The first place we went to on Monday morning was “Unbroken” hospital in Lviv. As our cab approached the hospital, we were surprised with what we saw. Twice. The first glimpse of the main building revealed an old façade of a multi-story, soviet-style, shabby-looking, L-shaped grey-brown concrete structure, which looked unimpressive to say the least. Where is the modern healthcare center we have heard and read about so much?

When we entered it was all inside: renewed buildings, equipment, and a totally new concept from a basic-care hospital it was 4 years ago, before the arrival of the new management. In those four years, Unbroken transformed into Ukraine’s national rehabilitation center, the largest medical complex, a leader in transplantation and cardio surgery.

“We have half a million patients: about 129,000 internally displaced patients, about 15,000 patients with mine-blast trauma. Because this war is a modern war, because it involves drone reconnaissance and the use of heavy artillery, most of the injuries are mine-blast trauma with amputation of lower limbs and less often upper limbs.”

Even before February 2022, Unbroken has started working on prosthetics and developing rehabilitation services. But they had to expand their activities and learn new skills when they started receiving thousands of patients in the first months of war in evacuation trains with heavy injuries at unprecedented scale. Good contacts with Western hospitals allowed to forward some of the heavily injured to Europe. But partners reached capacity a couple of months into the full-scale invasion.

“We were looking for more premises from the start, to help people,” says during a meeting with our group Unbroken Deputy Director Volodymyr Fedoriv. “It was cooperation with the Lviv city mayor which led to the decision to build a powerful rehabilitation center on the basis of the First Territorial Medical Association to provide a full cycle of necessary medical care. This is how Unbroken was born.”

Besides, the principles of treating a combat injury are fundamentally different from the principles of treating an injury sustained in everyday life. To learn how to treat war injuries, Unbroken rehabilitation center partnered with hospitals across Europe and the US to develop training programs for its staff and doctors from other Ukrainian hospitals in a full spectrum of care, turning a medical association into a powerful medical and training hub with unique experience.

“We have gained experience from the world, and we gain experimental experience, and the doors of our hospital are open for any surgeon, any traumatologist, reconstructive surgeon, rehabilitation specialist, prosthetist from Ukraine to adopt the experience we have already gained.”

Over the last 2.5 years it has become a comprehensive rehabilitation healthcare system, consisting of 2 hospitals, 1 children’s hospital, 2 maternity hospitals, and 2 rehabilitation centers – altogether employing 4500 medical personnel. Within this system, each specialized hospital has its own rehabilitation department: “Each of our hospitals has rehabilitation departments. St Luke’s has a separate rehabilitation department for children’s and children’s rehabilitation units,” explains Oleg Bilyanskyi, Head of Unbroken Rehabilitation Center. Furthermore, psychologists and psychiatrists are crucial in the rehabilitation process, working with patients from prosthetists, physiotherapists, general surgery, reconstructive surgery, neurosurgery, traumatology, cardio-vascular and other departments. The same methodology of comprehensive approach to rehabilitation is applied across different services.

Rehabilitation starts with an inspection and diagnostics of an incoming patient by a cross-sector team of doctors, who then map out different stages of treatment, including psychological, neuropsychological, physical, reconstructive surgery, prosthetics, lost vision rehabilitation, for example. Each type of rehabilitation will have a dedicated team, members of which will work with different patients in a cross-discipline rehabilitation team. The patient is at the center of the system, and the goal of each team is to reach the highest quality of life for each patient.

Psychological rehabilitation runs through all parts of this system. The areas of expertise by specialized doctors in Unbroken psychiatric center differ from child psychology to working with victims of rape (most of them men coming out of Russian occupation or captivity, in addition to numerous women and children), with people who lost their limbs, people brain damage due to multiple contusions, to people who look whole from the outside, yet carry bleeding scars on the inside. PTSD is a red thread running through the various types of psychological trauma inflicted by war. Thus, “when a woman whose face was blown off by an explosion or destroyed in a fire comes to the hospital, it is not just about reconstructive surgery and putting something in place of a face. It’s about working with her all through the process, so she does not kill herself after looking into a mirror at home after she is discharged,” says the Head of Unbroken Psychiatry Department Ulyana Bereznyak.

How long a rehabilitation may take depends on every individual and his or her family, and their acceptance levels of this new situation. Some patients can be discharged from the hospital after 14 days of rehabilitation treatment with major improvement, and those who have to stay up to one year with slow and patched progress. Some patients need repeated stages of rehabilitation, with work for decades, if not more, after the war, as physical functions degrade or psychological treatment reaches its limits. To prepare for the future, based on the recent experience, Unbroken is forming institutions for training, response planning, and anticipation of complications up to a year in advance.

Unbroken Rehabilitation Center is registered as an NGO. 80% of its funding come from the state authorities and from Lviv city. Among the state actors, the Ministry of Social Policy is the most important for their rehabilitation program. The remaining 20% of funds came from donations by over a thousand partners, including cities (Freiburg, Warsaw, etc.), private companies (e.g., Ikea) and NGOs (e.g., Red Cross) assisting war victims.