‘An artillery barrage came in ... that’s where I lost my arm.’ Cash-strapped Ukraine races to meet needs of tens of thousands of amputees

Oleh is blunt about why, in his mid-50s, he left his computer consulting business in Kyiv and volunteered for Ukraine’s 78th airborne assault regiment when Russia launched its all-out invasion two years ago: “Because I can. Because this is my country.”

He is just as frank about the events that would lead him to the Unbroken rehabilitation clinic in Lviv, where he is making adjustments to his new prosthetic left arm.

“It was October 10th in Verbove in Zaporizhzhia region. We had been there for at least a month and it was our second rotation in Zaporizhzhia,” he says, referring to a southeastern region that was the focus of Ukraine’s bloody and unsuccessful counteroffensive last year against Russia’s occupation force.

“We launched an assault and got into their trenches and killed them all. Then, within half an hour, their mortars started firing and I got injured,” Oleh (57) says in English of an artillery strike that wounded his left arm and leg.

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“I had to walk about two kilometres to our next line of trenches and then another artillery barrage came in and I got injured again. That’s where I lost my arm.”

More than 20,000 Ukrainians have lost a limb in Europe’s heaviest fighting since the second World War, which involves everything in the conventional arsenal of a powerful modern army. Ukraine has become the most mined country in the world, and it estimates that territory twice the size of Ireland is now seeded with landmines or other explosives.

The needs of these military and civilian amputees add to the strain on a medical system that is now having to cope with a massive surge in patients with severe and complex injuries, following decades of under-investment in its hospitals and their staff.

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New rehabilitation centres such as Unbroken and Superhumans, both in the relatively safe western city of Lviv, aim to revolutionise Ukrainian care in fields ranging from trauma surgery to psychological support to bionic prosthetics, and build expertise that could in time turn the country into a world leader in treatment of the war wounded.

The prosthetics department at Unbroken started work in September 2022 and has given a new artificial arm or leg to more than 200 people, combining parts made abroad and in Ukraine. The vast majority are conventional prostheses, but the centre has also fitted about 20 bionic arms, which move in response to electrical impulses picked up by sensors on the amputee’s residual limb.

One of Unbroken’s 14 prosthetists is Anton Haidash, who started in the field a few months into Russia’s full invasion. “This is the situation in our country now,” he says. “You either fight or do something else that is useful for the country. I volunteered to fight but they didn’t take me.”

Ukraine says it will pay for a patient’s conventional prosthesis for a year and then fund a bionic one, but the cost is steep for a country whose economy has been devastated by war and which spends more than half of its national budget on defence: a standard artificial limb may cost about €1,000 but a bionic one can run to tens of thousands of euro.

“I think we’ll manage, thanks to the assistance we get from abroad and the specialists who come here to help us,” says Haidash (30).

Jacques Hacquebord, the head of hand surgery at the NYU Langone Health hospital in New York, has visited Ukraine twice during the war, confers online with Unbroken’s surgeons about their complex cases and has hosted a study trip for Ukrainian medics.

“These are some of the most serious injuries you can sustain,” he says of damage that is done every day on the front line. A terrible car crash or industrial or farm accident could inflict similar wounds, but without the blast effect of a missile, shell or mine, he explains, adding that the sheer volume of severe cases facing Ukraine’s surgeons is daunting.

“They are in a resource-poor nation with an active war which has an incredibly high mortality and morbidity rate,” says Hacquebord, who is also an associate professor of orthopaedic surgery and plastic surgery at New York University.

“There is nothing in the US that comes close. I would imagine that even during the height of the wars in Iraq and Afghanistan, the magnitude of injuries coming back to the US could not compare to the magnitude of soldiers with severe injuries that they are seeing in Ukraine.”

The war has forced Ukraine to rapidly modernise its emergency trauma care, and western aid is helping some hospitals leap straight from outdated Soviet-era equipment to cutting-edge technology.

Hacquebord’s concern is that an influx of expensive and complex equipment could be seen as a “quick fix” for a system under huge pressure, and may outpace the training that Ukrainian medics need to master new technology and techniques; for example, an advanced prosthesis is useless if the basics of making it fit a patient properly are flouted, he explains.

“Are they coping? Yes. But you have to walk before you run… They are accelerating so quickly but is that base of knowledge being adequately addressed and built up? We need to fund … long-term, formalised education programmes” between Ukraine and the West, Hacquebord (42) says.

“Ukraine is now swimming with its head just above water, but in time it will become more and more knowledgeable… So I think the goal should be for Ukraine to become a place where people from around the world go to train and learn … a centre of excellence,” he says. “War is not going away, it will just be in different parts of world – so a need for this knowledge will always be there.”

The Unbroken centre tries to ensure that each amputee is guided through every stage of care by the same prosthetist, who can provide not only medical expertise but psychological support during the transition to a life with new limitations.

“A big problem is that people have huge hopes for their prosthesis and then they get disappointed. I have to make sure people have the right expectations – it’s not going to be a 100-per-cent replacement for their arm or leg,” Haidash says.

“And even with the very best prosthesis, a person won’t be able to walk well unless they have the determination to it. Mental approach is very important.”

Haidash says Oleh’s attitude sets him up for a good recovery, regardless of whether he achieves his ambition of returning to the army.

Oleh hopes to get a bionic upgrade in a year’s time but, as he adjusts the fit of his plastic arm and practices using a hook in place of his hand, he declares himself satisfied for now: “Absolutely,” he says. “It works.”

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