More than 20,000 Ukrainian amputees are suffering trauma on a scale not seen since World War I

The small group of soldiers gather outside to exchange cigarettes and war stories, sometimes casually and sometimes with a certain irritation at memories made unreliable by their last day of fighting, the day the war took their limbs away.

Some still remember the moment when they were hit by anti-tank mines, aerial bombs, a rocket or a grenade.

For others, the gaps in their memories are large.

Vitaliy Bilyak’s thin body is a web of scars, ending with an above-the-knee amputation. During his six weeks in a coma, Bilyak underwent more than 10 surgeries, including on his jaw, hand and heel, to recover from injuries sustained on April 22 when he fell on two anti-tank mines drove.

“When I woke up, I felt like I was born again and came out of the afterlife,” said Bilyak, who is just beginning his path of rehabilitation.

He doesn’t know when he’ll get a prosthesis, it has to be individually adjusted for each patient.

Ukraine faces a future with more than 20,000 amputees, many of them soldiers who also suffer from psychological trauma from their time on the front lines.

Europe hasn’t seen anything like it since World War I, and the United States hasn’t since the Civil War.

Mykhailo Yurchuk, a paratrooper, was wounded near the town of Izium in the first weeks of the war.

His comrades loaded him onto a ladder and went to safety for an hour.

He said all he could think about at the time was to end it all with a grenade.

A paramedic refused to leave his side and held his hand the entire time he passed out.

When he woke up in the intensive care unit, the paramedic was still there.

“Thanks for holding my hand,” Yurchuk told him.

“Well, I was afraid you would pull out the pin,” the paramedic replied. Yurchuk’s left arm had disappeared below the elbow and his right leg had disappeared above the knee.

In the 18 months since, Yurchuk has regained his balance both mentally and physically.

He met the woman who would become his wife at the rehabilitation hospital, where she was doing volunteer work.

And now he cradles her little daughter and, without the slightest hesitation, takes her for a walk.

His new hand and leg are finished in solid black.

Yurchuk has himself become the primary motivator for new arrivals from the front lines, encouraging them to heal their wounds and teaching them how to live and move with their new disabilities.

This type of connection needs to be repeated formally and informally for thousands of amputees across Ukraine.

“Your entire musculoskeletal system needs to be realigned. You have a complete redistribution of weight. This is a really complicated adjustment and needs to be done with another human,” said Dr. Emily Mayhew, a medical historian at Imperial College specializing in blast injuries.

There aren’t nearly enough prosthetics specialists in Ukraine to meet the growing need, said Olha Rudneva, director of the Superhumans Center for the Rehabilitation of Ukrainian Military Amputees.

Before the war, she said, only five people in all of Ukraine had completed formal rehabilitation training for people with arm or hand amputations, which are less common than legs and feet under normal circumstances, as the latter sometimes amputate due to complications from diabetes or other diseases would .

Rudneva estimated that 20,000 Ukrainians have suffered at least one amputation since the war began.

How many are soldiers, the government doesn’t say, but blast injuries are among the most common in a long frontline war.

The Unbroken and Superhumans rehabilitation centers provide prosthetic limbs to Ukrainian soldiers with funds from donor countries, charities and private Ukrainian companies.

“Some donors are not ready to provide military assistance to Ukraine, but are ready to fund humanitarian projects,” Rudneva said.

Some of the men in rehabilitation regret that they are now out of the war, including Yurchuk and Valentyn Lytvynchuk.

Lytvynchuk, a former battalion commander, draws strength from his family, particularly his four-year-old daughter, who has a unicorn engraved on his prosthetic leg.

He recently made his way to a military training ground to see what else he could do.

“I realized it’s unrealistic. I can jump into a ditch, but to get out I need 4WD. And if I move “fast,” a kid might catch me,” he said. Then, after a moment, he added, “Also, the prosthesis is falling off.”

For many amputees, the hardest part is learning to live with the pain — pain from the prosthesis, pain from the injury itself, pain from the lingering effects of the blast wave, said Mayhew, who has spoken to several hundred military amputees over the course of their careers .

Many struggle with disfigurements and the resulting cosmetic surgeries.

“This comorbidity of PTSD and blast injuries and pain — that’s very difficult to recognize,” she said. “When people have a physical injury and a psychological injury that comes with it, those things can never be separated. ”

For the seriously injured, rehabilitation could take longer than the war ultimately lasts.

The cosmetic surgeries are crucial for the soldiers to feel good in society.

Many are so disfigured that they believe no one can see them.

“We don’t have one year, we have two,” said Dr. Natalia Komashko, a facial surgeon. “We have to do this like it was due yesterday.”

Bilyak, the soldier who drove over anti-tank mines, still sometimes dreams of battle.

“I’m lying alone on the ward on the bed, and people I don’t know come up to me. I realize they are Russians and they shoot me in the head at point-blank range with pistols and rifles,” he said. “They get nervous because they’re running out of ammo, and I’m alive, giving them the middle finger and laughing at them.”