1253 - A Gap Analysis of Amputee Care in Ukraine During the Full-scale Russian Invasion

Ukraine’s Ministry of Health and the WHO–Europe estimate that there are tens of thousands war-related amputations since 2022, with many more people requiring complex trauma care and rehabilitation. Project Hope (a Non-Governmental Organization) with ongoing efforts in Ukraine, requested assistance in identifying gaps in care for Ukrainian conflict amputees with emphasis on military patients. 

Design: A three-physician team of volunteers with expertise in humanitarian assistance, rehabilitation medicine, and military medicine was assembled. The team traveled to Ukraine in late July and spent one week in western and eastern Ukraine. Multiple site visits to medical and rehabilitation centers in Lviv and Dnipro were completed as well as roundtable discussions with hospital staff and Project Hope-Ukraine professionals as part of a series of coordinated data gathering interviews with clinicians and administrators with direct experiences during the war.

Results:

As part of the gap analysis, several major gaps were identified.  These include a trauma system overload, insufficient integrated rehabilitation services outside major centers, limitations of prosthetic rehabilitation capacity, under-resourced mental health (Acute and Post Traumatic Stress Disorders) with integrated psychosocial care, geographic and population inequities, longitudinal care gaps and workforce training shortfalls. These have resulted in higher rates of complex limb loss, infection, and secondary amputations, more complex residual limb management required for later prosthetic fitting, delayed prosthetic rehabilitation, and limited access to sport/advanced componentry that aid recovery and reintegration.

Conclusions: High-priority practical recommendations were produced to include the support and scaling of rehabilitation professional development, the expansion of regional services and creation of mobile outreach capabilities, including the-use of tele-rehabilitation for follow-up and training where access is limited /dangerous and full integration of mental-health services throughout Amputee System of Care including "car for the caretakers" who are shouldering a very large burden.