"Guys in captivity are forced to walk with their heads constantly bowed down in places of detention." How those who survived captivity are rehabilitated and retrained to move
"We cannot comprehend what the Russians are doing. Neither as normal people nor as doctors. Perhaps this is some new form of torture. They were not just told to lower their heads; their entire torso had to be bent forward with their hands behind their backs," says Yuliia, head of the department at the National Guard of Ukraine’s medical center and a specialist in physical rehabilitation medicine.
For security reasons, we agreed not to disclose the name of the facility where servicemen who were returned during prisoner exchanges undergo rehabilitation, nor to reveal her last name. Instead, we spoke about what our soldiers had to endure in captivity, the consequences this had on their health, and whether it is possible to restore it enough for them to live a full life afterward.
"WHEN THE GUYS RETURN, THEY CRAVE SOMETHING TASTY — SHAURMA OR A HOT DOG, COKE OR PEPSI"
– Yuliia, recently, prisoner exchanges have been happening more often, and more of our defenders are coming home. We see that they are exhausted, injured, and severely wounded, have lost significant weight, and are disoriented due to limited access to information. Later, in interviews with journalists, they shared about the torture they endured. But how does the center work with those who have just returned? What do they tell you?
– Many of our soldiers are indeed captured while wounded. We can assess the adequacy of the medical care they received there by observing the condition in which the guys return and the consequences they suffer. For example, fractures with displacement that may have healed incorrectly or not healed at all. This can result in a deformed or shortened limb. We also see what kind of ‘care’ they were given for their wounds.
We also observe the effects of torture. Additionally, there is malnutrition and changes in their posture because, in fact, they are being retrained to move incorrectly.
– How are they retrained?
– In captivity, the guys are forced to walk with their heads constantly bowed down in places of detention. This goes on for months, even years, leading to significant changes in posture. They suffer from persistent pain and return with pronounced kyphoscoliotic posture and deformities.
Additionally, there is protein-energy malnutrition, disrupted mineral metabolism, and severe joint changes, even in young men.
When they return, assistance is provided to them in stages. They undergo a comprehensive examination with us, including laboratory and functional tests, MRI, and X-rays. We identify what impairments each individual has and where any fragments remain in the body. If necessary, surgical interventions are performed.
One of the stages also involves psychological support. Nutritional support is provided as well, aimed at restoring normal eating habits. In our recommendations, we always specify what they can consume and what they should avoid. When the men come back, they often crave something tasty — shawarma or hot dogs, cola or Pepsi. For their gastrointestinal tract, however, this is simply lethal.
The next stage of rehabilitation is functional assistance. Our center has established a multidisciplinary rehabilitation team that gradually works on restoring the patient’s normal functioning. Everything is tailored individually, depending on the patient’s specific issues. Whether they are patients recovering from mine-explosive injuries affecting limb function, need posture correction, or require comprehensive care, we address it all. Patients see both physical therapists and occupational therapists. They engage in gradual cardio training because most tire very quickly. Even if they were previously accustomed to covering distances of tens of kilometers with mild fatigue, now they struggle to climb a few floors. They experience shortness of breath, and dizziness may occur when bending over. Therefore, the set of procedures and exercises we provide is phased, and recovery can take several weeks or even months, depending on the person’s health condition.
– Could you explain in more detail what this complex includes?
– Kinesiotherapy exercises and mechanotherapy, we have numerous trainers and robotic systems for both upper and lower limbs. There are also devices to restore overall muscle tone. These include balance systems and systems designed to re-establish normal movement patterns and gait stereotypes.
Patients also receive physiotherapy treatments. These are device-based therapies, such as myostimulation to activate muscles when needed, ultrasound therapy, and stimulating procedures like magnetolaser therapy. Additionally, balneological treatments, manual massages, and much more are provided.
– You mentioned that the men describe being forced to walk with their heads bowed. Do they explain why they were made to do this?
– We cannot understand what the Russians are doing, neither as normal people nor as doctors. Perhaps it’s some new form of torture. They were not simply told to bow their heads; their entire bodies had to be bent forward, with their hands behind their backs. They were only allowed to move this way. Moving from one room to another otherwise was prohibited.
Overall, the men describe many types of torture. What was done to them is beyond comprehension.
– They were probably also forced to walk quickly, bent over, to make it even harder.
– Yes. The men also said they were forced to stand with their legs widely apart. For example, one patient had limited mobility in a limb and shoulder joint problems because he, like others, was forced to stand for 15–20 minutes with his arms raised. They had to stand until they no longer felt their arms. This goes beyond pain, it’s the inability to hold them up. This is another form of abuse. They might not hit you directly, but if you lower your arms, it’s inevitable.
– What are the consequences if someone stands like that for months, with raised arms and bent torso while walking?
– There will be organic changes in the joints, inflammation of ligaments and tendons, and muscle problems in those areas. All of this will require a rather lengthy recovery.
The peripheral nervous system is also affected when there is numbness in the fingers and trophic changes in the limbs.
Simply put, this results in impaired joint function. Any movement causes pain and cracking sounds. The pain can be quite severe and long-lasting. Therefore, anti-inflammatory therapy and local treatments that improve blood circulation, trophic processes, and promote the restoration of mobility and joint stability are necessary.
– Does it happen that a person essentially has to be relearned to walk "correctly"?
– In 90% of cases, we have to retrain the men to move. We show them what proper posture should look like.
Once, a patient came in and said he had practiced ballroom dancing. We could imagine the posture he had before captivity. But now, in front of us, stands a completely bent man with kyphotic and scoliotic posture. We understand how much he was tortured.
– Very often, those who have returned from captivity tell journalists that they were subjected to electric shocks. Do your patients mention this as well?
– We ask patients whether to prescribe procedures involving electrical stimulation so they don’t "relive" flashbacks. Some say it’s no problem, they understand it will help and affect their muscles. Others refuse such treatments.
There are patients who are even difficult to touch at first. We warn them: "I’m going to examine your back now. May I apply pressure?" Sometimes they jump, reacting to the touch. That’s why we proceed as delicately as possible, always asking permission before performing any procedure and explaining exactly what we’re going to do.
– If they generally don’t want to be touched, what do you do?
– We simply assess their range of motion, and then all rehabilitation support is provided without physical contact.
We have quite good and diverse equipment that allows patients to perform exercises independently.
Additionally, in such cases, psychological support is intensified.
– Once, a female servicemember told me about psychological support after injury. The psychotherapist asked her to imagine the sea. She shared that her imagination did not picture a blue or turquoise sea, but a red one.
She was not in captivity, but it was still very difficult for her. It’s unimaginable how the men who went through all that hell cope with psychological trauma. Are they able to get help?
– Psychologists use an incredible variety of methods tailored individually to each patient. For some, art therapy works well, where they paint pictures. Psychologists also pay attention to the colors they choose.
Their drawings often depict fear and chaos.
– And which colors dominate?
– At first, red and black.
– When do other colors appear?
– You’d better discuss that separately with psychologists, so I don’t give you incorrect information. I can only speak about the drawings shown to me, where red and black predominated. One patient, describing his drawing, said it looked as if it were painted by the director of hell.
When they find someone they trust and feel more open with, they start sharing a lot. Sometimes we talk for hours, not only about their captivity experiences but also about family and children.
You hear a lot of stories after working for several years. You learn how the types of torture evolve, how the men in captivity received information, and how to interpret it all.
"LETTERS ARRIVED, BUT ALL LIKE COPY-PASTE"
– We wanted to send a letter to a journalist colleague who has been held by the Russians for three years. The Red Cross Committee advised us to send not a written letter but a child’s drawing—to convey the message that his parents are healthy and that we are helping them. We followed the advice, and indeed, a five-year-old child drew it. But we never found out if he received it.
— The guys said that letters did arrive, but they were all like copy-paste. On the one hand, they recognized the handwriting of their relatives. On the other, it felt as if someone dictated these letters because they were all basically written the same way. Without much emotion, saying something like, "Everything is fine here, the house is intact."
But everything depends on where exactly the prisoners of war are held. In some places, for example, they were fed more or less adequately and given time to eat. Others said they were allowed only seconds to have a meal.
Some of the men have scars on their faces. When I asked where from, they explained that they had to shave their heads and faces in the dark with dull razors and only two minutes were given for this. There was no soap or water.
One patient told me, "You enter that bathroom, and everything is covered in blood."
– You said that the methods of torture are changing. Is this based on what the men tell you, or are you already seeing a pattern from those who have returned?
– We do see a pattern. These are not people who would commit such acts themselves.
– Were the Russians harsher towards prisoners of war at the beginning of the invasion or now? What do your patients say?
– They don’t compare; each person tells their own story. It all depends on who they were, their rank, and the conditions they ended up in. Recently, people have arrived at our center in quite serious condition, with trophic ulcers and lymphedema. This especially concerns older individuals who have chronic illnesses, atherosclerosis, and whose wounds no longer heal quickly.
– When military personnel freed from captivity arrive with amputated limbs, is there still something that can be done to enable future prosthetics?
– Usually, they undergo reamputation because most already have osteophytes. In other words, the initial traumatic amputation—done in Russia—was not performed properly for our servicemen. They just stitched it up and left it at that.
After reamputation, they proceed to prosthetics.
– With fractures, they don’t really bother much either—no casts applied and no rehabilitation afterward, is that correct?
– Splints were applied and dressings were done if the fractures were open.
When the bones healed somewhat, the men themselves worked on mobilizing the joint as best they could. I tell them they’re doing a great job because if they hadn’t, it would be much harder for us now to restore limb function.
In such cases, trauma surgeons decide whether repositioning and surgery are needed. Most often, they are.
– So, in most cases, these fractures have healed improperly?
– We observe this during medical examinations. Often, these are displaced fractures. They could have gotten them in various ways, not only during combat. In captivity, their limbs are broken, and their legs are often shot.
Even if a splint is applied, no one realigns the bone fragments. No one performs surgical interventions either.
– Do you treat women as well, or only men?
– Women, too, but fewer in number.
– Are their injuries similar to those of men?
– We have had women with bruises but no fractures. Contusions and soft tissue injuries to the lower limbs and back.
– Do they also lose a lot of weight?
– Yes, they also arrive with weight loss and protein-energy malnutrition.
By the way, among the men, some lost over 50 kilograms during captivity.
– Is there a certain weight threshold below which survival becomes impossible?
– It depends on the person’s height because of something called the body mass index. If a person’s weight drops critically low, at some point, their heart simply stops. Overall, multi-organ failure occurs, including liver and kidney failure. This happens because vital nutrients enter the body through food—carbohydrates, for example, are essential for brain function. If there isn’t enough, the body exhausts all its reserves.
– Sleep is an important part of healing and recovery after illness. How do your patients sleep after experiencing such horrors?
– I always ask those who arrive how they sleep. Some actually sleep normally. But there are other cases. One man said, "In captivity, I was exhausted and passed out. But now I can’t sleep."
Sometimes the men are in a state where they can’t understand what comes next. It seems like everything is okay—they’re home, there are moments of euphoria. But then they start overthinking, processing a flood of information they were previously isolated from. I believe this is some kind of nervous system overexcitation that causes their sleep disturbances.
– What do you advise them?
– The same as most people: avoid using gadgets in the evening to prevent information overload. Give the brain a chance to rest. It’s better to take a walk outside, at least 20 to 30 minutes at a calm pace.
Our center has a very supportive atmosphere. There’s no noise, there’s a forest nearby, a beautiful park, and fresh air. There’s no industrial zone in the vicinity.
We strive to create conditions that make them feel comfortable.
– One of the defenders of Donetsk Airport told me that PTSD caught up with him a year and a half after returning home. Can physical health problems also appear later on? Do you talk about this with your patients and recommend ongoing examinations?
– Absolutely. When patients undergo rehabilitation with us, they have specific recovery goals, smart goals that they achieve to restore mobility. Then there are long-term goals, so we give them homework. We explain what they need to do next, the stages they must go through before returning to their normal activities prior to captivity. We clarify when and under what conditions they can jump, run, or lift the weights they used to handle. For example, if a patient previously did powerlifting, we advise them not to do the same as before but to allow their body time to recover.
If men or women require further rehabilitation, they move on from us to the next stages at other medical facilities—we are not their final stop.
– How much time typically passes from the moment a former prisoner of war steps off the bus here in Ukraine until they return to a full life?
– Some start running within a month, while others need six months. It’s very individual. I usually tell them, "Give your body six months to recover." But that’s assuming there were no severe injuries to the limbs or spine.
– Doctors are supposed to remain detached and unemotional. Are you always able to hold yourself together when the men share their stories? Because I can’t always.
– You said it well, Tania—not always. Sometimes you sit with them here and cry. When the men talk about memorizing each other’s mothers’ phone numbers, about their families and what they endured... They write poems and read them aloud. Once, one of them played a video where he recited a poem written for a friend’s mother, the friend with whom they were held captive together. That young man who wrote the poem is still in captivity.
How can you not feel it deeply?
– Fighters wounded on the front lines also come to the center for rehabilitation. What are the most common combat injuries?
– The majority suffer from mine-explosive injuries and shrapnel wounds.
– Is there now a well-established system pathway for wounded soldiers from evacuation to rehabilitation?
– Patients come to us directly from hospitals. We also receive patients for rehabilitation after endoprosthetics, sometimes as early as the third day. That’s quite fast.
Additionally, we provide rehabilitation following arthroscopic joint surgeries. Patients are brought in with stitches still in place. We perform ongoing wound care and remove the stitches over time. Thus, this is also considered early rehabilitation.
All these processes are well established.
– Talking with men who have lost limbs, I’ve heard different things. Some are depressed and don’t want to go on living, while others are making grand plans for the future. I understand you’re not a psychologist, but the overall mood and psychological state of a patient affect their physical rehabilitation. How do you motivate people who don’t want to do anything?
– Military personnel with amputated upper or lower limbs rarely come to us because we don’t provide prosthetics. They are usually referred to centers where prosthetics will be fitted or closer to those facilities. Sometimes they stay with us during waiting periods. Our task is to restore, improve, and strengthen muscle activity and joint range of motion in preparation for prosthetics.
So, we don’t need to motivate anyone. The men know they will receive prosthetics and give their all during rehabilitation.
Regarding peripheral nervous system injuries, these are most often seen after mine-explosive trauma. If a serviceman lay under debris for an extended period or was trapped under concrete blocks, he may also develop compressive-ischemic neuropathy. Recovery in such cases is prolonged and occurs in the presence of pain and hyperesthesia, which can be extremely exhausting for the men. But these are soldiers—they are strong and motivated to recover, as they need it both for continued service and daily life—they keep working.
We have excellent specialists who always maintain a positive attitude, which they pass on to the patients. When you enter the rehabilitation hall, everyone is upbeat and working, with music playing.
Therefore, in most cases, patients remain motivated. Although sometimes what is needed more than us are psychologists to help the person start moving normally. But everything is individual. Fortunately, we have a sufficient amount of equipment, allowing us to select the appropriate rehabilitation tools for each patient and engage them.
Tetiana Bodnia, Censor.NET
Photo by the National Guard
