Editor's note: This story includes images and descriptions of war injuries that some readers might find disturbing.
Everything was dark and little made sense when Andrii Smolenskyi finally regained consciousness.
"The whole mission was just a dream," he thought to himself as he lay in bed. "Why's it so dark?"
Andrii, still groggy from having just awakened, thought the blanket was draped over his head.
"Then I realized that I couldn't pull off the blanket," he recalls.
And he could feel something over his eyes, which at first he dismissed as a sheet, until he got a feeling deep in his gut that something had gone horribly, horribly wrong.
He fell back asleep, for how long he's not sure. But when he awakened a second time, Andrii recalls, he could vaguely hear doctors speaking nearby. He tried to call for help but couldn't utter a word — there was an incision in his neck and a ventilator tube in his throat.
Unable to speak, he tried to spell out his questions in the air, waving a stump instead of his hand: "What's happened to me? What's happened [to] my hands? Do I have my hands? Why can I not see?"
Andrii's mind raced as he tried to quantify the loss of the life he once knew. As he lay in bed suspended in disbelief, he felt a presence in the room with him and then a gentle touch on his leg.
"Alina," he thought to himself.
Andrii's wife, Alina Smolenska, had traveled seven hours by car to be with her husband. And she had spent the past two days with him, hoping and praying, until he had finally awakened from his coma.
A wave of relief washed over Alina when Andrii awakened. It had been several days since two Ukrainian soldiers had come by the couple's home in Kyiv to deliver the news.
"He doesn't have his arms. He doesn't have his eyes. And we [don't] know what will be in [the] future right now," Alina recalls one of the soldiers telling her.
For Alina and Andrii, Russian President Vladimir Putin's war has taken so much.
It's a miracle that Andrii survived the blast that took his arms and eyes. Unfortunately, with no telling when the war will end, there's little that can be done in Ukraine to try to make him whole again.
Operation Renew Prosthetics and a second chance at life
This September will mark Andrii and Alina's fourth wedding anniversary, and at 27 years old they both have so much life left to live.
They no longer know what the future holds.
But what their lives look like could depend in part on the kindness of strangers.
And tragically, Andrii's plight is no longer an uncommon one in Ukraine.
Because the Ukrainian government doesn't release casualty figures, there's no way of telling exactly how many wounded soldiers and veterans like Andrii are in need. However, according to James Vandersea, director of upper extremity prosthetics at Medical Center Orthotics and Prosthetics (MCOP) in Silver Spring, Md., an estimated 7,000 to 10,000 wounded Ukrainian soldiers need prosthetics.
"Three to five times the number that we saw in Afghanistan and Iraq combined," he said.
However, with Ukraine keeping a tight lid on its casualty counts, there will be no way to know how many soldiers have lost limbs until the war comes to an end. The Wall Street Journal reported this month that between 20,000 and 50,000 Ukrainian soldiers may have lost limbs since the war began.
Mike Corcoran, a co-founder of MCOP and a prosthetist specializing in hip disarticulation, hemipelvectomy and military prosthetics, said it is a "staggering number" if true. He asked Ukrainian Col. Oleksandr Rozhkov at the Ukrainian Embassy in Washington, D.C., whether the reports were true. Corcoran says Rozhkov told him that he could not confirm or deny the numbers but that the figures were "not inaccurate."
"Even 25,000, in relation to the Afghan and Iraq wars, there was about 2,800 U.S. service members who lost limbs — you're looking at at least 10 times that," Corcoran said.
And with casualties mounting, Ukraine just can't handle that many patients. Olena Nikolaienko, president of Future for Ukraine (FFU) U.S.A. and the head of strategy and development for Future for Ukraine International, says the country used to treat approximately 3,000 new amputees every year, but the current volume of soldiers in need is overloading the health care system.
She said there used to be more facilities capable of caring for amputees in the eastern part of the country — where most of the current fighting is taking place — but those were forced to close when the war started. The remaining clinics in western Ukraine do what they can, she said, but they have limited resources to treat people with amputations, especially the complex cases that involve wounded soldiers. And as the war grinds on, she said, "the demand is going up exponentially."
Two new rehabilitation centers in Lviv, the Superhumans Center and the UNBROKEN National Rehabilitation Center, hope to someday meet that demand. But those facilities have only recently opened their doors. And with the sheer number of military personnel and civilians wounded and with no end to the war in sight, there's no telling how long some Ukrainians will have to wait for care.
That's why Future for Ukraine teamed up with two other nonprofits, United Help Ukraine and Revived Soldiers Ukraine, to help care for wounded individuals while the Ukrainian government focuses on the fight. In collaboration with MCOP, they launched Operation Renew Prosthetics, which cared for a dozen patients with amputations in 2022 and hopes to outfit another 24 this year.
"Losing an arm or a leg, or multiple arms and multiple legs, can be a great loss," Vandersea said. "You go through similar feelings as if you lost a loved one, you know? You're losing a part of your body, so you go through the five stages of loss and grieving, depression, etc. And it's important to try to make these individuals whole."
The medical center staff prepares for each patient in advance by reviewing photos of the injuries and then preordering the necessary components. This allows the soldiers to be cast and fitted with a starter device on Day 1 or 2, Vandersea said, until their custom prosthesis is ready. They then spend the next two to six weeks learning how to use their new limb under the care of trained occupational and physical therapists before returning home to Ukraine.
Making people whole again is expensive, and demand is high
According to FFU's Operation Renew Prosthetics fundraising page, it and United Help Ukraine have managed to raise just under $45,000 so far in 2023, of which about $31,000 has already been spent. And that's just on travel and accommodations for the wounded soldiers.
The major expenses come from the prosthetic devices themselves, which range dramatically in price. Vandersea said a basic below-the-knee amputation can be treated with a device that costs $8,000 to $15,000. But more complex cases, like hip disarticulation — removing an entire leg at the base of the pelvis — can run over $100,000. And most of the patients in the program require the most expensive devices.
"It wouldn't be uncommon for these prostheses, the equivalent market value, to be $100,000, $150,000, sometimes even a little bit more," Vandersea said.
The program has already provided care for 15 of the 24 patients it plans to help this year. And though the program obviously has a major impact on the patients it's helping, it's not nearly enough considering how many people are in need, Vandersea said. And funding is falling short.
"We need additional funds to take care of more of these soldiers," he said. "They need a lot more care than we have available to provide."
Vandersea said that Operation Renew Prosthetics and MCOP haven't announced whether they will be able to treat more Ukrainians in 2024. He hopes they can, but it all depends on the success of fundraising efforts.
Andrii lost both of his arms above the elbow, which could cost $60,000 or more per arm to outfit with a myoelectric prosthetic arm, according to MCOP, not including the follow-up care, rehabilitation and more.
And that kind of treatment may very well be possible for him, perhaps through a program like Operation Renew Prosthetics or through one of Ukraine's new medical centers.
As for Andrii's eyes, some of his doctors have put it to the couple plainly — he will never see again. But others remain optimistic, Alina says, because they believe the retinal nerves may have survived the blast.
"We really need the help, if it's possible, to do some surgeries or something else on the eyes. 'Cause Andrii doesn't have the eyes themselves," Alina says. "Hopefully, we think that the nerve is safe. We hope so."
Alina and Andrii are placing their hopes in experimental technologies that border on science fiction. They're exploring the possibility of volunteering to participate in new trials in optic prosthetics and bionic eyes so Andrii could one day see again.
"All my values were changed after that day"
Andrii had never wanted to be a soldier. He worked as a financial manager before the war, living with Alina in their Kyiv apartment. He had been putting money away to open an IT startup that would focus on app development.
Music was his passion outside of work. Andrii had started an annual music camp for small-town musicians, and it had 60 participants in its first program. The COVID-19 pandemic threw a wrench into his plan, but Andrii said he was very much looking forward to getting back into the music scene.
"I had really big dreams for the future," Andrii says.
But then the war came.
Friends urged him to leave Kyiv with them, but he refused. He wanted to fight.
"I wanted to protect what I had lost," Andrii says. "I feel a lot of compassion for all the people that live in my country. ... We all feel united that we just fight for what we love, for our country."
He struggled to join the military at first — the army desperately needed trained soldiers. But after a few months, he was able to join Ukraine's 47th Assault Battalion, which Andrii said was created as a unit for newly recruited civilians who wanted to defend their homeland. The unit has since expanded to become the 47th Mechanized Brigade.
On May 25, Andrii was low-crawling to retrieve a piece of equipment when the explosion happened.
"The official document states, 'artillery shell,' " Andrii says. "My friend told me they had no idea what specifically it was 'cause their focus was on my lost hands."
Whatever the ordnance was, it tore flesh and bone from limb. Shrapnel traveling thousands of feet per second battered his upper torso. Combined with the shock wave of the blast, it shattered every bone in Andrii's face and destroyed his eyes. Whether by dumb luck or divine intervention, the shrapnel didn't reach his brain. Additionally, his ears were badly damaged, resulting in temporary hearing loss, and capillaries in his lungs ruptured, filling the lungs with fluid.
Andrii's comrades rushed to save his life, treating him in the field before transporting him to a military hospital. They told him he was conscious, somehow, the entire time, but he says he doesn't remember anything following the blast.
The fact that he survived and with the injuries he sustained is nothing short of astounding considering the destructive power of an artillery round.
According to the global watchdog organization Human Rights Watch, a 155 mm high-explosive artillery round — the standard NATO round used by the U.S. and similar to the 152 mm rounds used by Russia — has a kill radius of 50 to 150 meters from impact.
The news reached Alina on the afternoon of May 26, and she arrived at the hospital around 2 a.m. the following day. The hospital staff members were less than thrilled when she showed up, given the time, but they let her see Andrii for 20 minutes.
Alone and far from home, Alina sat with her husband, cherishing every passing minute. She put her hand on his leg and hoped to God that Andrii could feel her presence.
"I believed that he [could] hear me, I believed that he could feel that I'm near him, and I believed — I knew — that it was important for him to know that I'm near him," she said.
Andrii came out of the coma the next day, May 28, scared and confused, but alive. He later told Alina that he did feel her with him in the hospital room.
Alina says that Andrii's brush with death was a transformative moment for her, an instant realization of what matters.
"All my values were changed after that day," she said. "I understood what is really valuable for me. I understood that family, Andrii, our house, is the most valuable thing in our life."
Alina has been documenting Andrii's journey on Facebook. She wrote in early June that she and Andrii were moved to a hospital in Kyiv. She also shared how Andrii's recovery has inspired her through his hospital-bed dance parties and when he makes the other patients laugh.
At the end of June, she chronicled how the two were finally able to spend time outside together and how he can talk again, though his voice was raspy with a light whistling from the tracheostomy tube in his neck.
Andrii says navigating what care and rehabilitation options are available — and those that are not — is difficult for himself and other wounded soldiers like him. He's dedicating the upcoming year to fighting for his future, in hopes of finding a path forward that he can then share with his fellow veterans.
"It's really hard. It's even hard to understand what's gonna happen tomorrow," Andrii says. "I'll do everything so the next veteran after me can just come and be helped psychologically, physically, in any kind of surgery."
