Since the escalation of war in Ukraine in February 2022, an estimated 300,000 have registered as people living with physical disabilities, according to the country’s Ministry of Social Policy. Many have suffered blast injuries, shrapnel wounds, and limb amputations, all of which require intensive, specialized care.
Doctors Without Borders/Médecins Sans Frontières (MSF) launched an early rehabilitation project in March 2023 at Cherkasy Hospital in central Ukraine, that integrates physiotherapy, psychological support, and nursing care to address the complex needs of war-wounded patients in the process of early recovery.
“All injuries take time” is a sentiment that resonates deeply for both medical staff and patients at Cherkasy Hospital. To physiotherapists, this saying points to the significance of each minute spent on exercises and techniques immediately after surgery. For psychologists, it emphasizes the value of timely counseling sessions and emotional support. For patients, it reflects the fact that the healing process, both physical and emotional, is a journey that requires resilience.
An epidemic of physical trauma
Ihor has been receiving medical treatment for over a month after sustaining multiple injuries from shelling in the Sumy region. His wounds include small fragments of shrapnel embedded in his eyes and a fractured wrist. “At night, the pain is unbearable,” he explains. “I’ve screamed from the pain and even asked them to amputate my arm.”
MSF physiotherapist Oleksii Taranenko has been using therapeutic exercises and electrotherapy to treat Ihor’s injured arm, and his condition is gradually improving.
“Last night was the first time in a week that I slept through the night,” Ihor says. In recent weeks, he has regained some ability to move his hand and can now grip a one-liter bottle of water for a short period of time.
"Those few moments when he could hold something without sharp pain, with a sense of confidence, were a true achievement and we celebrated it,” says Taranenko. “We show patients that they are capable of improvement; it’s a powerful driver for recovery.”
Many of the injuries treated in Cherkasy Hospital are blast-related, and the number of patients with limb amputations is on the rise. “Patients come with severe leg injuries from stepping on landmines or with shrapnel injuries,” says MSF physiotherapy activity manager Blanche Daillet. “The war has created a ‘physical trauma epidemic.’”
When patients reach MSF’s early rehabilitation department, often they have already been treated at two or three hospitals. MSF staff frequently encounter complications like muscle atrophy and joint stiffness in addition to the patients’ primary injuries. This is because surgeons often prioritize tissue integrity and the wound-healing process, which can take the focus away from restoring functionality to limbs, despite this being necessary for effective rehabilitation.
Mental support as a part of physical recovery
Many of MSF’s patients experience sleep disorders, panic attacks, and pain syndromes—particularly phantom pain following amputation. Through early rehabilitation, our team aims to improve patients' quality of life, stabilize their emotional state, reduce pain, and prevent the long-term complications frequently associated with severe injuries, including the risks of infection and muscle atrophy. This approach supports patients in ultimately regaining independence, enabling those with severe injuries to care for themselves.
“Imagine caring for patients who have undergone 20, 30, or even 40 surgeries in a short time span,” says MSF mental health supervisor Vitalii Pavlieiev. “These patients need support from nurses and psychologists. One patient was being prepared for a leg amputation, which the surgeons could not avoid. Our psychologists worked with him to help him accept the procedure. After the surgery, we shifted our focus to managing phantom pain.”
“I used to express everything in my soul through my fingers, but now I can’t play,” says Volodymyr, who arrived at Cherkasy Hospital with leg and arm injuries. As a guitarist and sound engineer, the amputation of his finger had affected him deeply, and he was also experiencing severe anxiety, sleep disturbances, and nightmares. MSF’s mental health team has been helping him come to terms with his loss. “Psychologists are people I can tell everything to—they listen to my pain.”
Patients’ mindsets and the support they receive from family and friends all play a critical part in their successful recovery. As well as providing patients with one-to-one psychological support, the team also conducts group sessions and works with patients’ families.
Long-term mental health needs in Ukraine
Despite the clear advantages of a multidisciplinary approach to rehabilitative care, implementation within Ukrainian hospitals is challenging, as there are currently too few staff who are qualified in the relevant fields. This is, however, likely to change in the coming years, says MSF emergency coordinator Thomas Marchese.
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Read more“Although more students are now pursuing relevant studies, it will take another three to four years before they enter the workforce in fields such as physiotherapy, occupational therapy, and clinical psychology,” Marchese says.
To tackle the large gap between people’s high needs and the limited capacity to respond, it’s important to make the best use of the resources available to reach as many patients as possible. MSF is working closely with the Ukrainian Ministry of Health and other partners to expand our approach in Cherkasy to more regions, with the aim of lessening the lasting impact of war injuries on people across Ukraine.
