Dmytro Polovian laughed as one of his doctors tried to pot a ball but instead sent several ricocheting across the billiard cloth. Even playing from a wheelchair for the first time, Polovian looked set to win.
As the forests of western Ukraine darkened outside the window, for a brief moment the war seemed far away, the patient and medical team just another group of friends relaxing. But it was a carefully planned moment of happiness.
At the edge of this quiet town in Rivne region, dozens of men and women who have survived some of the worst trauma of this war are starting their reckoning with the personal cost of the conflict on their bodies and the long, difficult path to rebuilding their lives.
The centre is the only one in Ukraine dedicated to rehabilitating veterans with spinal injuries. Many arrive with their physical trauma compounded by post-traumatic stress disorder from brutal trench warfare, or spells in Russian captivity as prisoners of war.
Polovian, 25, worked on the railways until Moscow’s full-scale invasion in February 2022. Fighting outside Kherson in July, his unit was ambushed, he was taken prisoner by the Russians, and after an operation in Sevastopol spent three months in a hospital bed in the Crimean city of Simferopol.
“As a prisoner of war, you feel very alone,” he said. “The first week is the worst, because you worry that your friends and family don’t know what has happened to you, if you are alive or dying.”
In October he came home in a prisoner exchange, and at the end of December, after treatment at several different hospitals, he found his way to the rehabilitation clinic.
As Russian artillery pounded Ukrainian lines throughout 2022, the lists of the wounded mounted fast. In November, the hospital in Rivne officially doubled the size of the spinal trauma unit, from 50 to 100 beds. It already had 88 patients on the wards then, and the 12 new beds were filled almost immediately.
A team of foreign experts helping advise and train the Ukrainian medical staff suggest that it should double again to serve 200 veterans. Canada, which has a similar-sized population to Ukraine, has about 1,000 beds in spinal rehabilitation units and it is a country at peace, said Andrei Krassioukov, professor of physical medicine and rehabilitation at the University of British Columbia, who is working at the clinic.
Campaigners inside Ukraine agree. “It is not nearly enough – there is still a whole queue of people waiting for a bed at the centre,” said Oksana Koliada, a retired colonel and former minister of veterans’ affairs, who is the project director for veterans at the non-governmental organisation Opportunities Space.
But it is a small miracle that this centre exists at all. Andrii Badarak, a double swimming gold medalist at a recent Warrior Games-style competition for wounded veterans, is finishing his own rehabilitation there and preparing to join the therapy team.
Seven years ago, when a sniper’s bullet smashed into his spine during a battle outside Mariupol in 2016, there were no rehabilitation centres in Ukraine for his kind of injury. He moved from hospital to hospital, trying to obliterate his memories. “For the first two years, I drank,” he said, with brutal frankness. “If only this place had existed in 2016. Then it was all sadness.”
He ended up by chance in what at the time was just another veterans’ hospital, part of a system of military medical care. Until 2014, it had mostly served elderly survivors of the second world war and the Soviet occupation of Afghanistan.
Then forces backed by Vladimir Putin tried to split off parts of eastern Ukraine, and a new generation of injured veterans needed treatment. Hospital managers saw a need for something new.
“Many were arriving with spinal injuries. So we decided to create a centre for rehabilitation, as there was no such thing in Ukraine,” said the hospital’s director, Andrii Burachyk.
This was a legacy of Soviet Union-era attitudes to disabled people, who were treated as an embarrassment to be hidden away, according to medical director Oksana Kyrychuk. It meant there had been little focus on rehabilitation in Ukraine, even as specialised medical practices developed in the west.
There was a swimming pool that could be used for therapy, but beyond that the team members had to learn as they went. They even made some of the early equipment themselves, out of wood, and it is still in use as they try to treat as many veterans as possible.
They have built up expertise fast, partly through exchanges with international centres of excellence, including the British military’s rehabilitation centre in Selly Oak, Birmingham, and partly through the grim pressure of necessity, with a constant stream of patients through the door.
There is a psychological and psychiatric team as well, which is a critical part of treatment for life-changing injuries. “However strong you were mentally before the injury, there is no way you can get through this without psychological help,” said Kyrychuk.
Badarak said: “I realised I needed to do something with my life.” He found that purpose in swimming, and jokes that Kyrychuk had to drag him into the pool at first. But once in the water, he discovered the ability to move freely again: “I didn’t have to relearn how to swim.”
Now Badarak motivates newer patients, and as a wounded veteran can reach them in a way that even the best doctors cannot. “It is important because they understand you like no one else, people who have been through war.”
His only complaint is that the stays at the centre, usually three to four months, should be longer. “You need at least a year to come back to your senses and accept your new reality. I’ve seen in the US that they have centres where people spend at least a year.”
Russia’s full-scale 2022 invasion has made the doctors’ work harder. The patients are younger and they arrive in overwhelming numbers, even more battered by war.
“The injuries are much more complex,” said Burachyk. “A bullet hits one part, but shelling and shrapnel can damage a whole body. A broken spine could also be combined with damaged lungs, intestines and loss of a limb, for example.”
He wants to keep expanding and improving the centre. It is creating the country’s first specialist wheelchair workshop, with each one individually tailored for a patient based on their height, weight, injuries and how active they are.
Outside the two main buildings, fully renovated and connected by a tunnel accessible by wheelchair, are 40 cabins in the woods. Patients can stay here, as a first step towards the independent life that is their ultimate goal.
Burachyk’s dream is a large rehabilitation gymnasium, “filled with sunlight”, where patients could work together. At present, small therapy rooms for just one or two patients are spread across several converted wards. He already has the site ready and is just looking for the funding – an estimated $2m.
In a country at war, the needs of injured veterans are only going to grow. Kyiv has not published recent figures for injured soldiers, but a senior adviser to Ukraine’s president, Volodymyr Zelenskiy, admitted in December that at least 10,000 had been killed, meaning there are almost certain to be tens of thousands wounded.
“It is absolutely vital to carry out high-quality rehabilitation, as these men and women are the future of our country,” said former veterans’ affairs minister Koliada.
“Doctors don’t know what to do after surgery – the veterans just get sent home,” she added. “Some look for support and rehabilitation, but particularly in the countryside, others just stay home, and we are losing them.”
