Did Vladimir Putin do the math before invading Ukraine to see what the war would cost Russia overall? In addition to the direct costs of the war and the costs of sanctions, there are also the costs of the dead and wounded – a nightmare.
Freshly mobilized Russian soldiers saying goodbye before being transported to the front, Moscow 2022.
Sefan Karacan / Anatolia / Getty
Throughout its history, Russia has rarely taken good care of its soldiers, both on and off the battlefield. The Kremlin’s current attempt to properly treat its Ukraine veterans seems as inadequate as it is unaffordable. The war of aggression against Ukraine will leave behind legions of broken men while draining the state’s coffers.
After nearly two and a half years of grueling warfare, both Ukraine and Russia have suffered horrendous losses and spent hundreds of billions of dollars. Yet the conflict is unlikely to end anytime soon, as both sides continue to believe they have more to gain. But the price will not be paid on the battlefield alone. Even if the fighting were to end today, the economic and demographic consequences for Russians will be generational.
Based on freely available information on healthcare costs and the state of the Russian healthcare system, as well as historical studies and medical publications, it is possible to determine the overwhelming economic damage of the war to Russia in terms of expenditure on existing and future support for military personnel. The state is neither logistically, fiscally nor culturally prepared for the enormous burden that will be placed on it, and it is likely to reach the limits of its capacity.
Dizzying numbers
First and foremost, the Russian state has a duty to provide long-term financial support to the families of the fallen soldiers. Then there are the wounded. They will be out of the workforce forever, and even those who are able to work again will require lifelong psychological and physical medical care. The number of dead or wounded soldiers will further exacerbate the negative demographic trends in Russia.
First, it is important to consider how much the Russian state currently spends on utilities. The one-off costs of compensating wounded soldiers and the families of dead soldiers are very high, not least because of recent decrees promising large payments to incentivize participation in the Ukrainian campaign.
The open discussions about the war that are part of trauma recovery are likely to be seen in Russia as undermining public trust in the military.
A law passed before the war entitles the family of a fallen soldier to 3.3 million rubles as an insurance payment from private insurers and another 5 million rubles from the state. Wounded soldiers are entitled to 3 million rubles, according to a decree issued in the first days of the invasion. President Putin has announced a separate payment of 5 million rubles to the families (combining the aforementioned 3 million rubles for the wounded with another 2 million in the case of death). Each Russian oblast offers a separate payment of at least 1 million rubles, some even pay up to 3 million.
In total, the cost of paying compensation to the family of a soldier killed in Ukraine currently amounts to at least 14 million rubles.
According to estimates, the Russians have suffered around 400,000 casualties so far, including over 100,000 dead. A simple calculation shows that the one-time payments would amount to 900 billion rubles for the wounded and at least 1.4 trillion for the families of the dead, for a total of 2.3 trillion rubles. This corresponds to 6 percent of the state budget in 2024, a truly staggering amount that will continue to rise.
Of course, the Kremlin cannot get away with one-off payments if it wants to ensure adequate medical care for veterans. After Afghanistan and Chechnya, caring for the wounded was cheaper than it is today because the scope of treatment was smaller and the costs of medical equipment, medicines and nursing staff were lower. Russia’s wounded return home with complex, long-term injuries.
Significant capacity problems
Emotional wounds may be even harder to treat. A 2022 study estimated that the total economic cost of war-related post-traumatic stress disorder in the United States in 2018 was $232 billion. The annual per-person cost of post-traumatic stress disorder for military personnel and veterans was $25,700 per year, and for civilians it was $18,640 per year. Adjusted for inflation, these figures would be around $32,000 and $23,000 per year, respectively, today.
Based on this, we can make a rough estimate of the costs for Russia, adjusted for purchasing power. The annual cost of treating a soldier with post-traumatic stress disorder would be around $15,000. At an exchange rate of 90 rubles per dollar, this would be 1.35 million rubles per year per person. If a million soldiers are fighting in Ukraine, half of them are expected to suffer some form of post-traumatic stress disorder. In this case, the estimated annual cost to Russia would be over 660 billion rubles, which is about 2 percent of the 2024 budget.
Aside from the enormous costs, there are significant capacity problems. The number of hospitals in Russia has fallen by about 20 percent since 2012, and there are only ten veterans’ clinics in the country. The only hospital specializing in psychological rehabilitation has just 32 beds. The military hospital system must be massively expanded, otherwise the state risks the collapse of the medical system, especially in poorer and less populated areas.
It is unclear where the money and personnel for such an expansion will come from. But if the state does not provide the necessary resources, either Russian veterans or citizens will not receive adequate medical care.
Whether due to a lack of resources or the widespread stereotype that post-traumatic stress disorder is merely a personal weakness, it is becoming apparent that a large number of traumatized veterans will not receive adequate psychiatric treatment upon their return.
A 2009 study examined people who had experienced trauma during the Yugoslavian wars and never received psychological treatment. The results show the drastic impact of untreated trauma on productivity. The respondents consistently reported extremely high unemployment. This clearly shows the catastrophic impact that untreated post-traumatic stress disorder can have on a person’s ability to function in society.
Alcoholism and drug addiction
In addition to increased care costs and productivity losses, there are a host of other negative effects. For example, in November 1989, up to 60 percent of Soviet veterans of the Afghanistan war suffered from alcoholism or drug addiction. The Chechen wars also had other drastic and costly consequences: by the mid-2000s, around 100,000 veterans were in prison.
Given the precedents set in the wars in Afghanistan and Chechnya, where mental health care was ignored or severely underfunded, there is a chance that this will be repeated in the invasion of Ukraine. Antiquated attitudes that view mental illness as a moral and spiritual weakness are likely to still be prevalent among the leadership. Such views are also likely to be prevalent among Russian soldiers, making them reluctant to seek treatment.
Add to that the fact that frank and open discussions about the war, which are part of trauma recovery, are seen in Russia as undermining public trust in the military. All of this means that as money tightens in Russia (especially as oil prices fall), mental health programs could be on the brink of collapse early on.
Overall, the available figures show the enormous burden that the war in Ukraine will place on Russia when the guns fall silent. Treating post-traumatic stress disorder, caring for physically wounded soldiers and supporting their families will be a major budget item in the coming decades and could become a political vulnerability for the Kremlin if it fails to meet the expectations of veterans and their families. In the long term, increased spending combined with unstable revenues will force the Russian state to make difficult choices.
Thomas Lactantius is a fellow at the Johns Hopkins School of Advanced International Studies with a focus on security, strategy and statecraft. Harry Stevens is a graduate of the University of Chicago, specializing in Russian affairs and economic history. The text printed here is an abridged version of a longer piece that was published on the platform War on the Rocks was published. Translated from English by A. Bn.
