A soldier from Ukraine’s 47th Mechanized Brigade runs past a U.S.-made Bradley Fighting Vehicle as the engine is started at a secret workshop in a wooded area in the Zaporizhzhia region in July. (Ed Ram/The Washington Post)
Bodies ripped to pieces. Arms and legs mangled beyond recognition.
The mental anguish of amputating limb after limb after limb is a grim reality of Ukraine's counteroffensive for doctors working in the Zaporizhzhia region.
Heavily mined Russian defenses have slowed Ukraine's attack to a bloody, painstaking crawl, and hard-won gains come at the cost of mine blast injuries more abundant than some medical professionals say they have seen in the war thus far. With Russian forces having dug in over months, any push to regain territory means traversing land dense with mines — even as civilians far from the front lines grapple with a diffusion of mines and other explosives in previously contested areas across much of the country.
"The mines are just everywhere," Ukrainian military surgeon Dmytro Mialkovskyi, who has worked in the country since start of the war, told The Washington Post from a hospital in Zaporizhzhia — a region at the heart of the counterattack — which he would not identify for security reasons.
Mialkovskyi said he has treated more mine blast injuries since the start of the counteroffensive in early June than in his previous work in Kherson and Kramatorsk — and even Zaporizhzhia last year. His hospital typically receives a minimum of two mine blast injuries every day, though doctors recently treated 11 such casualties, including traumatic amputations, in a single day.
"It's really devastating because when you see a young fellow, 21 to 24 years old, with no foot, no lower leg, you understand that at least he's alive, but for his entire life he must use a prosthetic," Mialkovskyi said.
"He's a disabled person. And there are many now," he said — a rising number of people injured by land mines in Ukraine.
Ukraine has become the most mined country in the world, with more than 67,000 square miles of the country estimated to be contaminated by dangerous mines, unexploded bombs, artillery shells and other remnants of war. Hundreds of civilians have been injured, and fertile farmland rendered dangerous or unusable, in a catastrophe experts say will take decades to clear.
The start of Ukraine's counteroffensive brought stark changes to Mialkovskyi's Zaporizhzhia caseload. Before, he was able to perform elective surgeries such as hernia repairs. Now, he is only able to treat bullet wounds, extract shrapnel from wounded tissue and attempt to salvage limbs shredded by mine blasts. He performs three to four major surgeries and a few minor surgeries every day, primarily treating Ukrainian soldiers evacuated from field hospitals and battlefields.
Mine blast injuries are especially grotesque. Samer Attar, a Syrian American orthopedic surgeon at Northwestern University who recently volunteered in Zaporizhzhia with Mialkovskyi described the wounds as "a jumble of tendons, bones and muscles."
The "anatomy is distorted and mutilated and you can't make any sense of it," he said.
High-energy injuries like those caused by mine blasts change tissue on a molecular level, meaning patients must often wait for days while doctors remove dying flesh and determine what parts of the limb are salvageable. Then come multiple surgeries in which Attar says doctors find themselves "fighting for every square inch of functional limb," because prosthetic performance increases with the length and coverage of the residual limb.
Mialkovskyi said he was translating a recent medical training session hosted by U.S. volunteers when he was called away to assist on a surgery. He joined another doctor desperately trying to save a young mine blast victim with severe and complex injuries to both legs.
As the physicians worked, the patient's vitals declined and Mialkovskyi had to make a split-second decision. Choosing life over limb, he removed both legs in 10 minutes. The case would stay on his mind for days to come.
"I did what I had to do," Mialkovskyi sighed, recounting the harrowing procedure.
"The guy lost both legs and now his life is still in danger," he said. "I am not sure he will make it."
Later, Mialkovskyi said he went to check on the 24-year-old, who had been moved to the intensive care unit. The patient was in grave condition, but to Mialkovskyi's relief, still alive.
To the physicians, small victories like keeping one patient alive through the day offer slivers of hope in an unending torrent of suffering.
The doctors cling to daily glimmers of normalcy and resilience: A hospital cook who makes it his mission to keep the staff fed. A civilian coffee cart parked in front of the hospital, creating a sense of safety and solace just miles from the war's front lines. But the relentless exposure to injuries of war that will take a lifelong toll is demoralizing.
For Attar, the experience is not a new one. Before Ukraine, he treated patients mangled by Russian munitions in Syria, where conflict has raged for more than a decade.
In the course of multiple medical missions to under-resourced, underground Syrian hospitals in rebel-held areas, including during the years-long siege of Aleppo, Attar treated patients as Syrian President Bashar al-Assad laid waste to rebel-controlled civilian neighborhoods — with the help of airstrikes by his Russian allies and backers, who first intervened in the Syrian civil war in 2015.
Attar treated more bombardment victims in Syria, but more mine blast injuries in Ukraine.
"The injuries look the same, whether they are Ukrainian or Syrian," he said. "A jumbled mess of bone fragments, splayed tendons and muscle from an arm or leg underneath blue surgical drapes."
In Ukraine, Attar has removed limbs from people from all walks of life: an opera singer who cheerfully proclaimed his injury would not affect his passion, a mine clearer who was struck by a drone in the midst of a minefield.
"It's hard to feel good about yourself and the world when all you are doing is removing limbs from healthy young folk," Attar said.
Mialkovskyi said he, too, was haunted by the influx of brutal, life-altering injuries.
"We try to behave like nothing happens," he said. "But it hurts."
