Get out of hell to fail to make it to your turn, or treatment abroad as a new quest for Ukrainian soldiers

The mechanism for sending wounded service members abroad for treatment or rehabilitation was simplified during the year of the full-scale invasion. According to the new algorithm, the maximum waiting period for documents (from the battlefield to traveling abroad) is at most two weeks. However, in anonymous comments, the service members admit that fundamental changes never happened, and in some cases, Ukrainian doctors oppose their treatment abroad.

As of the beginning of 2023, more than four thousand wounded Ukrainians have been sent for treatment abroad, including about a thousand wounded service members, the Ministry of Health reported. The Ministry representatives commented to hromadske that the exact number cannot be disclosed to the public for the service members' safety. They only say that all those who need it vitally (or who cannot get help in Ukraine) are traveling outside Ukraine.

"A soldier of the Armed Forces of Ukraine in this system is the most disenfranchised element"

In April 2023, treatment and rehabilitation abroad became easier for Ukrainian service members. Before, healthcare facilities prepared the service members' documents, sent them to a military hospital, and there, the commission reviewed the documents to conclude if the treatment abroad was necessary. It took about a week to send the documents to the hospitals, conduct consultations with doctors, and make a decision. Now, medical institutions can decide whether a service member needs treatment abroad alone.

"Now, doctors look at the documents and see that they have a patient who wants to undergo treatment abroad, or the care in the other country is better, or that they just need to reduce the load on the hospital. Then, he concludes that treatment abroad is necessary and sends the documents directly to the Medical Forces Command. That is, the consultation stage was removed, and the process accelerated since there are no interruptions," says Ministry of Health representative Arman Kacharian.

Before the mechanism for sending service members abroad for treatment or rehabilitation was updated, it was almost impossible to organize the collection of documents on your own. This is confirmed by Volodymyr (Shamil) Sheredega, who couldn't go abroad for rehabilitation. In the summer of 2022, he injured his knee on duty. A seemingly minor injury due to improper treatment led to Shamil almost losing his inability to walk. When his leg stopped functioning properly, he wanted to go abroad.

"You cannot imagine how hard I tried to get abroad for treatment or rehabilitation. My friends and acquaintances tried to do something for me. But they failed. That's why reading stories about how someone could leave immediately is so cool. Because these promises of welfare and care for the military are just words. In reality, a service member of the Armed Forces is the most powerless element in this system. A slave, a serf who cannot do anything, is not allowed to do anything. Believe me, it is very painful for me to write all this. The last thing I want is to demoralize people in such difficult times. But I'm very tired," Volodymyr Sheredega said in late January 2023.

A year after he was injured, he still couldn't leave, even though Shamil had the money for treatment.

"They will say that some ignorant people work here and injure people" 

Anton, a defender of Mariupol, admitted to hromadske that it was also difficult for him to travel abroad. Due to a medical error in a Dnipro hospital, his left arm became almost non-functional.

"I had a metal piece in my hand for several months. In April 2022, a metal fragment broke my arm and remained there. They couldn't get it out because it was in a very inconvenient place. They said to leave it, and everything would be okay, and my arm would start working. A week later, it didn't work, two weeks later, a month later, it still didn't work. I went to the doctor again, but in another city, and during the examination I was told that the fragment had pinched a nerve in my arm, so it was unlikely that my arm would move. To be more precise, I would be able to raise and lower my arm from the elbow to the fingers. But I couldn't move my fingers, turn it, or perform any actions with it. 

In fact, I was offered to amputate it so it wouldn't "just hang." I was laughing for several hours because it seemed I had an arm, but in fact, it was a piece of wood instead," says Anton.

However, Anton's wife decided that the amputation should wait. So they went to another hospital, and the doctors there told them that the injury could be treated abroad and the arm's functions could be restored.

"We started collecting documents: tests, certificates, X-rays, all previous certificates, and medical reports. And in every office, I was told, "Just wait, your arm will work again. And if you go abroad, they will say that some ignorant people are working here, injuring you. You are a patriot, aren't you?" Meaning, I was manipulated so that I would not embarrass Ukrainian medicine. Honestly, I was ashamed back then, but not of myself. And at the same time, I was told that all hospitals abroad were busy because there were guys who were even worse off as if I was feeling great," the service member explains.

In June 2022, Anton finally collected all the necessary documents. Volunteers helped him find a hospital – the medical facility in Kyiv where Anton was examined said there were no places abroad. However, a clinic in Sweden responded to the volunteers' request, and at the end of June, the service member was admitted to a rehabilitation center. Today, thanks to surgeries and rehabilitation, his arm works almost as great as before the injury.

"If you're still alive after all the documents are agreed and delivered, congratulations, you will be treated abroad!"

Alina Sarnatska, a combat medic at the Kyiv Territorial Defense, notes that you need to be in good health when waiting for your turn for treatment abroad. And even though the procedure was simplified in April 2023, it's not that easy.

"How do you go abroad for treatment if your leg is torn off or you have some other serious problem that is better treated in Switzerland than in Ternopil? It is very easy; the Medical Forces Command took care of everything. All you have to do is choose a hospital abroad, make an appointment, and contact your doctor at the hospital, who contacts the administration of the medical institution, which in turn prepares a package of documents and sends it to the Medical Forces Command (MFC). Then, it returns the documents for revision several times and sends the package to the Ministry of Health. The Ministry of Health sends a request to the country where you are going to be treated, receives a letter confirming that they are indeed ready to accept you, and the Ministry of Health prepares its own confirmation letter and sends it to the Medical Forces Command, the State Border Guard Service, and the Ministry of Foreign Affairs. Then, MFC prepares another confirmation and sends it to your hospital. If you haven't died or retired yet, you're going to be treated abroad," the medic explains the stages you must go through to receive treatment abroad.

Sarnatska adds that this list of documents is permanent, unchangeable for anyone, and approved in an order. While the countries and institutions correspond with each other, service members with serious injuries have to wait.

"And it's not just red tape. It is made to be pretty impossible, except for cases where money or connections are involved. But this is a common legal scheme for the entire army, an officially approved procedure," the combat medic notes.

However, the Ministry of Health representative explains in a comment to hromadske that the procedure seems long only because of the number of processes. According to Arman Kacharian, the first steps (correspondence within Ukraine) can be completed in one or two days, a week at most. Waiting for a response from abroad takes the rest of the time.

Arman Kacharian says that, in fact, the entire process of collecting documents is based on the principle that papers "follow" the service members, not vice versa. In fact, doctors have to print out documents themselves and hand them to patients rather than oblige them to look for places where they can make copies of all the necessary papers.

Now, the Ministry of Health says that the process from submitting documents to evacuating a service member abroad takes about two weeks; sometimes, it's faster or longer, depending on various factors. For example, a victim with burns is usually sent to another country for treatment within one or two days. These patients usually go to Poland or Germany. Instead, service members who need prosthetics or rehabilitation may be sent abroad a little later, when their wounds have healed, in a month or two.

"Sometimes Ukrainian hospitals compete with foreign hospitals, so they are reluctant to let service members go for treatment outside Ukraine or do not make such a decision at all" 

However, delays do occur. There are cases when Ukrainian medical institutions are reluctant to facilitate service members' departure for foreign treatment or rehabilitation. 

"Sometimes hospitals delay this process. Sometimes, they do not even submit documents anywhere but tell the service members they were denied treatment abroad. Sometimes, the service members were told that doctors did not have time to submit these documents. In this case, the service members or volunteers contact us (the Ministry of Health, ed.) and tell us about the problem. We call the coordinator or hospital director in that region and talk directly to them. Usually, this solves everything," explains the Ministry of Health representative.

The second stage, which can cause a delay, is when a seriously wounded, incurable service member applies for treatment abroad. If he is inoperable or no treatment will bring him back to life, such a patient will most likely be denied.

"For example, medicine is still unable to restore the spinal cord, or severe brain injuries when a service member is in a vegetative state (a coma during which the brain cannot restore its functions). Relatives of these people ask about medical evacuation or care for these patients in other countries. But even abroad, it is impossible to help someone in such a condition. Nevertheless, we still submit the documents of these service members for consideration by partner countries. If, during the consultation, the doctors conclude that some medical interventions can help or improve his condition, the patient is sent abroad to a country ready to take them. But doctors can also agree that nothing can be done and refuse to provide medical evacuation," says the Health Ministry representative.

According to Arman Kacharian, the Ministry of Health has not received any reports of corruption in medical institutions at the stage of collecting documents for foreign treatment. However, there is another issue that delays the treatment of service members.

"There is a moment related to competition in hospitals. Sometimes, we realize that doctors feel some competition for a patient with their colleagues from the EU. That is, they are reluctant to send them abroad. They say, "Can't we treat him in Ukraine?" When we communicate with them, we explain that this program exists to relieve Ukrainian hospitals of other patients and wounded service members. We are not saying that the treatment in Ukraine is worse, but there are a lot of military personnel in medical facilities and a large influx of new patients, so it is quite difficult to provide a personalized approach to everyone. The medical evacuation will enable an individual approach to everyone who needs medical attention." 

As of today, 26 countries are ready to take Ukrainian service members for treatment and rehabilitation. The receiving party pays for the transportation, escort, and stay in the clinic for the service members and, if necessary, the person accompanying them (wife or husband, one of the parents, or one of the children, including adopted children). It also covers their return to Ukraine. In addition, the service member does not pay for treatment, medicines, or tests. 

Author: Alina Yevych