A group of Ukrainian Army soldiers pierced by Russian grenades and mortar shells arrived at a hospital recently in need of surgery. It would have been a familiar scene from the bloody war grinding on in Ukraine, except for two crucial differences: Most of the wounded soldiers were American, and so was the hospital — the U.S. Army’s flagship medical center in Germany.

The Army has quietly started to treat wounded Americans and other fighters evacuated from Ukraine at its Landstuhl Regional Medical Center. Though the number so far is small — currently 14 — it marks a notable new step in the United States’ deepening involvement in the conflict.

When the war erupted in 2022, hundreds of Americans — many of them military veterans — rushed to help defend Ukraine. Nineteen months later, perhaps a few hundred are still there, volunteering for local militias or serving under contract with the Ukrainian national army.

An unknown number of them have been shot, hit by artillery, blown up by mines or otherwise injured in combat. About 20 have been killed. Most of the wounded have had to rely on a patchwork of Ukrainian hospitals and Western charities for help. Now, though, the Pentagon has stepped in to offer some of them the same care it gives to American active-duty troops.