American officials say they fear that Ukraine has become casualty averse, one reason it has been cautious about pressing ahead with the counteroffensive. Almost any big push against dug-in Russian defenders protected by minefields would result in huge numbers of losses.

In just a year and a half, Ukraine’s military deaths have already surpassed the number of American troops who died during the nearly two decades U.S. units were in Vietnam (roughly 58,000) and about equal the number of Afghan security forces killed over the entire war in Afghanistan, from 2001 to 2021 (around 69,000).

The number of dead and wounded reflects the amount of lethal munitions being expended by both sides. Thousands of rounds of artillery are fired every week, tanks batter buildings, land mines are everywhere and drones hover overhead picking off troops below. When close combat does occur, it resembles the battles of World War I: brutal and often taking place in trenches.

The numbers also point to a lack of rapid medical care on the frontline. Wounded soldiers are increasingly hard to evacuate given how much artillery and gunfire bookend each engagement. Unlike the U.S. wars in Afghanistan and Iraq, where American forces strictly adhered to evacuating casualties within an hour to a well-stocked medical facility, there is no such capability in Ukraine.

Instead, injured troops are often thrown into any vehicle available or leave the front on foot. In some cases, the wounded and dead are left on the battlefield, because medics are unable to reach them. Hospitals and aid stations are often overwhelmed.