Russia Is Medically, Economically Unable To Care For Wounded, Families of Dead Soldiers

Even if its healthcare system were not already moribund, Russia has neither the financial resources nor the culture to care for wounded and/or mentally unstable veterans, as well as the families of those killed in Ukraine. 

In addition, the loss of manpower to its economy is likely to be a financial drag for decades. And based on its experience with the veterans of Afghanistan and the Chechen wars, Russian society can expect to be plagued with suboptimally performing veterans for years to come, worsening its already bleak prospects. JL

Thomas Lattanzio and Harry Stevens report in War On the Rocks:

After two and half years of war, Russia is logistically, fiscally, and culturally unprepared for the burden of supporting veterans and their families, presenting serious questions about state capacity going forward. The entitlement to the family of a Russian soldier killed in Ukraine would come to 14 million rubles. The Russians have taken  400,000 casualties, with over 100,000 of those dead. Simple math shows one-time payments would equate to 900 billion rubles for wounded personnel and at1.4 trillion for families of the dead, 2.3 trillion rubles total. This equates to 6% of the 2024 budget. Traumatized veterans who do not receive care will have vastly lower employment rates and lean much more heavily on government benefits, further weakening the Russian economy

Throughout its history, Russia has rarely cared for its soldiers, on or off the battlefield. The Kremlin’s current attempt to do right by its veterans looks to be simultaneously insufficient and unaffordable, destined to leave behind armies of broken men while draining state coffers. After nearly two and a half years of grinding warfare, both Ukraine and Russia have taken horrendous casualties and spent hundreds of billions of dollars. Despite such a price, the conflict is unlikely to end soon, with both sides believing they have more to gain. This price is not just paid on the battlefield. Even if the fighting were to end today, the economic and demographic impact felt by the Russians would be generation-shaping.

Through open source information on the costs of health care and the state of the Russian medical system, alongside historical scholarship and medical publications, we examine the crushing economic damage of the war on Russia from the lens of military personnel. We conclude that the state is logistically, fiscally, and culturally unprepared for the tremendous burden of supporting veterans and their families, presenting serious questions about state capacity going forward.

Above all else, the Russian state has to financially support the families of fallen soldiers in perpetuity. Many of the wounded (to say nothing of the dead) will permanently be out of the workforce, and even those who return to it will require lifelong mental and physical health care. And the numbers of dead or wounded servicemembers will only worsen the negative demographic trends in Russia. These challenges will grow larger as the war continues and the bodies pile up.

 

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Holding aside the long-term implications of the personnel costs of the conflict, one has to appreciate how much the Russian state is currently spending to care for casualties. The one-time costs of compensating wounded and dead soldiers plus their families are very high, in no small part due to recent decrees that promise major payouts to incentivize volunteers. A law passed before the war entitles the family of a soldier who has been killed to 3.3 million rubles as an insurance payment from private insurers, and an additional 5 million rubles from the state. Wounded soldiers are entitled to 3 million rubles, as per a decree from the early days of the invasion of Ukraine. President Vladimir Putin has announced a separate 5 million ruble payment to families (this combines the previously mentioned 3 million ruble payout for injury with an additional 2 million in case of death). Every Russian oblast or province provides a separate payment of at least 1 million rubles, with some paying up to 3 million. Combining all of the above, the cost of payouts to the family of a soldier killed in Ukraine would come to at least 14 million rubles at the time of writing, excluding several smaller, long-term payments.

Based on open source estimates from the governments of France and the United Kingdom as of May 2024, the Russians have likely taken around 400,000 casualties, with over 100,000 of those dead. Simple math shows that one-time payments would equate to 900 billion rubles for wounded personnel and at least 1.4 trillion for families of the dead, 2.3 trillion rubles total. This equates to 6 percent of the 2024 budget, a truly staggering amount that will continue to climb.

Unfortunately for the Kremlin, it will not get off the hook with one-time expenses, at least if it wants to provide an adequate level of medical care for veterans. If anything, caring for wounded troops will be more difficult now than in the past; after Afghanistan and Chechnya, care was cheaper than today as the scope of treatment was narrower and the cost of medical equipment, drugs, and labor was lower. Physically, Russia’s wounded are returning with complex, long-term injuries. Russia’s deputy minister of labor himself reported that the majority of disabled veterans have at least one amputation.

Mental wounds may be even more daunting to treat. A 2022 study carried out by researchers from the U.S. Department of Veterans Affairs estimated that the total economic cost of post-traumatic stress disorder, society-wide, in the United States was $232 billion in 2018. Approximately 80 percent of those with post-traumatic stress were civilians, while 20 percent were servicemembers. The annual, per-person cost of post-traumatic stress disorder in military personnel and veterans was $25,700 per year, and the same figure was $18,640 per year for civilians. Adjusted for inflation, those same figures would be approximately $32,000 and $23,000 a year.

Applying this research to the Russian case, if we divide these costs by purchasing power parity, which compares different countries’ cost of living, we get an approximate estimate of the cost of post-traumatic stress disorder. The purchasing power parity modifier for Russia is roughly 2.2, meaning that goods and services worth $100 in the United States would cost roughly $45 in Russia. Using this, we estimate the yearly cost of treating a soldier with post-traumatic stress disorder in Russia to be approximately $15,000. Assuming the dollar-to-ruble exchange rate remains constant at 90 rubles to the dollar, this would be 1.35 million rubles per year, per individual. If one million soldiers end up serving in the invasion of Ukraine, 500,000 of them could reasonably be expected to acquire some sort of post-traumatic stress disorder based on historical estimates. If so, the estimated yearly cost to the Russian economy of post-traumatic stress disorder among Ukraine veterans would be over 660 billion rubles a year, roughly 2 percent of the 2024 budget.

Holding aside the staggering costs of treating veterans in Russia, there are also significant capacity issues that the Russians are woefully ill equipped to deal with. The number of hospitals in Russia has declined roughly 20 percent since 2012, and there are only 10 veterans’ hospitals in the country. The only one that focuses on psychological rehabilitation has just 32 beds. There will need to be a massive expansion of the Russian military hospital system, or the state risks the collapse of the medical system, particularly in poorer and more sparsely populated areas. It’s unclear where the money and personnel for such an expansion would come from. Yet, if the state does not disburse the required resources, then either Russian veterans or the citizenry will not get adequate medical care. There is no middle ground. Further, Russian policymakers seem unwilling to assess if post-traumatic stress disorder is even an issue, since, according to grassroots veteran organizations and veterans themselves, “no one tests veterans for psychological trauma” and “there are no rehabilitation programs.” Instead of funding central treatment centers, the Russian government is supposed to provide grants to support groups or various programs set up by former soldiers, yet funding is sparse.

 

The Kremlin ordered the creation of the “Defenders of the Fatherland Foundation” in June 2023, and the organization has reportedly opened branches in several regions, including St. Petersburg. Government claims that the foundation has helped thousands of people seem dubious, as only 3 percent of its budget is dedicated to actually treating psychological ailments. The total first quarterly budget for the foundation was a mere 1.3 billion rubles ($15–$20 million under current exchange rates), for what is supposedly a national organization.

Even when volunteers overcome funding challenges to care for veterans, additional roadblocks have been encountered. For example, there are cases where volunteer medical staff are not allowed into St. Petersburg hospitals, and volunteers must fight the government tooth and nail to distribute aid. This may be part of an attempt to limit the exposure of civilians to the real effects of Putin’s war. Even with government-run organizations, access to aid is held up by rampant incompetence and bureaucracy. The wife of a veteran, seeking help from the Defenders of the Fatherland Foundation, was told that her amputee husband had to personally appear to file a claim to initiate the process of receiving treatment.

Whether due to a lack of resources or to a view of post-traumatic stress disorder as a personal weakness, it appears highly likely that huge numbers of traumatized veterans will not receive adequate mental health treatment upon their return. This will only be compounded by aspects of Russian society, such as the interrogation of veteran organization medical volunteers, who were summoned by security forces to an investigative committee for “undermining” the Russian Ministry of Defense.

A 2009 study examined those who had endured traumatic experiences during the Yugoslav wars and who had never accessed psychological treatment. The results reveal the drastic impact of untreated trauma on productivity. At the time of the study, respondents universally reported extremely high unemployment. Of the participants who lived in Croatia, 43 percent were unemployed, at a time when the Croatian unemployment rate was under 10 percent. Participants in Serbia reported a 55 percent unemployment rate, those living in the United Kingdom a 50 percent rate, and those in Germany, 85 percent. While it would not be appropriate to say this relationship will be exactly reproduced in Russia, it clearly demonstrates the disastrous impacts untreated post-traumatic stress disorder can have on an individual’s ability to function in society. Traumatized veterans who do not receive care can be expected to have vastly lower employment rates and lean much more heavily on government benefits, further weakening the Russian economy in the decades to come.

While we focused our discussion on the costs of post-traumatic stress disorder in terms of cost of care and lower productivity, there are plentiful cases of other negative effects. For example, up to 60 percent of Soviet veterans of the Afghan war suffered from alcoholism or drug addiction in November 1989. The Serbsky Center estimated in 2003 that 70 percent of veterans from the two Chechen Wars had some form of post-traumatic stress disorder. By the mid-2000s, about 100,000 veterans of “local wars” (primarily Chechnya) were in prison. Using budgetary data taken from Russian journalists, the state would be spending 10 billion rubles a year jailing local war veterans.

Given the precedents set in the Afghan and Chechen wars of ignoring or severely underfunding mental health care, there is a serious possibility that this will be repeated with the invasion of Ukraine. Old attitudes that see mental illness as moral and spiritual weakness likely remain strong among leadership. Such attitudes are very likely to have sway among Russian soldiers, making them less likely to seek out treatment. As we have also noted, the kind of frank and open discussions about the war that are a part of coping with trauma may be seen as undermining public confidence in the military. All this means that if and when money becomes scarcer in Russia (especially if oil prices drop), mental health programs might be early on the chopping block.

The figures here are not exhaustive, and the true costs of veteran care will likely be higher. Even still, they demonstrate the tremendous burden that the war in Ukraine will exact on Russia after the guns go quiet. Treating post-traumatic stress disorder, caring for physically wounded soldiers, and supporting their families will become either a major budget item for decades to come, or a political weakness for the government if it fails to satisfy the expectations of veterans and families. In the long term, heightened expenditures, coupled with unstable revenues, will force the Russian state to make difficult choices.