“Weapons more advanced, mutilating and destructive than I’ve ever witnessed”
Gaëlle Smith, HI’s emergency rehabilitation specialist, went to Ukraine to support the local teams in the country. She tells us about her experience.
Damage in Kiev after a missile fell overnight .onto a shopping mall and its parking lot. March 2022. | © V. de Viguerie / HI
“I went out to Ukraine to support a request from a regional hospital in Dnipro, for a specialist to work alongside the rehabilitation professionals in treating blast-injured (poly trauma) patients during the early stages of their recovery."
The journey to Ukraine
“As a rehabilitation specialist, I know how to prepare myself before going on an emergency deployment in a conflict zone, drawing on previous experiences of work in similar contexts. I know I have continual support from the HI’s Emergency Division, as well as my colleagues, my family and friends. However, the reality when I actually got to Ukraine, and fully understood what civilians have endured and continue to go through day and night, well, there is no true preparation for that.”
“The journey across the Romanian border into Ukraine started that ‘better understanding’. Knowing from the UK news of people that queued for days to leave the country, trying to comprehend what they would have been thinking and feeling, the majority having left male relatives behind. I thought to myself, ‘could I do that and be OK? Could I leave my father behind? See my brothers-in-law having to leave their families... and us, not knowing what will happen to them at any given moment?’”
“Our journey continued by road towards Dnipro, the check points getting more frequent the further East we went.”
“Constant and unrelenting reality of war”
“As I travelled East, what struck me was the contrast within Ukraine of places able to go about life, though with an ever-looming risk of an attack, compared to the villages and towns that were truly in survival mode, under the constant and unrelenting reality of the war. I could not help but think of my own home in Scotland, how safe our everyday life is and the fact that we don’t always value it... I have such respect for the resilience of those affected by this war.”
Dnipro, where Gaëlle would be working, has become a logistical hub for humanitarian aid and a reception point for people fleeing the fighting. It is roughly equidistant from most of the war's major battlegrounds — Donetsk, Mariupol, Kherson and Kharkiv are all within 200 miles. As a result, health services in Dnipro have been under enormous pressure.
Hospitals are overwhelmed by need
“The hospital I was supporting has 11 operating theatres, staffed and working round the clock due to the continual stream of ambulances arriving with injured patients from the frontline areas and other regions that are under shelling. The high level of skills, knowledge and commitment of all the staff around me was evident in every aspect of patient care. The ever-growing number of patients however, was pushing the staff to work longer hours and not take much-needed time off. Support from HI, to help with rehabilitation staffing and patient equipment needs, was welcomed and straight away, I was welcomed as part of the team, part of the hospital.”
“One of the challenges faced by the teams is the risk of burnout. There is no let-up in the pace of work, the complexity of the work, the amount of work. Sirens ring day and night warning of possible shelling. Each member of the team is constantly thinking about their own safety and their colleagues’ safety, as well as the safety of their patients and the community around them. How do you find the chance to rest and recharge, in such a setting?”
“Typically, the hospital has beds for 750 patients, for all conditions – surgical and medical. Since the end of February, they have added more beds, and repurposed wards, moving some services to other, smaller hospitals and now have over 1,000 beds, filled with patients directly injured or medically unwell as a consequence of the war.”
Early rehabilitation is vital for war-wounded patients
“Blasts from explosive weapons put people at risk of multiple different kinds of injuries at once. First, pressure from the blast can impact your lungs, ears, eyes, and intestines. The explosion itself or fragments and shrapnel from the explosion can lead to broken bones and flesh wounds, which could require amputation. Upon impact after a blast, you may get traumatic brain and spine injuries from the collision. Finally, there are burns to the skin and even respiratory damage as you breathe in smoke, dust and chemicals. In Dnipro, the patients presented with a mix of all these injuries. Some of these injuries on their own can be serious, and then when you put them together, it’s staggering”
“Both early rehabilitation and ongoing input are vital in war-wounded patients. Functional input in the early stage helps to promote recovery, healing and prevent complications. Accompanying the patient (and their relatives/carers) who requires rehabilitation from day 1 is crucial. Educating them on what their injuries are, what they mean for them now, or may mean in the future, HI also provides mental health and psychosocial support (MHPSS) as making sure they are coping emotionally and mentally, is just as important (in their rehabilitation).”
Civilians are injured daily
“The weapons being used in Ukraine do not discriminate and are far more advanced, mutilating and destructive than anything I’ve ever witnessed. Ukrainian hospitals, health and rehabilitation staff and facilities are doing an incredible job, but the heart-breaking reality is that there are more civilians needing care than they have resources for. And more will continue to be injured daily, not only until the war ends, but until each item of explosive ordnance has been safely disposed of.”
HI teams in Ukraine are working to help the most vulnerable people affected by the conflict, including injured people, people with disabilities, older people and those with chronic illnesses. Our activities include emergency rehabilitation care, mental health and psychological support, and will soon also include risk education sessions to prevent accidents with explosive ordnance.
Our vital work is only possible thanks to our generous supporters.
 Early (often called acute) rehabilitation focuses on providing timely input to offer patients the best outcome. By focusing on optimising function and mobility, preventing further impairment and reducing disability, early rehabilitation aims to promote recovery and return to activities of daily living. A crucial part of this approach is integrating a patient’s environment and psychosocial wellbeing into their care. More information: https://www.who.int/activities/strengthening-rehabilitation-in-emergencies/early-rehabilitation-in-conflict-and-disasters