Every war not only changes the political map of the world but also profoundly impacts medicine. Russia's full-scale invasion of Ukraine since February 2022 has created an unprecedented challenge for the healthcare system. But it has also opened a unique window of opportunity for the development of previously neglected medical fields. One such field is phage therapy—treatment using bacteriophages, viruses that specifically destroy bacteria.

While global clinics are only just returning to phages due to the antibiotic resistance crisis, Ukraine has the opportunity to transform this microscopic weapon into a real tool for treating wounded soldiers, patients with purulent complications, and chronic infections.

Resistance in Wartime: Bacteria That Can't Be Treated

War involves not only wounds and injuries, but also infections. In combat situations, the risk of infection with resistant bacteria increases severalfold. The causes include soil contamination, wounds in the field, inadequate sanitation at the front, and the widespread, uncontrolled use of antibiotics.

Ukrainian military hospitals are already recording numerous cases of infections caused by multidrug-resistant strains of staphylococci, acinetobacter, and pseudomonas aeruginosa. These bacteria are often resistant to most available antibiotics. This means wounds fail to heal, leaving patients with chronic inflammation and, sometimes, the risk of amputation.

At the same time, statistics reveal a disturbing trend: according to the Center for Public Health, antibiotic resistance in Ukraine has increased severalfold since the start of the full-scale war. This is a natural bacterial response to the chaotic and widespread use of antibiotics in military conditions.

In such cases, phage therapy is not an alternative, but sometimes the only real option. It is the bacterial viruses that retain the ability to destroy drug-resistant microorganisms that can offer a chance for a full recovery when all else fails.

Bacteriophages in military medicine: what we have today

Despite Ukraine's long history of phage therapy (since the 1930s), phage preparations are not used systematically in military hospitals. In isolated cases, they are used on an individual basis—mostly when antibiotics are ineffective and doctors are seeking a cure.

However, the situation is gradually changing. Over the past two years, several Ukrainian laboratories, including private ones, have begun producing customized phage cocktails for treating the wounded. This was made possible by bacterial culture—wound samples are sent to a laboratory, where the bacteria's sensitivity to bacteriophages is determined and a targeted preparation is created.

These personalized phages have already saved dozens of patients with incurable infections following mine blast injuries, burns, and open fractures. Doctors have observed a reduction in purulent processes, a disappearance of odor, and a decrease in body temperature—all of which demonstrates the effectiveness of these "good viruses" in combating complications.

Furthermore, specialists from the Institute of Microbiology and Virology of the National Academy of Sciences of Ukraine, as well as several volunteer medical initiatives, have begun rebuilding national bacteriophage banks to ensure a wide range of these viruses for various applications. However, without adequate government support, this work remains ad hoc.

Problems and barriers: why aren't phages used on a large scale?

Despite all its advantages, phage therapy has not become a standard treatment for the wounded in Ukraine. There are several reasons:

• Lack of clinical protocols. Currently, there are no Ministry of Health-approved guidelines for the systemic use of phages in hospitals. This forces doctors to act at their own risk.

• Insufficient research funding. Developing new phage cocktails, large-scale testing, and production require resources. Most labs rely on the enthusiasm of their scientists.

• Lack of understanding among doctors. Many doctors have no practical experience working with phages or consider them experimental.

• Bureaucratic barriers. Custom production of bacteriophages requires approval, licensing, and inspections—and time is often limited in critical situations.

Because of this, bacteriophages remain an underappreciated weapon against post-traumatic infections in wounded soldiers. This means thousands of patients are missing out on a full recovery.

What to do now: concrete steps at the state level

For phage therapy to become part of the medical care system during wartime, action is needed in several directions at once:

1. Adopt clinical protocols for the use of phages. The Ministry of Health should initiate the development of guidelines that will allow the official use of these viruses in hospitals.

2. Invest in the creation of a national phage bank. It should contain strains active against the most common pathogens encountered by military doctors.

3. Train medical personnel. Phage therapy courses should be held at military hospitals, and experience exchanges should be established with Georgian and Polish clinics.

4. Support manufacturers. It is necessary to simplify the registration procedures for phage preparations and permit the use of customized cocktails in hospitals.

5. Generate demand and trust. Educational campaigns, successful cases, and support from renowned doctors will all help dispel myths about the method's "experimental" nature.

The future of medicine after victory: a chance for Ukraine

War is a tragedy. But it also creates a unique opportunity. Ukraine can become a world leader in the use of phage therapy, particularly in the treatment of combat injuries and hospital-acquired infections.

With a history of bacteriophage research, scientific schools, the practice of personalized drugs, and demand from physicians, we are capable of building a national phage platform—medical, industrial, and export.

After the war, hundreds of thousands of people will require long-term treatment. Many will have chronic infections, wounds, and complications. Phages can accelerate healing, reduce disability, and improve the quality of life of veterans. And at the same time, they can reduce the burden on the healthcare system.

They will also help prepare for future biomedical challenges: superbugs, new epidemics, and the shortage of effective antibiotics.

Phage therapy during wartime is an opportunity to save lives when nothing else can. It's a sign of respect for those who defend the country and a strategic investment in the nation's health.

A microscopic answer to big challenges—that's what Ukrainian phage medicine can become if we don't miss the moment.