May 23, 2024

LVIV, Ukraine — A dozen men formed a circle inside the state-of-the-art gym, tossing a ball with their one good arm or trying to balance on their one good leg as they got used to their new bodies. They chuckled as one of them dropped the ball or made a bad throw and then limped over to retrieve the missed catch as their physical therapist-turned-coach shouted support and the occasional joke. Upbeat music blasted from surround-sound speakers.

Each man was a Ukrainian veteran who had lost a limb, sometimes two or three, while fighting the invading Russian forces that had launched a full-scale invasion of their country more than a year and a half ago. Each man had been injured months before and had taken the same arduous path from hospital to hospital to arrive at Unbroken, Ukraine’s newest comprehensive rehabilitation center in the western city of Lviv, about 30 miles from the Polish border.

The laughter and jovial atmosphere are signs of hope for a country struggling to persevere as war drags on and casualties mount.

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Analysts now estimate that between 20,000 to 50,000 amputees are in Ukraine, with tens of thousands more killed or otherwise injured. Such a massive influx of amputees has not been seen in Europe since World War I, and with the war’s end nowhere in sight, Ukraine has already become home to one of the largest populations of amputees anywhere in the world, joining countries like Afghanistan, Vietnam, Cambodia, Sudan, Bosnia and Rwanda. Several new rehabilitation centers opened in Ukraine last year in response to the exponential growth in amputee victims.

“The Unbroken project is about hope. It’s about the future,” said Andriy Sadovyi, the mayor of Lviv and founder of Unbroken, in an interview late last year.

Since the full-scale invasion began, Sadovyi’s team has been kept busy shoring up Lviv’s electrical grid and food supplies, organizing housing and humanitarian aid for the millions of internally displaced people who flowed into the city in the first months of widespread war, and eventually organizing the treatment and care of tens of thousands of casualties who have arrived for care. Lviv became an essential transit hub for people, military supplies and civilian aid almost overnight when Russian forces began dropping bombs on the capital of Kyiv and pushing across the country’s eastern, northern and southern borders last year.

“We want to become the biggest rehabilitation center in Europe,” Sadovyi said.

The Unbroken consortium is already the largest medical group in the country, made up of over 1,000 doctors, and has already treated thousands of patients, including adult and child victims of the war. A big part of the project is focused on sharing best practices and other resources amongst rehabilitation centers across the country.

Serghiy in Kyiv, August 2023
Serghiy in Kyiv, August 2023 (photo courtesy of Serghiy)

Serghiy’s Story

Serghiy is a patient at Halychyna, the oldest rehabilitation center for amputees in Ukraine and a part of the Unbroken consortium. Originally from Kyiv, the 43-year-old joined the 130th Battalion of Ukraine’s Territorial Defense Forces the day after the full-scale invasion began and, thanks to his previous military experience, was soon sent to the front line as a sapper — a mining expert tasked with both laying defensive mines and clearing enemy minefields during advances.

Because Serghiy is still an active member of the Armed Forces of Ukraine, Military.com is only identifying him by his first name for security reasons.

Serghiy’s sapper unit was “cleaning” the villages near the Russian border after the first wave of liberating forces entered the area last October, looking for any Russian soldiers or hardware left behind and removing hidden mines along the way.

“And then my leg found a mine in the grass,” Serghiy said with a wink and a smirk — typical Ukrainian humor.

A demining team had already passed through the area with metal detectors, but some of the munitions currently in use across the front are made with plastic parts that are impossible for traditional demining techniques to pick up – like the PFM-1 “butterfly mine” or “petal mine” that wounded Serghiy. The completely plastic, green-colored, Soviet-era, anti-infantry mine has a wingspan of about five inches and is commonly rained down on enemy lines over wide areas. Their size, shape, composition and color make it easy to overlook them in grassy areas, and they have proven devastatingly attractive to children who may come across them after the civilian population returns, as has become common in Afghanistan.

“It was like a leaf, undetectable.” Serghiy said many sappers are injured with these types of “invisible mines.” With about 40 grams of explosive material inside, butterfly mines are designed to maim soldiers, not kill them. Rescuing an injured soldier from the battlefield can occupy up to 10 fellow soldiers for hours at a time, draining essential resources during key moments of fighting.

“I remember a very high sound, and my ears popped,” he said. The explosion had blown off the front half of his foot.

“And then I remember the ketamine,” he said, “because I had very interesting feelings on the way to the hospital. I had a good mood.”

Though he had lost only half of his foot in the initial blast, upon arrival at the Kharkiv military hospital, doctors told Serghiy that they would have to amputate the remaining half because the trauma from the blast had pulverized the surrounding flesh and bone beyond repair.

“The first cut,” Serghiy called it.

He was still in relatively high spirits when his wife, Valentina, came to visit him the next day, he said, before he was transferred to a better-equipped hospital in Kyiv, closer to his family. But his new medical team had more bad news for him. They would need to cut further up Serghiy’s leg, because the flesh around the wound was still too damaged and infected with debris to allow for healing.

“The second cut,” he said.

They gave the second amputation a couple weeks to take, constantly cleaning and redressing the wound to encourage healing. It didn’t work; the traumatic effects from the blast had worked their way further up his leg than they had hoped.

“And then the final cut.”

In addition to the three amputations Serghiy received on the leg that had stepped on the mine, he required other surgeries to repair another serious injury on his remaining right leg. “My bed was my home for three months,” he said, as he was completely unable to walk or even stand for that time.

And although Serghiy was still getting used to his new reality, he was not depressed, he and his nurse said.

“Waiting is the worst part,” he said. “Waiting for an attack on the front. Waiting to get better.”

The dark circles under his eyes were from spending late nights awake on his computer, putting in hours as a programmer at the information technology (IT) company he had decided to found while lying prostrate for weeks in the hospital. He readily joined his fellow patients and friends for meals and hearty laughs. He looked forward to visits from his wife and their two children, ages 13 and 18, and returning to teach carpentry or astronomy at the homeschool they had started a few years back.

His positive outlook stands out even more against the grim realities facing his brothers in arms. Serghiy estimated that about 40% of his battalion was injured or killed during the fall counteroffensive. While celebrated by allies around the world for its lightning speed and the huge swath of land that was quickly retaken — about 20% of the territory Russia had occupied during the first days of the full-scale invasion — the counteroffensive cost Ukraine dearly in manpower and resources. No official data is available on Ukrainian casualties, but a typical counteroffensive sees 3-to-1 losses for attacking forces.

Human rights organizations and foreign intelligence officials have accused both Ukrainian and Russian forces of using petal mines, which are condemned under the 1997 Mine Ban Treaty to which Ukraine is a signatory, but not Russia. Russian forces are known to have used anti-personnel PFM scatterable mines in other conflicts, notably during the Soviet invasion of Afghanistan. After Human Rights Watch called on Ukraine to investigate its own forces’ use of the mines in January, the Ministry of Foreign Affairs pledged to look into the matter in an official statement.

After his third amputation in Kyiv, Serghiy was eventually transferred to the Halychyna rehabilitation center in Lviv in early 2023. There he faced several months of physical rehabilitation before he could even hope to be well enough to walk out on his own, using the prosthetic leg he had already been fitted for but still could not bear to stand on.

A New Generation of Amputees

Amputations are a unique type of injury, especially when caused by trauma. Many patients must undergo multiple amputations before they can begin healing, usually due to collateral damage caused by the injury or a hasty amputation performed by a combat medic on the front line that needs correcting. In Ukraine, the treatment of amputees is further hampered by a simple lack of medical professionals experienced in treating these specific types of wounds or facilities properly equipped to meet all of their needs. Prosthetic arms and legs have historically been imported into the country from specialized companies abroad, extending the rehabilitation timeline even more.

And the likelihood of suffering from post-traumatic stress disorder or related psychological issues is several times higher for amputees than for those suffering from other types of traumatic injuries, further complicating rehabilitation plans.

But Ukrainians have faced these obstacles head-on, aware of what is at stake for the future of their country and their very existence.

Serghiy ultimately needed several more small surgeries on his stump to wear a prosthetic comfortably, a common situation with amputations caused by traumatic injuries. He was able to move back home by early summer, however, and has already returned to many of his favorite activities like biking and hiking. The company he began while in the hospital is growing, and he is looking forward to rejoining his unit by the end of the year, he said in an interview earlier this month.

His experience has not only given him a new perspective on his own life, but also changed the way he feels about his country.

“All my life, I avoided contact with government institutions. I tried not to deal with them,” he said. “But after the injury, I felt supported — by the government, friends, even just people on the street.

“There are many soldiers who try to use the war to their advantage. There are also many government employees who do this as well,” he admitted. “But there are also many real people who know why they are here — and that is what counts.”

When asked how they could be so hopeful about such an uncertain future rife with mounting challenges, Sadovyi and Serghiy both had the same answer.

“Because I’m Ukrainian.” Because I have to be.

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