With Russia’s full-scale invasion in February 2022, Ukraine has now become the most heavily mined country in the world—a title that no nation wants.
An estimated 30 percent of Ukraine's territory may be contaminated with landmines and unexploded ordnance, according to the State Emergency Service of Ukraine.
The accompanying surge in patients with amputations and complex injuries has created a critical need for medical specialists—particularly physiotherapists—to provide post-operative rehabilitation care. According to the Ministry of Social Policy, since the escalation of the war in February 2022, the number of Ukrainians with disabilities has increased by 300,000, and the demand for physiotherapists with experience treating acute or chronic injuries has doubled.
Building physiotherapy capacity in Ukraine
In mid-2022, Doctors Without Borders/Médecins Sans Frontières (MSF) initiated a project in response to this need, focusing on the early rehabilitation of war-wounded patients at hospitals in Vinnytsia and Kyiv. In collaboration with the Ministry of Health and the Ministry of Internal Affairs, MSF medical teams started implementing new and evidence-based approaches to rehabilitation to support the recovery of injured patients.
“Physiotherapy is not well developed in Ukraine. There are not enough physiotherapists,” said Viktoriia Vantsarovska, a physiotherapist who joined MSF a year ago. “We are treating amputations, multiple traumas, and nerve injuries. At first, it was very difficult to mentally accept what I was seeing. I have never encountered such war-related traumas before.”
At a glance: Physiotherapy in Ukraine
- About 30 percent of Ukrainian territory may be contaminated with landmines and unexploded ordnance
- Ukraine has become the most heavily mined country in the world
- The number of Ukrainians with disabilities has increased by 300,000 since the escalation of the war in 2022, and the demand for physiotherapists has doubled.
- MSF has provided more than 19,000 physiotherapy sessions for 668 patients and 2,638 psychological sessions for 508 patients since mid-2022.
To support the training and capacity-building of local medical staff and university students, MSF invited physiotherapists with experience working in international armed conflicts—in places including Afghanistan, Yemen, Palestine, and Sudan—to share their experiences and the latest techniques in physiotherapy. MSF also conducted dozens of training sessions to teach evidence-based and progressive methods of physical rehabilitation.
“The international staff helped us a lot with their teaching and providing us with knowledge,” said Viktoriia. “We have learned how to provide treatment to patients’ stumps in preparation for prosthetics.”
MSF’s physiotherapy team began employing a range of techniques with patients, using stretches and exercises with equipment like parallel bars, fitness balls, and a climbing structure called the “Swedish Wall.” A method of electrical stimulation called transcutaneous electrical nerve stimulation (TENS) was implemented to alleviate the pain of patients experiencing acute and chronic pain as a result of damaged nerve endings in the affected limbs.
“We explain to our patients, ‘If you follow our exercises, you will be able to become independent again,'" said Viktoriia. “When [I] see progress and the patients not giving up [...] I realize that my job is not in vain and I become really happy.”
Since the rehabilitation project commenced, MSF has provided more than 19,000 physiotherapy sessions with 668 patients. One of these patients is Andrii, who has been receiving treatment at the hospital in Vinnytsia.
“I stepped on a landmine in Donetsk in July and since then I’ve had six surgeries,” said Andrii. “My right leg was amputated, and I also have nerve damage in my left arm. The physiotherapist always tries new activities and approaches to help me. I would be immobile without physio.”
The role of mental health in recovery
Mental health care is also an important part of rehabilitation. MSF counseling services help patients process their traumatic experiences, gain motivation to maintain their physiotherapy treatment, and better accept and adapt to their new body and living conditions. MSF teams have provided more than 2,600 psychological sessions to over 500 patients, as well as more than 100 psychosocial group activities.
One particularly innovative component of psychological services for amputee patients involves a "mirroring" exercise, which is performed by putting a mirror between the surviving leg and stump. The patient sees their leg in the reflection of the mirror and moves it, creating the perception that they are moving both limbs.
The exercise helps patients adapt to and accept the prosthesis in the future, with the psychologist playing an essential role in explaining the perception of movements and addressing patients’ fears and worries about their new body. It’s also used to address phantom pains in the missing limb, whereby the patient can address imaginary pain by rubbing or moving the existing limb while looking at the mirror.
The process of treatment and rehabilitation can be quite lengthy, and some patients with serious injuries remain in the hospital for many months. A change of environment is therefore essential for patients’ mental health, which is why MSF psychologists and social workers also organize recreational trips to the zoo, cinema, or fishing. In addition, there are regular excursions to the prosthetic and orthopedic enterprise, where doctors explain the types of prostheses available and how to choose them.
For patients who cannot join these trips due to their health condition, MSF has been bringing activities to them. Art activities are organized on a weekly basis, and special events such as barbecues and visits from trainers with horses and dogs are set up in the hospital gardens.
These activities not only allow patients to have some respite, but also builds their confidence, showing them that they are still capable of doing many of the things they did before they were injured.
From June 2022 to November 2023, MSF provided more than 19,000 physiotherapy sessions with 668 patients in Vinnytsia and Kyiv. Ukraine 2023 © Verity Kowal/MSF
Addressing ongoing needs
As the war in Ukraine continues, injuries from landmines, explosions, and shelling are still constant, and the need for rehabilitation services remains high. MSF continues to support Ukraine's Ministry of Health by providing physiotherapy training and technical support to hospitals in the Zhytomyr region, and implementing a new rehabilitation project for war-wounded patients in Cherkasy, where many patients arrive within the first days of being injured due to its proximity to the frontline. Rehabilitation should begin shortly after surgery or limb amputation, which is crucial to the recovery process. If physiotherapy is delayed, joints can become immobilized, which can make the use of prosthetics impossible in the future.
“Patients with war-related trauma receive early and comprehensive treatment from our multidisciplinary team that provides physiotherapy, mental health support, and nursing care,” said Katerina Serbina, MSF project coordinator for Cherkasy and Zhytomyr. “We work in close partnership with the Ministry of Health [staff], who are very dynamic, but also face a huge challenge because of the war. Our team supports them by building their capacity, so that MSF’s presence has an added value to the whole system of rehabilitative care in the country.”
After setting up the rehabilitation facilities and services in Vinnytsia and Kyiv and providing 18 months of patient care and building staff capacity, MSF handed over these projects to Mehad, a French NGO managing health and development projects in December 2023. All the Ukrainian health specialists, including the physiotherapists and psychologists, are being retained by Mehad, and MSF has donated the medical and office equipment, as well as two vehicles to support the continuation of rehabilitation activities.
