one military district has already issued an order for the formation of a unit composed of troops who have been deemed fit only for “limited duty”, according to Kashevarova, who added that as well as being made to wear armbands denoting their health status, they would only be tasked with holding defensive positions.

Warning civilians to be concerned about this development, Kashevarova said that there was a growing risk of an epidemic involving “socially dangerous” diseases, and claimed that hepatitis, HIV, and tuberculosis were already widespread in the ranks, were spreading through frontline regions and could potentially spread far deeper into Russia.

Drafted by desperation

Professional soldiers or reservists who have been formally mobilised are now a minority in the Russian military, according to Yevgeny Rybakov*, a Russian army doctor who works with wounded soldiers. Rybakov told Novaya Europe that a significant portion of the Russian army’s ranks is now made up of former convicts, drug addicts, and individuals from other socially marginalised groups, few of whom enlisted out of patriotism, but rather to escape debt, prosecution or prison.

According to Rybakov, some units are composed entirely of men from the so-called Donetsk and Luhansk People's Republics, Russian-occupied regions of Ukraine where public health infrastructure has been virtually non-existent since the war in Donbas began in 2014. Many of these recruits are living with HIV, hepatitis, or other chronic diseases, Rybakov said, adding that many of them have been deployed despite the risk they pose to their fellow soldiers.

Rybakov also said that these so-called “trench diseases” (particularly tuberculosis) are now rampant on the frontline, spreading fast due to overcrowding in bunkers, lack of hygiene, limited access to clean water, and the consequent struggle to wash or clean utensils during winter. In addition, poor nutrition and extreme stress both serve to weaken soldiers’ immune systems, leaving them highly susceptible to infection.

Many former drug users relapse into addiction during deployment, Rybakov said, adding that drug trafficking networks are now believed to operate actively within frontline units, involving not only military personnel but also locals. What’s more, many soldiers have turned to excessive alcohol consumption as a way of coping with ongoing trauma and of suppressing symptoms of PTSD.

After being diagnosed with chronic hepatitis C while in hospital for a shoulder injury sustained in combat, platoon commander Alexander Kuznetsov* was deemed fully fit for service by a military medical commission and was sent back to his unit in Luhansk. Kuznetsov had informed his examiners about his illness, and despite challenging their findings in court, submitting evidence of both his hepatitis diagnosis and an untreated orbital fracture he was suffering from, the military authorities still refused to grant him protective measures or demobilisation.

In theory, soldiers diagnosed with chronic hepatitis C can be discharged, but in practice, only those suffering from end-stage liver disease or who have been deemed severely disabled are ever freed from military service. For many, this means becoming critically ill before being demobilised. Even in cases of HIV, where discharge is legally possible, many troops reportedly choose to conceal their condition when signing contracts in order to avoid losing their benefits.

The growing HIV crisis

According to a report by Russian investigative outlet Verstka that used the Defence Ministry’s own data, by the end of 2023, the number of registered HIV cases among Russian military personnel had risen twentyfold from its pre-war figure. The Verstka investigation found that nearly all HIV-positive soldiers were serving under contract, and many had knowingly submitted falsified medical documents certifying them free of infection in order to enlist.

However, the authors of the Verstka investigation warned that real infection rates could be significantly higher than the official figures, noting that laboratory-confirmed cases likely underrepresent the true scope of the problem. The number of unconfirmed or unregistered cases, they estimated, exceeds official figures by as much as 45%, a discrepancy they attributed to serious failings in diagnostic and reporting systems during wartime.

The study also highlighted a lack of coordination between Russia’s Defence and Health Ministries, particularly in the wake of the partial mobilisation declared by Putin in September 2022. According to survey data cited in the article, over 60% of newly contracted HIV+ soldiers had previously been registered at AIDS clinics, suggesting that most had been infected prior to joining the military. The breakdown in information sharing between agencies became especially acute during mass conscription, the investigation found.

Hundreds of Russian soldiers with HIV are currently being treated in military hospitals and in specialist wards for those who are also infected with active tuberculosis. In addition, an epidemiologist who spoke to Verstka suggested that many Russian servicemen may have contracted HIV on the frontline due to the consistent disregard for medical hygiene, most notably the reuse of syringes for medical procedures.

Rybakov stressed that this was not as far-fetched as it sounds, explaining that the rapid depletion of syringe supplies is common in wartime, something that was corroborated by another Russian military medic who, speaking to Novaya Europe on condition of anonymity, described the extremely challenging conditions in frontline hospitals, where blood gets everywhere and cleaning is only possible during rare lulls in fighting, which are nevertheless frequently interrupted by drone strikes.

Wounded soldiers are initially brought in on soiled stretchers, and shortages of basic supplies such as bandages force staff to sterilise and reuse old materials. Blood transfusions are frequently required, but many donors are unaware of their HIV or hepatitis status, thus risking further transmission.

Plague barracks

The Russian military’s reported plan to create separate military units for servicemen suffering from chronic conditions was described by everybody we spoke to for this article as being extremely difficult to carry out.

“Military personnel do not undergo medical examinations in combat zones. The only way to determine who is sick and with what is during a rotation to the rear. And even then, once on leave, most soldiers either immediately go on a drinking binge or return home to their families and drink there,” Rybakov says. “Either way, they spread hepatitis. They rarely go to the doctors. They should be treated in army hospitals. But those are already packed with wounded and shell-shocked soldiers.”

“Mortality rates in such units would likely be high even if they weren’t at war, as the close quarters would facilitate rapid cross-infection,” Rybakov continued, adding that “within a week, all members might contract tuberculosis, and within a month, hepatitis, effectively turning these formations into plague barracks.”

Soldiers suffering from chronic disease should be demobilised and placed into civilian medical care, Rybakov said, while noting that many had already received their enlistment bonuses, making their discharge from the military highly unlikely.

The doctor’s final warning is perhaps his starkest, however. “A severe epidemic of serious diseases is already raging within the Russian military, and when peace eventually returns, a wave of demobilised soldiers could bring a surge of infections to Russian cities, something the country’s weakened healthcare system may be not prepared to handle.”

*Names have been changed for safety reasons.