Ukraine: MSF provides holistic care for people with war injuries

Some 300,000 people have been registered as living with physical disabilities, according to Ukraine’s Ministry of Social Policy. The increased demand for early rehabilitation services has put extra strain on the country’s healthcare system. 

In response, Médecins Sans Frontières (MSF) launched an early rehabilitation project at Cherkasy hospital, in central Ukraine, in March 2023. The project integrates physiotherapy, psychological support and nursing care to address the complex needs of war-wounded patients early recovery process.

“All injuries take time” is a sentiment that resonates deeply for both medical staff and patients at Cherkasy hospital, and for each group it holds a special meaning. For physiotherapists, it points to the significance of each minute spent on exercises and techniques immediately after surgery. For psychologists, it emphasises the value of timely counselling sessions and emotional support. For patients, it alludes to the fact that the healing process, both physical and emotional, is a journey that requires time and resilience.

Sleep disorders, panic attacks and pain syndromes – particularly phantom pain following amputation – are common among MSF's patients.

Volodymyr, arrived at Cherkasy hospital with leg and arm injuries. One of his fingers had to be amputated. He was also experiencing severe anxiety, disturbed sleep and nightmares. As a guitarist and sound engineer, the amputation of his finger had affected him deeply. “I used to express everything in my soul through my fingers, but now I can’t play,” says Volodymyr. MSF’s mental health team have been helping him come to term with his loss. “Psychologists are people I can tell everything to – they listen to my pain,” he says.

Patients’ mindsets and the support they receive from family and friends all play a critical part in their successful recovery, according to MSF’s mental health team. As well as providing patients with one-to-one psychological support, the team also conduct group sessions and work with patients’ families.

Through early rehabilitation, MSF aims to improve patients' quality of life, stabilise their emotional state, reduce pain and prevent the long-term complications frequently associated with severe injuries, including the risks of infection and muscle atrophy. Ultimately, this approach supports patients in regaining independence, enabling those with severe injuries to care for themselves.

Despite the clear advantages of a multidisciplinary approach to rehabilitative care, implementing it within Ukrainian hospitals is challenging, as currently too few staff are qualified in the relevant fields. But this is likely to change in the coming years, says MSF emergency coordinator Thomas Marchese.

“Although more students are now pursuing relevant studies, it will take another three to four years before they enter the workforce in fields such as physiotherapy, occupational therapy and clinical psychology,” says Marchese.

To tackle the large gap between people’s high needs and the limited numbers of qualified staff, MSF suggests making the best use of the resources available and trying to reach as many patients as possible. MSF is working closely with the Ukrainian Ministry of Health and other partners to expand its approach in Cherkasy to more regions, with the aim of lessening the lasting impact of war injuries on people across Ukraine.