In the early 1980s, military forces from the Soviet Union went to war in Afghanistan in an effort to prop up a failing Marxist regime. At the time, Ukraine was part of the union, and many of its people were conscripted. Plenty of soldiers ended up losing legs in the fighting 鈥� and back then, their options weren鈥檛 good.
Shockingly, the Soviet authorities鈥� response was to offer them a medical version of a skateboard to get around. 鈥淭hat was your only option,鈥� says , a former adviser to Ukraine鈥檚 government. 鈥淭hey were just rolling on wooden boards with wheels around the cities.鈥�
Fast-forward to today, and Ukrainians have again been thrust into a war they didn鈥檛 choose. This time, the conditions of modern warfare mean that unprecedented numbers of people are losing limbs, presenting the country with a huge challenge. The response, however, has been very different. Kumka, who is a co-founder of , an initiative to improve the lot of Ukrainians with amputations, has been stepping up her work. And her organisation is just one part of a sprawling network of clinics, start-ups and research labs that has sprung up to help the injured.
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Thankfully, no skateboards are involved. But questions abound. Does Ukraine really have what it needs to help the legions of injured people 鈥� many of whom will need prostheses for decades to come? Is this newly created industry always acting in the best interests of those it assists? And it is worth asking what the rest of the world can learn from Ukraine鈥檚 booming prosthetics industry.
Unsurprisingly, statistics on the number of Ukrainian amputations are murky. Figures of up to 100,000 are often mentioned in news reports, apparently based on government estimates. But Ukraine has an interest in exaggerating this number to bolster international empathy and support. Kumka, who can access official statistics as part of her work, tells New 女生小视频 the real number is around 24,100, counting from the beginning of 2021 to the end of 2025. (Neither the Ukrainian Ministry of Health nor the Ministry of Social Policy responded to requests to confirm this number.)
However, even that lower estimate represents a tragic loss for a whole generation of Ukrainians. For context, 12,000 UK service members lost limbs in the six years of the second world war, while around as a result of injuries sustained during 16 years of fighting in Iraq and Afghanistan. For Ukraine, which had one of the lowest incomes of any European country even before Russia鈥檚 invasion, the necessary medical response is an enormous challenge.
The nature of the war today means that not only are amputations more common 鈥� on both sides 鈥� but they also tend to be particularly difficult cases. The front lines are shrouded in a wide no-man鈥檚-land, known locally as the Kill Zone, in which drones dominate and no vehicle can move without attracting deadly attention. Anyone from Ukraine injured in this zone faces a difficult extraction that is only partially being addressed with ground drones at the moment.
works at (which translates as Prosthetics Foundation), a non-profit clinic in Ukraine that supplies and fits prostheses (and which isn鈥檛 connected to Protez Hub). He says one person recently came in having been stuck on the front line wearing a tourniquet for 60 days. These devices stem blood loss in the short term, but create complications in the long term. They were simply never designed to be used for such lengthy periods. 鈥淭ourniquets are saving lives, but losing limbs,鈥� says Gradinar. He estimates that as many as 95 per cent of these patients would be dead without the life-saving devices, but that they also lead to amputations much higher up the limb because the flesh below them rots once it is deprived of blood flow.
Payments for prosthetics
One of the reasons the prosthetics industry in Ukraine now extends far beyond Gradinar鈥檚 organisation comes down to money. Before Russia鈥檚 invasion in 2014, Ukraine had only a small number of prosthetics workshops dealing with cases from car accidents and medical amputations. The government would pay almost $700 per limb, which the individual could use as they saw fit. Since then, Kumka has been a leading figure in campaigning for greater investment and better legislation. Now, the Ukrainian government will pay $100,000 to soldiers for each lost limb, allowing them to go to any of the country鈥檚 increasingly numerous private clinics, or even abroad, and choose a limb that suits their needs. When limbs wear out after two to five years, they can receive the payment again. (It is a similar situation for civilians who lose a limb, albeit with less money available.) Over the coming years, this will cost the government 鈥渂illions and billions and billions of dollars鈥�, says Kumka.
This investment has catalysed the development of new clinics, labs and more. Former doctor launched a company called six years ago 鈥� before the full-scale invasion 鈥� to develop sensor technology that could be licensed to other companies for use with prostheses. But when the war ratcheted up, Gazda wondered whether this technology could be adapted so the company could create its own prosthesis for wounded soldiers. 鈥淭he Ukrainian prosthetics market is definitely shaped by war. We as a company, also, we are shaped by war,鈥� he says.
Since then, Esper has developed an advanced robotic prosthetic hand that has six motors controlled by sensors, allowing the wearer to move the hand faster or slower as needed. It is more dextrous and capable than most prosthetic hands. Around 60 per cent of its nearly 250 components are made in Ukraine. The Esper Hand is waterproof, can carry loads of up to 35 kilograms and is highly modular, so breakages can be easily repaired without having to ship it to a service centre. It is also 10 per cent lighter than a human hand 鈥� although Gazda says everyone who holds it thinks it is heavy, largely because they have never held a human hand in the same way.
Esper now employs 65 staff, and although its head office is in New York, most of them work in Ukraine. More than 600 soldiers have been fitted with at least one Esper Hand, and more than 50 of those are back on the front line. According to Gadza, one soldier called Volodymr, who lost both arms in a drone attack, has now been fitted with a pair of Esper Hands. He subsequently qualified on an elite sniper course, which he put down to the hands no longer having a pulse running through them, allowing him to be unnaturally still and precise. He also started to paint, and has held his first exhibition.
Another example of Ukraine鈥檚 burgeoning prosthetics industry is Gradinar鈥檚 Protez Foundation. Amputations higher up a limb generally lead to a harder rehab, and any prostheses with a knee, which are more difficult to learn to use, are more complex to build and fit, and therefore more expensive. We have long known that . Not only is Ukraine seeing huge demand for prosthetics care, but it is also seeing the most challenging cases imaginable.
Gradinar says that many new clinics take only the easier cases, but he prides himself on never saying no. He has fitted devices from Icelandic company 脰ssur, which uses resin and glass fibre to mould a socket that fits the user closely, on shorter amputations than the company had ever previously seen done 鈥� pushing the boundaries of what was believed to be possible.
Other Ukrainian companies are emerging all the time. Kyiv-based makes an electronic hand with 3D-printed construction, backed up by aluminium where needed, which runs for two days on a single charge. A smartphone app helps users learn to operate the device and track usage stats. Syla makes a prosthetic knee that uses AI to help the wearer control it intuitively and lets them walk at up to 10 kilometres an hour, with a battery life of 24 hours. There are also treatment clinics, such as , which has three sites across Ukraine and more than 600 staff.
However, it isn鈥檛 a uniformly positive picture. Kumka says some prosthetics clinics are spending a great deal on marketing and PR, and are prioritising their bottom line and patient numbers over quality of care. 鈥淧rosthetics and amputations in general are very lucrative for charities right now, I鈥檒l be honest,鈥� she says. Patients face multiple pitfalls, she reckons, including clinics that fraudulently fit cheaper devices while claiming the cost of more expensive ones, or charities that seek foreign aid but also apply for government reimbursement for treatment. Gradinar concedes there are problems in places. 鈥淚t鈥檚 corruption, but it鈥檚 survival mode,鈥� he says. 鈥淚t鈥檚 getting, each day, better and better.鈥�
The economics of medical devices in wartime can also be jarring. For instance, many prostheses currently fitted in Ukraine come from German company Ottobock. But it also openly sells to Russia. The company told New 女生小视频 that Russia represented 8.8 per cent of its global revenue in the first half of 2025, up from 5 per cent in 2023. A puts the figure at closer to 35 per cent, and says that despite claiming to sell only to civilians, Ottobock鈥檚 devices have been seen in footage of Russian soldiers. Ottobock refuted that figure and told New 女生小视频 it doesn鈥檛 work directly with the Russian military, but cannot rule out that its devices may end up on its front lines.
On top of that, there鈥檚 a more direct worry: that the swift innovation going on in Ukraine may result in Ukrainians being fitted with untested devices in a manner that would be considered unethical in peacetime. 鈥淭here are so many different companies going into Ukraine with their less-than-perfect solutions and trying to use Ukrainians as [experimental] material,鈥� says Kumka. 鈥淭hey would never pass ethical board regulations [in other countries], and they would never be approved, but in Ukraine, they can do that because nobody stops them. They鈥檙e using it as a testing ground.鈥�
Finally, despite the number of start-ups and new clinics working on advanced devices, many prosthetics experts believe there remains a critical shortage: medical expertise. On average, someone with an amputation requires nine medical visits in the first year alone, whether that be fittings, physiotherapy appointments or psychological support. And even when the prosthesis is in place, that isn鈥檛 the end. Amputation surgery causes a great deal of swelling, so the person being treated often finds that their first prosthesis quickly becomes ill-fitting as the limb heals and reduces in size. Given all of this, prosthetics engineer at the University of Southampton, UK, says the biggest problem in Ukraine isn鈥檛 necessarily to do with the prosthetics hardware. 鈥淚t鈥檚 the [lack of] trained clinicians,鈥� he says.
In the medium term, there will be further changes, as muscles that once had a strenuous job find themselves doing much less, or even nothing at all, and atrophy, while others get stronger. So, someone may have three prosthetic limbs in their first year.
Then, in the longer term, prostheses simply wear out. Once an individual has adapted, this can happen every two to five years, meaning they may get through a dozen or more in their lifetime. 鈥淚t鈥檚 a really good sign [when a prosthetic] leg falls apart, because it shows the person鈥檚 working really hard on it. It actually got them back to really good physical activity,鈥� says Dickinson. 鈥淪o, it鈥檚 lifetime care that these people need.鈥�
Ukraine has already shown itself capable of building a drone industry from scratch, reducing its reliance on politically problematic supply chains, then becoming a global expert and exporting its knowledge and products around Europe and the US. It is possible the same could happen with prostheses 鈥� the fact that Esper now has a head office in the US may be a sign of that.
Still, it is fair to say that helping people with amputations adapt to their new lived reality goes far beyond fitting a prosthesis or even providing ongoing mental health support. Take the fact that cities in Ukraine aren鈥檛 exactly known for their ease of access for people with disabilities. On a recent reporting trip to Kyiv, I was struck by the city鈥檚 beauty, but surprised by how car-centric and hostile to pedestrians parts of it were.
Many of those who have lost limbs are young men with long lives ahead of them, which perhaps explains why there is now plenty of talk about addressing this problem. The military veteran and double amputee Oleksandr Budko has a YouTube show in which he takes Ukrainian celebrities to different cities to test them for accessibility. In one episode, he and television presenter Masha Efrosynina roll through Lviv in wheelchairs, and their inability to get up the steps into cafes.
Making old cities accessible is vital in every country, but for Ukraine, the need is being thrust into the mainstream by a young generation of recently injured people. As the country rebuilds in the coming years, it will need to ensure that it is done with accessibility first and foremost in mind 鈥� and Budko has found that air for advice. All this will take time, no doubt, but we have already come a long way from those medical skateboards.
