Country’s medical system now has to deal with a huge influx of complex injuries suffered in the ongoing war – and that includes psychological trauma.
Evgen Smirnov, a 43-year-old soldier, describes his treatment at Ukraine’s Lisova Polyana rehabilitation centre as akin to a spa visit.
“The hospital is in the forest, there are double rooms, people walk around slowly, you can play billiards, volunteers visit,” he said. Activities include pottery and sessions with therapy animals; he had had the chance to play with a dog and a tame racoon.
“There are also psychological therapies to treat headache, insomnia, and anxiety,” Smirnov said.
His stay at Lisova Polyana, the national veterans’ mental health and rehabilitation hospital near Kyiv, represents the final stage of a complex treatment plan for Smirnov, who suffered concussion and a broken leg in fighting earlier this year around Lysychansk in the Luhansk region.
Thousands of others like him are being processed through a medical system that has had to pivot to deal with a huge influx of sometimes complex injuries suffered in the ongoing war. Soldiers typically receive treatment at multiple sites across the country, with the aim of returning them to active duty as soon as possible. For some, psychological care plays a key part in their recovery.
“We have to treat many problems simultaneously.”
Smirnov, for example, was treated in four hospitals in the cities of Druzhkivka, Pavlohrad, Dnipro and Kyiv before arriving in Lisova Haliavyna for his final stage of rehabilitation.
“The hospitals in Druzhkivka and Pavlohrad are essentially transit points, where primary diagnoses are made,” he explained. “If the case is difficult, doctors send the person on. Every day there is an evacuation further, so the fighters do not accumulate in these trans-shipment centres. Severe patients are treated in Dnipro in several large hospitals. However, servicemen can stay at the hospital for a week maximum as there are many wounded. Later, fighters are transferred to other hospitals in Ukraine. I stayed in Dnipro for three days, then an evacuation train to Kyiv was organised, and I went there.”
Oleksii Mykhailov, a neurologist at Kyiv’s main military hospital, said that they mostly dealt with patients with severe injuries who required complex surgeries.
“We have to treat many problems simultaneously,” the 46-year-old said. “For example, we now have a patient with a head injury – we removed shrapnel from his head – who also had a fracture of the leg and [damage] to his lungs. We performed bowel surgery on him as well.”
Most patients at the hospital are aged between 25 and 35, and are from the first wave of soldiers who volunteered after Russia launched its full-scale invasion of Ukraine in February.
Mykhailov said that they had likely survived serious battlefield trauma because of the emergency medical training they had received, often after being dispatched to the frontline.
“On the battlefield, there are sanitary instructors who provide first aid: they stop bleeding, stabilise pressure and breathing, immobilise in case of fractures, apply primary bandages,” he explained. “There are so-called stabilisation points – field or inpatient – deployed at hospital bases. Emergency surgeries and other lifesaving medical actions are conducted here. Next, the patient is transferred to hospital.”
The Kyiv hospital provides intensive medical care, but is too overwhelmed with patients to provide onsite rehabilitation, Mykhailov continued.
“We have a system of hospitals for war veterans,” he said. “For example, we work closely with the regional hospital of war veterans [in the Rivne region], and there is a good rehabilitation system. There are Lviv and Kyiv rehabilitation centres in the city hospitals, but this is not enough. We have hundreds, if not thousands of people. If there was a coordination resource to create a base of rehabilitation beds in Ukraine and distribute them among all those in need, it would solve part of the problem.”
If needed, the final stage of treatment involves psychological rehabilitation, with Lisova Polyana serving as national centre for therapy and training.
Currently about 200 patients were being treated there, according to Anna Ostapchuk, a neurologist working in the centre. Patients were initially admitted for 21 days, although in severe cases this could be extended.
“The soldiers often complain of poor hearing, tinnitus, dizziness, headache. We help them medically, and a psychologist also works with them,” Ostapchuk said. Treatments include biosuggestive therapy for stress and anxiety, as well as cognitive-behavioural therapy (CBT).
“We have put many soldiers back on their feet already.”
Ostapchuk described the experience of a 19-year-old fighter from the Zaporizhzhia region.
“His family is in the temporarily occupied territory,” she said. “The villagers told the occupation authorities he was a fighter in the armed forces of Ukraine. Russians took his sister to the basement and beat her.”
As a consequence, he began to suffer uncontrolled panic attacks for which he was receiving treatment.
Rehabilitation specialist Sergii Kapralov travels around Ukraine with his team to provide services to wounded soldiers and train other medical personnel. The 54-year-old said that they were faced daily with complex issues, with patients often presenting with osteochondrosis, scoliosis, protrusions and hernias. This is in turn led to sleep and emotional problems.
“Many soldiers, after constantly wearing heavy bulletproof vests and experiencing spinal problems, suffer psychosomatic disturbances. They are in severe pain, it is impossible to turn the head, to lean,” Kapralov noted.
A month ago, he conducted the first training for military paramedics on rehabilitative and self-care.
“I teach self-massage of the knees, feet, hand, upper and tender limbs, scalp. We have put many soldiers back on their feet already and they are serving again,” Kapralov concluded.
If a soldier’s condition has not improved significantly after four months of treatment, they are seen by a military medical commission that determines suitability for service. Once fully recovered, they return to their previous positions.
Former truck driver Pavlo Bayenko is about to complete his final cycle of treatment. He was serving on the frontline as a junior sergeant when, on May 8, he was injured in a mine blast which badly wounded an arm and damaged his eyes. The 46-year-old was evacuated to the Petropavlivsk hospital in the Dnipropetrovsk region before receiving treatment in two clinics in Dnipro and then another in Oleksandriya in the Kirovohrad area.
His next destination was a hospital in Lviv, where he remained for two months.
Bayenko said he had no memory of the first two days after he was injured but said that his treatment was good.
“I received professional help from a psychiatrist, as I had PTSD, that’s common among fighters. I spent nights not sleeping, and was given infusions and shots.”
He also underwent surgery for his injuries, before being sent for 20 days to a state-run sanatorium in Khmilnyk, Vinnytsia region. His last stage of treamtent is being finalised in a hospital in Shpola, in the Cherkasy region, after which he will rejoin his unit.
“It’s not my desire to return to war – it’s a duty to friends, country, brothers on the battlefield. And the understanding that there will be no peaceful life until the war is over,” he concluded.
This publication was prepared under the “Ukraine Voices Project” implemented with the financial support of the UK’s Foreign, Commonwealth, and Development Office (FCDO).