Oksana Hryn had no warning of the Russian shell hurtling towards her, no air raid siren or crash of mortars landing elsewhere in Hulyaipole, a frontline town in southeastern Ukraine.
“I was working in the garden of our house, and there were no Ukrainian soldiers or military targets anywhere nearby,” she recalls now, two months after the attack.
“If I’d heard the whistle of a mortar shell I’d have taken cover, but there was nothing. Then suddenly I fell, or was thrown, to the ground and there was a loud noise. I covered my ears, and when I uncovered them there was another explosion in another garden nearby. And then silence, and I realised I couldn’t feel my legs.”
Neighbours rushed to help Hryn, calling an ambulance and bandaging up her legs, which were badly burned and damaged by shrapnel.
“I never lost consciousness,” she says. “I didn’t close my eyes because I thought I might bleed to death. I was very scared at first and wanted to hold on to the end, so I remember everything.”
Hryn (31) underwent six operations in two hospitals in Zaporizhzhia, a government-held city 100km west of Hulyaipole which is also a frequent target of Russian missiles, including amputation of her lower right leg and skin grafts.
Now she is in St Panteleimon hospital in Lviv, western Ukraine, starting rehabilitation and waiting for news of when — and where — she can receive a prosthetic leg.
“I could get it here in Ukraine but I would have to wait a long time,” says Hryn, who has a young daughter and worked in a cafe in Hulyaipole.
“I think it would be quicker to go abroad and I want to work again as soon as possible. But I don’t know yet which country will choose [to help] me or when it will be.”
Now in its fifth month, Russia’s full-scale invasion of its neighbour has already killed thousands of soldiers and civilians and left many with life-changing injuries.
In some cases, even doctors from the US, UK and other countries who have experienced war in Iraq and Afghanistan do not have experience of dealing with these injuries
The casualty toll grows every day, yet even as the Kremlin’s war threatens its very survival and destroys swathes of its economy and infrastructure, Ukraine must find a way to provide medical and psychological care to its people on an unprecedented scale, now and for years to come.
Lviv, 80km from the Polish border, has launched a global €70 million fundraising drive to build a state-of-the-art national rehabilitation centre called Unbroken, where staff will be able to perform some 10,000 operations and treat more than 50,000 patients annually.
“Now we are doing very difficult work in our surgery, trauma, orthopaedic and rehabilitation departments, but to do this on the highest level and with the best results we need to combine these in one place like Unbroken — a modern facility with modern equipment,” says Hnat Herych, head of the surgical department at St Panteleimon.
Ukraine’s allies are helping ease its burden by taking wounded soldiers and civilians for treatment, providing medical equipment, and sharing expertise with surgeons and doctors who are having to learn on the job how to handle horrendous injuries, whether inflicted on the battlefield or in missile attacks on towns and cities far from the frontline.
“We have already gained big experience working with combat-type injuries because our region was bombed by Russian aviation and rockets... and we also have lots of patients from frontline areas of eastern Ukraine,” says Herych, who is expected to be the chief surgeon at Unbroken.
“They have their first operations in the east and then come here on evacuation trains for secondary operations, and a lot of them need serious, very difficult and very specific reconstructive surgery,” he explains.
“It is very difficult for Ukraine, but it would be difficult for any country, because two powerful armies are fighting here with very powerful weapons. In some cases, even doctors from the US, UK and other countries who have experienced war in Iraq and Afghanistan do not have experience of dealing with these injuries.”
Kyiv officials say that on average more than 100 Ukrainian soldiers are being killed and hundreds injured every day in fierce artillery battles for the Donbas region in the east of the country, where cities including Mariupol, Severodonetsk and Lysychansk have been reduced largely to ruins.
In fighting near the government-held city of Pokrovsk late last month, Russian tank fire injured a Ukrainian soldier who goes by the call sign “Tefal” — a nickname he says friends gave him years ago in reference to a slogan that was used in Ukrainian adverts for the firm’s products, “Tefal always looks after you.”
“The tank saw us and took a shot, and when we fired back it shot at us again, and I was injured by the blast wave. Then it shot a third time and thankfully missed,” he says.
“I was told that a couple of the shells landed three or four metres from me. I suffered concussion and a few other minor injuries, but luckily no shrapnel hit me. The main problem is nerve damage to one of my legs, which is not working properly, so I can’t fight.”
Tefal (41) — who does not want his real name to be published — received treatment in several hospitals before being sent back to his native Kyiv for rehabilitation and physiotherapy.
“It seems we need more good staff,” he says of his experience of Ukrainian medical care.
“With all due respect, not all of them are the best. Many were educated in the Soviet style and their treatment seems too narrow. They don’t see the full picture of what is needed for rehabilitation. So we need plenty of good, new personnel, with the right motivation and mentality.”
The war may last for years, but Ukraine needs to build new facilities, systems and teams now to cope with its growing wave of injured and traumatised soldiers and civilians.
Young Ukrainians are carrying much of the burden of this war, whether fundraising, fighting, reporting from the frontline or treating the wounded.
“We are making a new young team, with young doctors with a new vision, because this is a new kind of surgery for us,” says Herych (32), whose team recently performed a microsurgical procedure with help from British colleagues that was groundbreaking for Ukraine.
The Veteran Hub in Kyiv was also something new for Ukraine when young volunteers founded it in 2018 — a bright, modern and welcoming drop-in centre that offered a wide range of services to current and former soldiers and their families, emergency workers and others, from psychological and legal support to help finding work and learning English.
That site, on the 20th floor of a building shared with a television centre, is now considered too vulnerable to missile attack, so co-founder Artem Denysov and his team are looking for a new location in the capital while continuing to operate a telephone “trust line” and a walk-in hub in the supposedly safer city of Vinnytsia, 240km southwest of Kyiv, where Russian rockets killed least 23 people and wounded dozens more this week.
From Vinnytsia they also plan to relaunch a “mobile office” service, which involves former soldiers travelling sometimes hundreds of kilometres to visit veterans who need help and advice — peer-to-peer contact that Denysov says is vitally important to people who can otherwise slip into isolation and depression after the comradeship of military service.
“We bring attention and a connection to people who are really lacking that,” he explains. “Some veterans are too tough to ask for help because they feel lonely, so it’s easier to ‘cover’ it with a legal consultation. So there’s often a bit of legal consultation and then lots and lots of talk about other things.”
Denysov was a driver for the army at the start of the war, when Russian troops were in the Kyiv suburbs, and now understands better the psychological needs of soldiers when they return to civilian life.
“Now I know from the inside that there are things you won’t talk to your wife about. I have a brilliant wife and I’ve shared a lot, but some things are still too hard to explain. But when you’re talking to the guys who were with you in that situation, when you ask if they remember ‘that’, you don’t have to explain what ‘that’ is.”
Some 460,000 Ukrainians officially took part in eight years of fighting in Donbas, many of whom are now on the frontline again, some without having recovered from their previous experiences.
“It will hit afterwards,” Denysov says of post-traumatic stress disorder and other potential problems.
“Now they are in a place they really know... with a sense of brotherhood, meaning and purpose. While you are in uniform you are somebody and people respect you, and in Ukraine there has never been this much trust and admiration for people wearing uniform. But afterwards, you’re just a civilian, just some guy again.”
Denysov estimates that perhaps one million Ukrainians have now been in combat situations; consider emergency workers and civilians wounded or traumatised by Russian bombing or occupation, and the scale of the country’s future care needs becomes clear.
“A huge number of people will need some sort of support,” he says. “So we need to prepare for this now. People will return home needing help, and we can’t ask them to wait two or three years for that.”
Russia’s invasion is doing immense damage to so many Ukrainians, soldiers and civilians alike, at the frontline and in places hundreds of kilometres away from it. Yet the determination not to be beaten, either in the war or in personal battles with injury, feels like a common national trait.
Tefal, recovering in a military medical facility in Kyiv, says Russia’s grinding advance in Donbas “is only temporary. We’ll take back all our territory in time.”
“I’ve seen some men lose morale when they’re injured, but mine doesn’t drop. I just want to recover and go back for revenge, to get the tank that fired at me. I’ve hit one tank already, so I need two more — as they say here, ‘God loves a trinity.’”
In Lviv, Hryn is also thinking of the future as she waits for a prosthetic leg, and about getting back to her mother and young daughter, who are now in the government-controlled city of Dnipro.
“I want my leg to be fixed, so I can walk and work, and start life again,” she says.
“I worked in a cafe before, in the kitchen and serving customers, but I don’t want to go back to that. And I trained as an accountant but didn’t like it. What I always dreamed of was becoming a nurse — so that’s what I want to do next, when all this is over.”
