From its earliest beginnings, the citizens of Russia demonstrated humanity and generosity towards victims of war and armed conflict, whether military or civilian.

Nikolay Pirogov first became involved in military surgery in 1847 during the Caucasian War due to a long-lasting Russian invasion (1817-1864) of this region. Emperor Nicholas I sent Pirogov to the warzone to demonstrate the use of the new ether technique on the battlefield Nikolay and his colleagues treated Russian soldiers, Caucasian rebels and prisoners with equal attention. In 1848 he was awarded with the Order of St.Anne 2nd class.Because of “…his pioneering work in military medicine and surgery and his concern for the amelioration of the condition of the wounded and sick in armies in the field..”Pirogov was named “…a forerunner in the struggle for humanitarian rules that was to result in the signature of the First Geneva Convention and the founding of a Red Cross Society in Russia…” This was seven years before the Crimean War, and seventeen years before the Convention of Geneva.

At a meeting early in October 1854, Pirogov and Elena Pavlovna discussed helping the army in Sevastopol. Pirogov blamed many unnecessary deaths and complications on the chaotic accumulation of the wounded at the dressing stations. He wanted to introduce immediate triage of the wounded, but this would require considerable paramedical personnel close to the line of action. During their conversation, both considered that women could play an essential and proper role in hospital management. The Grand Duchess told Pirogov of her plan to establish the Holy Cross Community of Nurses. Pirogov immediately gave his wholehearted endorsement and saw a role for these women in the military hospitals. Emperor Nicholas I granted his consent to their plans and appointed Pirogov as the overall head of the army medical services.

In the autumn of 1854, Elena Pavlovna appealed to Russian women to train as nurses. Soon volunteers began to arrive at the Mikhailovsky Palace. They represented all sections of Society. Most were well educated and included the wives, widows or daughters of the nobility, landowners or military officers. However, there were also nuns from nursing orders and women from the poorer classes with limited education. The Grand Duchess paid expenses, but the work was unpaid; the volunteers were motivated by a sense of patriotism and self-sacrifice.The volunteers committed themselves to practice charity, kindness and to obey their superiors. They were not permitted to accept payment or gifts from the patients. These precautions were considered necessary because they would be working among thousands of men. The volunteers underwent a short (few weeks) intensive training at the St. Petersburg Imperial Medico-Surgical Academy and other hospitalsbefore being sent to the Crimea, enabling them to lend support to surgeons working at the battlefront. They even attended operations carried out by well-known doctors, formers pupils of Pirogov.

The Grand Duchess turned her Mikhailovsky Palace into a military medical back office. The Palace became a collecting point for the materials and medicines to be shipped to Crimea. It received gifts such as drugs, bandages and linens, and many cash donations for the war effort. The Grand Duchess' ladies-in-waiting even took on duties as seamstresses and, together with volunteers, made uniforms for the nurses. The availability of charitable funds stimulated the formation of several other nursing communities.

Because of a constant flow of nurses, Pirogov finally had sufficient female staff. In March 1855, Pirogov took upon himself the overall management of all first-aid posts and hospitals. Because of the complex workload, he decided to form the nursing staff into specialised groups. He divided them into bandage masters helping surgeons, pharmacy assistants preparing drugs and supervising their distribution, housekeepers taking care of clean linen and the sick, and overseeing the doctors and the administrative staff. Pirogov's confidence in the nurses allowed them to show their full potential. He was firm in his praise for them. He wrote:
“…The women bore superhuman strain without a murmur, with the greatest selflessness and resignation. Their conduct towards the surgeons and their assistants was exemplary; their treatment of the patients was of the kindest, and all their activities cannot be qualified other than noble…”

To deal with the massive influx of injured, Pirogov adopted and modified the use of triage earlier used by the French military surgeon Dominique-Jean Larrey to manage mass casualties. Pirogov divided the medical facilities into three sections: dressing stations right at the front, a flying brigade, and emergency field hospitals some distance behind the front. In the spring of 1855, when the fighting intensified, the management changes introduced by Pirogov proved their worth. The personnel now knew how to perform triage with an improved outcome for the patients with fewer severe casualties. They also were less exhausted, with less disease and improved job satisfaction.
The escalating violence made it necessary to evacuate the wounded and transfer them to the building of the Noble Assembly in Sevastopol, the central dressing station.

The French, Sicilians and the British also used women as nurses. Under pressure from the media and public, nurse Florence Nightingale (1820-1910) was asked to go to the Crimea to organise humanitarian aid to the wounded. Under the British military doctors, Nightingale and her small group of nurses enjoyed little authority. Florence Nightingale recognised the quality of the care for the wounded by the Russian aid in the Crimea. In her Subsidiary Notes as to the Introduction of Female Nursing into Military Hospitals in Peace and War published in 1858, she wrote '…It remains to mention the Russian system, which, as regards the organisation of the duties of the "sisters" appeared to me by far the best I have known...'. In the House of Commons, two army officers reported that Russian nurses had only insignificant duties in the hospitals on the battlefield. Nightingale corrected them and stated that '…the Russian system seems to be the only perfectly organised system of female attendants in military hospitals, that was developed in the Crimean War...'.She explained that the nurses were in charge of all that related to the patient's bedside care. They received orders from the medical officer, attended him in his rounds, conferred with him afterwards and communicated with the feldshers or nurses. Nightingale stated that the Russian organisation appeared to be the nearest approach to good organisation she had ever encountered.

After the Crimean war, the nurses received the social recognition they deserved, and more nursing Communities were founded. Their actions in the Crimea and the subsequent public recognition went a considerable way to establishing public acceptance of nursing and, more generally, the role of women in Russian Society. The Holy Cross Community of Nurses are regarded as the model for the Russian Red Cross nursing societies.

The Crimean War (1853-1857) counted many deaths and injured on both sides.
The suffering Pirogov witnessed during the Crimean War profoundly influenced his outlook on life. His way of thinking changed more toward humanitarian goals and education. He devoted his latter days to advancing the cause of medical education in Russia and actively reported and consulted on European regional conflicts for the International Red Cross.

Nikolay Pirogov made a plea for an international treaty to guarantee the safety of volunteers who provided aid to war victims on the battlefield, regardless of rank or nationality. Later, others would make similar pleas.
In the Sonderbund War, ninety-three deaths and 510 wounded were counted. Guillaume-Henri Dufour was supreme commander of the Swiss army with the highest rank as the General in wartime. He had first served in the French military from 1811 till 1817 to help to defend the French Empire. Where he since 1814 was added to the general staff. In 1859 during the Austria-Sardinia War, during which the battle of Solférino took place, Dufour was appointed the supreme commander of the Swiss army again. The battle of Solférino (1859) was the decisive battle in the Second Italian War of Independence. It was the last major battle in world history where all the armies were under the personal command of their monarchs. The Swiss surgeon, Louis Appia (1818-1898), took part in the battle. With his brother George, a pastor, he wrote letters to Italian and French doctors, collected necessary materials, and Swiss friends for fund donations. There Louis Appia met with the Swiss army general Guillaume Henri Dufour and with the head of the French military medical service, Hyppolite Larrey (son of Dominique Larrey), and Henry Dunant, a Swiss humanist and social activist. Also, another Swiss surgeon, Théodore Maunoir, a friend of Appia, and the Italian General and nationalist, Giuseppe Garibaldi, participated in this battle for freedom. Pirogov was in one or another way in contact with all mentioned persons. Although there is still no proof, it may be assumed that Pirogov, while he stayed in the German city Heidelberg in 1862-1866, had met Dunant.

The work of Dunant is considered a decisive factor leading to the foundation of the International Red Cross (ICRC). A five-person committee chaired by Gustave Moynier and Dunant, one of the critical members, was formed to investigate the possibility of implementing an organisation of care for the wounded on the battlefield. Their first meeting on 17 February 1863 is now considered the founding date of the International Committee of the Red Cross. In October 1863 the Committee of Five organised an international conference in Geneva (the first Geneva Convention) which effectively marked the launch of the Red Cross movement. During the meeting, the delegates recognised that the volunteers could endanger their lives in battle zones unless they could be readily identified as non-combatants. Accordingly, they decided that volunteers should wear an band around the arm with a distinctive identifying emblem. The emblem chosen was a red cross on a white background,

In Russia, the idea of a voluntary committee along the lines of the Conference of Geneva gained momentum. The first meeting of the Russian Red Cross was organised on 14 December 1866. The main office was in Saint Petersburg. On 15 December, Empress Maria Aleksandrovna accepted the patronage of the Society. Nikolay Pirogov was 17 February 1867 appointed Privy Councilor to the Russian Red Cross and the Empress. In the minutes, Nikolay Pirogov is mentioned as one of the original founders of the Society. On 30 April 1867, the statute was finally approved by the members.

During the Russo-Turkish War 1877-1878, Nikolay Pirogov, now 67-year-old, travelled again on request of the Red Cross community to the war zone. He visited dressing stations and hospitals in Romania and Bulgaria to investigate the procedures, the care, the evacuation and the staff circumstances. He also instructed the doctors on how to manage patients with burns. He noted with satisfaction that the organisation and the treatment of wounded soldiers reflected what he had taught them. The Russo-Turkish (Balkan) war accelerated the development of the Russian Red Cross. The general recognition of the Sisters of Mercy was confirmed with Pirogov's verdict: '…Every doctor who works with Merciful Sisters must bow to their activity. The Merciful Sister is an indispensable aid to the doctor, especially to the surgeon. A doctor who knows and loves his job will find in the Merciful Sister his tireless assistant...'

Others valued Nikolay Pirogov's heritage. His contribution to improving the plight of the casaulties of war was recognised by the Belgian Red Cross. In 1898 Frédéric A. Ferrière (1848-1924), deputy to the Grand Council and vice-president of the International Committee of the Red Cross and cousin of Louis Appia, wrote in the Bulletin International des Sociétés de la Croix-Rouge, that '…in 1854 the Grand Duchess Helene Pavlovna sent a detachment of Sisters of Mercy to the Crimean War, led by the famous surgeon Pirogov for the many wounded of all nationalities, who had fallen under the walls of Sevastopol….' He also stated in the same journal'…that the idea of the Red Cross society has its cradle in Russia. That's where it was realised for the first time...'