SUMY REGION, Ukraine — Sitting on his hospital bed and bleeding through bandages on each arm, the exhausted Ukrainian soldier described how two days earlier, after being shot in both hands by a sniper in Russia’s Kursk region, he walked 16 hours under shelling while being hunted by Russian drones.

Until recently, Ukrainian medics treated wounded soldiers like him at stations inside of Kursk, in territory occupied by Ukraine since an invasion five months ago. But Russians have advanced far enough into the salient that the fighting has pushed the medical staff back over the border.

With no medics to treat him nearby, both hands gushing blood and the four other men in his unit all killed, Yurii, 45, said he used his teeth to tie tourniquets on each arm, took a radio off his dead commander and eventually found fellow troops who the next day loaded him onto a U.S.-made Stryker fighting vehicle and took him back over the border — and then on to the hospital where he told his story.

Yurii’s devastating wounds came during a massive Russian counterattack that poses a serious threat to Ukraine’s only territorial bargaining chip in the war and the result of one of the war’s biggest gambles — August’s incursion into Russia. Like other Ukrainian ground troops in this article, he spoke on the condition he be identified by only his first name, in keeping with military rules.

The intensity of the attacks in Kursk signals Russian President Vladimir Putin’s growing desperation to take that chip off the table — and quickly — as pressure mounts for possible negotiations to end the war ahead of U.S. President-elect Donald Trump’s inauguration next month.

Russia has deployed 60,000 troops to the region and is assaulting Ukrainian positions with all means at its disposal, Ukrainian commanders and soldiers say, often moving by motorcycles, buggies, bicycles and on foot to limit their losses on roads controlled by Ukrainian firepower. In recent days, waves of North Korean troops have also appeared on the battlefield, advancing in large groups that have made for easy targeting.

Outnumbered, Ukraine is clinging to the sliver of territory it still controls — bolstered in part by President Joe Biden’s recent decision to allow Kyiv to use U.S.-made missiles, known as ATACMS, to strike deeper inside of Russia. Muddy conditions and natural barriers including rivers have also helped Ukraine hold some lines. But the huge Russian deployment to Kursk has helped Moscow claw back around 40 percent of the 530 square miles Ukraine initially seized.

When Yurii and his fellow troops drove into Kursk for their final mission this month, “we were sure we were going to achieve something,” he recalled. “But we were not sure we were going to survive.”

Putin downplayed Ukraine’s brazen incursion when it happened in August, framing it as a futile sideshow to the main fighting in Ukraine’s east. But almost five months on, as the fighting intensifies, the battle for this corner of western Russia has proved that Ukraine’s cross-border incursion marked a watershed moment in the war — even if the final outcome remains unclear.

“I can be frank with you: Even when I was creating this operation … I was very skeptical about it in general,” said Col. Dmytro Voloshyn, commander of Ukraine’s 82nd Brigade. Since, then, he said, the importance of the fight in Kursk has become “undeniable.”

There has been skepticism of the effectiveness of the Kursk operation — both in Ukraine and among its partners — with critics suggesting Ukraine would have been better served reinforcing its existing front lines in the east.

Its supporters, however, say the assault was Ukraine’s only option: A Russian attack on the north was imminent, officials claim, and Russia’s fortifications in Ukraine’s south and east would have made similar missions there nearly impossible.

Although Russia still targets the Sumy region across the border, it is also using its weapons at home for the first time — damaging its own towns and infrastructure instead of just Ukraine’s.

Ukraine’s seizure of hundreds of Russian soldiers as prisoners “forced Russia” to restart exchanges with troops from Ukraine’s Azov Battalion who were captured in early 2022, said Vasyl Malyuk, head of Ukraine’s internal security service, the SBU. Interrogations with Russian prisoners have aimed “to obtain evidence of war crimes committed by them in Ukraine, and bring criminals to justice,” he said.

The operation also forced Russia to move tens of thousands of troops away from front lines in Ukraine.

“This is a story of principle for Putin, first and foremost. He threw [his] ready-made and best brigades here. These are trained, confident types … We are fighting the elite,” said Capt. Oleh Shyriaiev, commander of Ukraine’s 225th Assault Battalion, whose troops crossed the border on Aug. 6. “We pulled them back from other regions.”

“The positive thing,” he added, “is that we have destroyed the warehouses with drones, ATACMS, and so on. We destroyed arsenals, ammunition depots, all of it.”

Still, many Russians troops stayed in Ukraine’s east to focus on seizing the strategic city of Pokrovsk. They are now nearly in reach of the city, though the advance has taken much longer than most expected. Months of grinding battles have caused significant Russian losses there and in Kursk.

And Ukraine has more reason than ever to stand its ground in Russia: Officials say if they retreat, the 60,000 troops they are fighting off will follow them back into Ukraine.

“We will not go anywhere,” Shyriaiev said.

In border villages in the Sumy region, where Russia has struck regularly with glide bombs, most civilians have left home. Their houses are now empty, destroyed or made into makeshift military bases and medical points.

In one such house, medics from Ukraine’s 82nd Brigade had set up a small clinic. The first group to establish a medical station inside of Russia in August, they have seen the cost of Kursk firsthand, treating 1,200 wounded troops in the months that followed — with all casualties now treated on the Ukrainian side of the border.

On a frigid December morning, they crowded around a soldier named Vova, who hours earlier took shrapnel to his lung. He had waited hours in the cold for an evacuation, his lung filling with blood. His eyes rolled backward as they pumped him with plasma. He screamed as they used a tube to drain two cups of his blood into the bottom half of a plastic water bottle they had cut and placed on the floor.

When they moved him to an ambulance, they shouted at journalists to stay inside. Russian drones hovered overhead constantly, and the houses where they treat casualties have been targeted before. Several of their medical colleagues have been wounded or killed, they said. They fear so much for their safety that they hide their location even from neighboring Ukrainian brigades. Dozens of glide bombs can land nearby each day.

Despite the risks, Roman, 41, interim commander of the medical unit, said he still thinks the Kursk operation was worth it. “If we keep them on their territory, our territory is less destroyed,” he said.

In another such house, troops from Ukraine’s 95th Brigade sat at desks, preparing attack drones to use inside of Kursk. A gray rescue cat named Bandit meandered through stacks of weapons and energy drinks on the floor.

Andrii, 35, commander of the drone unit based there, described how recent Russian methods show they are seeking “to retake [Kursk] at any cost.”

His unit has observed how Russia has recently sent columns of vehicles down roads Ukraine controls — seemingly willing to take their chances at losing multiple armored vehicles and many personnel if it means even one or two might get through.

“They send a tank, we destroy it, they send an APC, we destroy it, they send a BTR, we destroy it. And now they’re using motorcycle groups,” he said, referring to types of armored vehicles. “Even if we are still destroying them, they will probably still come on foot.”

Dmytro, 25, an assault company commander in the same brigade, described Russia’s tactics as “meat assaults.”

But even as they expend huge numbers of troops and equipment on attempts to retake the territory, he doesn’t expect Russia will be able to easily push past Ukrainian defenses this winter.

“There’s a cemetery of destroyed Russian vehicles in Kursk,” he said.

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