Little is available in the English language about the history or the general organization of Russia’s military health system. Most studies on the lessons learned from the ongoing conflict focus on the Ukrainian experience. However, the larger and more conventional Russian military health system may be a better analog to the U.S. Therefore, CNA's Russia Studies Program reviewed open-source Russian-language documents to better understand the challenges the Russian military medical system has faced as Russia sustains its protracted campaign in Ukraine and describe efforts undertaken by the Russian government to provide care for the wounded. Our review found that the Kremlin’s political assumptions about a quick victory in Ukraine, the lack of inclusion Russian military health personnel in operational planning, the geographical scale of the front line in Ukraine, and preexisting personnel and material shortages have significantly affected Russia’s ability to provide care for the wounded in Ukraine. These challenges have been compounded by a military health system optimized for peacetime care. The Russian military health system lacked the appropriate skill mix and experience to treat trauma patients and was poorly integrated with the Russian civilian health system. Despite gaining experience in patient movement during the COVID-19 pandemic, the Russian military has struggled to evacuate casualties from the point of injury to life-saving damage control resuscitation and surgery. The scan of open-source Russian language documents also showed that Moscow has established formal and informal efforts to overcome these challenges. Efforts include: leveraging partner (Belarusian) medical capacity to treat combat casualties; improving and standardizing the medical training of Russian military personnel (to include implementing tactical combat casualty care); placing medical personnel forward; expanding capacity by building new military medical facilities; and involving volunteer groups to rectify materiel shortages. The Russian government is also working to integrate the civilian health care system to augment the military medical system’s capacity. Despite these efforts, sustaining the Russian military health system during protracted combat has been difficult, requiring a whole of government approach. Extracting preliminary lessons from the Russian military medical experience can provide a guide to the difficulties the US military may encounter when providing care for the wounded during large scale combat operations.