In 1914, with the onset of World War I, the first wounded began to appear in Russian hospitals. A year later, epidemics of cholera, dysentery, typhus, and abdominal typhus erupted at the front. There was a catastrophic shortage of hospitals, and no one expected the war to reach such proportions. Then Empress Alexandra Fyodorovna proposed to use part of the Winter Palace to accommodate the wounded.

Where meals were once held, children played, and balls took place, hospital beds were set up, operating rooms were equipped, and wards were created. Expensive parquet was replaced with more practical linoleum. Almost half of the Winter Palace was allocated for the hospital, including the Heraldic, Pikety, Alexandrovsky, Nikolayevsky halls, and other rooms.

The hospital opened quietly, without the presence of the tsar. Nicholas II believed that celebrations were inappropriate during wartime. In 1915, the emperor went to the front, and his wife and daughters began training as nurses. They completed a full course in surgery and additionally studied internal medicine.

Practice did not take long to arrive. Alexandra Fyodorovna often worked with the wounded from morning till night: bandaging, assisting surgeons, extracting shrapnel, and preparing patients for surgery. The empress always followed the doctors' instructions and did not shy away from any work.

The only thing that irritated the staff was the frequent visits from high-ranking guests from the Red Cross and delegations from England, Belgium, and France. They took photographs with the wounded, disrupting the doctors' work.

On October 25, 1917, chaos began in the hospital. Revolutionaries, bursting into the building, tore bandages off the wounded, believing that ministers of the Provisional Government were hiding beneath them. On October 28, the hospital was disbanded, and the Soviet authorities preferred not to remember the hospital, as the noble gesture of the imperial family did not fit their view of tsarism.