Victoria John sat on the floor and watched Alexander attempt what had once been ordinary. After losing both legs, he told her he wanted to walk without prosthetics, to move independently rather than surrender that part of his life to the injury. A photograph of the moment, which John believes appeared in Bild, captures his first steps and the concentration on her face as clinician and patient realize together that he has done it. Alexander had lain wounded in a field for 12 hours with three tourniquets on. Before the injury, he was engaged and had qualified to study ecology at Kyiv University. Now a few unsupported steps made a clear case for what rehabilitation should try to achieve.
But another patient first showed John the gap in Ukraine's rehabilitation system. His left leg had been amputated up to the groin, and his clinicians were understandably focused on that catastrophic, visible injury. Yet the amputation was only part of the damage caused by the blast. The soldier also had a massive traumatic brain injury, and half of his right foot was missing. His treatment accounted for neither condition.
The problem is not simply that too few people receive rehabilitation. The care available may also fail to see the whole injury. John puts the number awaiting therapy at 300,000 plus, while repeated exposure to blasts and shockwaves causes damage that can be less obvious than an amputation but no less consequential. She has had to be selective: prioritize eastern units, reach soldiers before redeployment and use a train the trainer model so that veterans can continue treating one another after she leaves.
The care available may also fail to see the whole injury.
The patient whose amputation hid two more injuries
On John's first day at a Ukrainian rehabilitation center, staff tested her with a question familiar to any clinician entering an unfamiliar institution: what would she do with this patient? The answer seemed to begin with the left-leg amputation, an injury so extensive that the limb had been removed up to the groin. Yet John's first move was not to prescribe an exercise. She asked the staff to return to the cause of the wound and examine what the blast might have done beyond the loss everyone could see.
The records revealed a massive traumatic brain injury. That changed every rehabilitation task that followed, including the use of a prosthetic. John compared the difficulty to learning to use one while drunk: clinicians could not assume balance, coordination and perception were intact simply because they were treating the amputation. Her assessment then uncovered another injury. Half of the soldier's right foot was missing, with serious consequences for the remaining limb on which so much of his mobility would depend.
The missed injuries did not mean the center's clinicians lacked competence. John found them very good, but short-staffed and pressed for time. Their treatment had narrowed to one injury when the patient needed a full assessment. A technically correct intervention can still fail if it isolates one wound from the body carrying it. The case showed John that more than three decades in NHS and British military medicine, particularly her work at the Defence Medical Rehabilitation Centre, had prepared her for a need in Ukraine that was larger and more complicated than she had expected.
A technically correct intervention can still fail if it isolates one wound from the body carrying it.
"Don't go easy on them" became the treatment rule
Military rehabilitation taught John to begin with a different assumption about a wounded person. At HMS Nelson, Tidworth and the Defence Medical Rehabilitation Centre, she saw care organized around community, teamwork and the patient's control over an injury. The goal was not simply to reduce vulnerability or manage dependence. Clinicians showed military patients what remained possible, including a return to their careers. Professional identity was part of treatment because it helped define the function each patient wanted back.
British triple amputee Mark Ormrod distilled that approach into a blunt instruction: "don't go easy on them." In less careful hands, the advice could sound callous. In John's practice, it means something different. She does not ignore pain or force a body beyond safe limits. She controls the injury, chooses the exercises and pushes the patient far enough to reveal what the body can do. The demand comes from close clinical attention, not bravado.
John treats Ukrainian soldiers with what she calls utmost respect because they have endured pain and circumstances that are difficult to imagine. But respect does not mean lowering expectations so far that patients never discover what they can do. Care that defines a wounded person primarily by fragility may deny that person a chance to recover function. John's approach is direct: manage the injury precisely, then ask more of the patient. For those still closely connected to a unit, role or military career, restored function is not an abstract return to "normal." It is a route back to the life and responsibilities the injury interrupted.
Why soldiers facing redeployment move to the front of the list
The Ukrainian military was said to acknowledge about 300,000 people awaiting therapy. John's working estimate is 300,000 plus because that figure excludes some people who have left therapy and those who never seek it, instead carrying their injuries back into daily service. The waiting list is only one measure of the crisis. Another is the soldier who has learned to live with pain, impaired movement or the effects of a blast because no realistic route to treatment exists.
Scarcity forces uncomfortable choices. John prioritizes eastern Ukraine, where units may have little or nothing, while more money reaches hospitals, units and charities in the West. Before traveling, she provides her arrival date and asks units to identify what they need. They send details of soldiers recently returned from deployment, the injuries they carry and when they are expected to go back. The resulting clinic list reflects both the severity of an injury and what each soldier faces next.
That is why an injured soldier nearing redeployment may move ahead of someone who appears more critical. If someone returns to a trench without functioning properly, the impairment can endanger that soldier and nearby colleagues. Treatment before redeployment may prevent another casualty and ease pressure on medics and hospitals further down the chain. Some of John's patients have received no intervention since discharge; others have managed their injuries alone. She asks for whatever medical records exist, establishes whether any care took place and often starts again with an initial assessment.
If someone returns to a trench without functioning properly, the impairment can endanger that soldier and nearby colleagues.
In Dnipro, veterans learn to treat the person beside them
John generally returns to Ukraine every two months. However effective one treatment may be, that interval leaves ample time for symptoms to change, exercises to be misunderstood and new injuries to appear. One visiting clinician cannot treat enough patients individually. Her train the trainer approach leaves practical skills inside units and rehabilitation centers: basic treatments, exercises and instructions that veterans can use with colleagues between her visits.
At Way to Health in Dnipro, the turning point came when observation gave way to hands-on work. Alex, the center's trilingual CEO, helped explain John's instructions while participants watched politely and nodded. Then she asked them to pair up, copy her actions and work with the person in front of them. An arm moved better. A knee felt better. The participants could see that the improvement had not required expensive machinery. It came from a technique they had just performed themselves.
That result changes the trainee's role. A veteran who has regarded health care as something only professionals provide begins to recognize an ability to help the colleague beside him. John can later answer questions online when a trainee reports a particular symptom, but remote advice cannot replace guided practice at the outset. Longer stays would let her turn informal teaching into a complete program, taking trainees from instruction through supervised practice until they can apply the methods confidently without her. Her aim is straightforward: treatment should not depend on her being there.
Alexander's first steps show what the rebuild requires
Alexander was critically injured, in John's recollection, on September 23. He lay in a field for 12 hours with three tourniquets on before surviving as a double amputee. The sequence is brutal, but it does not tell the whole story of who he is. He had been preparing to study ecology at Kyiv University. He was engaged. When he approached John in a mechanized wheelchair, he did not ask only for greater comfort. He said he wanted to walk without prosthetics and become independent.
The photograph of his first steps records a shared realization despite differences of language and culture: he had done what he asked to do. John had recently received Mark Ormrod's advice not to go easy on military patients, and Alexander's effort put that rule into practice. His injuries had not disappeared. Rehabilitation had uncovered a function that might easily have been dismissed as unrealistic if no one had tested it.
Rehabilitation had uncovered a function that might easily have been dismissed as unrealistic if no one had tested it.
Ukraine's eventual rebuild will require the same refusal to equate injury with an absence of capacity. John argues that veterans living with amputations and traumatic brain injury should be placed front and center rather than treated as passive recipients of care. Corporations participating in the rebuild should employ them and provide therapists who can support them at work. Eastern Ukraine, where front-line fighting has created extensive need while rehabilitation resources remain scarce, cannot be excluded while benefits accumulate in the West.
A veteran treating a veteran is more than a partial answer to the shortage of clinicians. Shared military experience can help the treating veteran understand what the patient has endured, which functions matter and what outcome the patient wants. John saw that principle in British military medicine, where soldiers treating soldiers understood their patients in ways that were difficult to reproduce from outside. In Ukraine, it can also provide a role for wounded veterans whose knowledge came from conditions no classroom can reproduce.
Purpose and belonging cannot replace physical therapy, and John does not claim they can. They are part of what gives rehabilitation a practical meaning. A veteran trained to help another veteran receives treatment while also contributing to a unit, a workplace and, eventually, a national rebuild. Alexander's first steps matter because they show what can emerge when clinicians treat the whole person rather than only the missing limbs. The rehabilitation gap begins with injuries overlooked under pressure. Closing it requires more trained people within the communities carrying those injuries, ready to recognize and develop the capacity that remains.
