DNIPRO, Ukraine — Artillery strikes and aerial bombardments. Drone attacks and grenade blasts. Land mines, mortars and bullets. Such are the front-line perils for soldiers in Ukraine.
In war, the dead are buried. Lost limbs are fitted with prosthetics. Less visible are the thousands of combat-related brain injuries that represent one more grim toll in Ukraine’s war of attrition.
For many, the journey that begins in a battlefield medical unit leads to Mechnikov Hospital in the eastern city of Dnipro. Since Russia’s invasion in 2022, the hospital has admitted more than 26,000 combat casualties. Some 90% arrive with blast-related concussions or severe brain injuries.
The influx has made Mechnikov among the busiest combat trauma centers in the world, a place where hallways and operating rooms have been converted into critical care wards to hold the 50 or so new casualties that arrive every day.
Mykola Polishchuk, 34, was one of them. A member of a mortar team, Polishchuk was running ammunition to a forward position in January when an anti-tank round exploded a few meters from him. A piece of shrapnel pierced his cheek and lodged 3 inches inside his skull.
“The first thing I felt was a sharp pain in my cheek,” he said. “I thought I had lost half my face.”
Andrii Sirko heads Mechnikov’s team of 20 neurosurgeons. Since the start of the war, he and his colleagues have performed more than 1,300 brain surgeries.
“This job is not difficult physically,” Sirko said. “It’s difficult emotionally because these patients are the same age as my eldest son.”
During a three-hour operation on Polishchuk, Sirko used a microscope and long surgical tongs to retrieve the fragment from his skull. The next morning, he offered it to Polishchuk when he visited him on the recovery ward.
Once stabilized, patients are evacuated by train to hospitals and rehabilitation facilities away from the front line.
Roughly 70% of Ukraine’s war casualties suffer polytrauma, or multiple injuries, according to Sirko.
At a military hospital near Lviv, in western Ukraine, patients with blast-related injuries undergo both physical and cognitive rehabilitation.
The hospital also performs follow-up surgeries.
Petro Yakovych, 35, a Ukrainian soldier who was shot in the head during fighting in the southern Zaporizhzhia region last September, emerged from previous procedures with a hole in his skull. He recently had an operation to replace missing bone fragments with a polymer plate.
Blast-related injuries are common in an artillery war with an entrenched front line. Even without penetrating wounds, that pummeling can inflict lasting trauma on the brain — that roughly 3-pound mass of fat and protein that makes us who we are.
At close range, a blast’s force can be incredibly destructive — necessitating intricate reconstructions of the skull to repair what bombs can destroy in an instant.
Mykhaylo Bielov, 31, a soldier with Ukraine’s national guard, was defending the eastern city of Bakhmut on Dec. 31, 2022, when a Russian grenade exploded above his head.
“I remember a white light and how it went out,” he said. “I remember putting out the fire on my uniform and spitting out my tooth.”
Emergency surgery at Mechnikov Hospital saved his life. He spent a month in a coma. His recovery will take years.
After a year of physical therapy, he still has limited mobility, and the shrapnel that his doctors deemed too dangerous to remove remains lodged in his head and neck. In January, he endured what is known as a brain prolapse, in which tissue and fluid bulged from the part of his skull where the bone was missing.
His 10th brain surgery — to insert a titanium plate — repaired the damaged area and contained the swelling. He has since resumed his rehabilitation at a facility in western Ukraine.
Doctors said Bielov could make a full physical recovery. But true healing takes time.
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“Sometimes, tears just flow when I wonder when this prison will end,” said Bielov, whose son Yevhen, 8, has struggled in the wake of his father’s injury.
Bielov’s wife gave birth to a daughter six months ago. They named her Viktoriia.
“I understand that it will not be like before,” Anhelina Bielov said. “My husband, even after returning home, will no longer work and do as he did before. I do not make special plans for the future. We live as it is.”
This article originally appeared in The New York Times.