Beyond the Front Lines: The Realities of Ukraine’s Veteran-Centric Society

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The state apparatus loves the word “veteran-centricity.” It rolls smoothly off the tongue at specialized forums, looks impressive in panel presentations, and fits neatly into the headlines of upbeat press releases. Officials speak enthusiastically about a “seamless pathway,” the “digitalization of services,” and an “inclusive environment” with such confidence that one might think we already live in Switzerland — if only the war weren’t slightly getting in the way.

But the real crash test of state capacity begins far from ribbon-cutting ceremonies and the launch of yet another chatbot. It begins in quiet hospital wards that smell of medicine, where a person lies after a severe injury — with multiple amputations, spinal cord damage, and traumatic brain injuries. Here, life for years depends on other people’s hands around the clock, on specialized medical supervision, adequate pain management, and daily, exhausting hygiene care. Without this foundation, a veteran’s life begins to crumble before your eyes, turning into an endless physiological and psychological hell.

It is at this point – at the junction of exhausted medicine and a virtually non-existent social sphere – that something extremely unpleasant and politically explosive comes to light. Rehabilitation and long-term care for seriously injured veterans in Ukraine still do not look like a well-thought-out state infrastructure. They look like a narrow, suffocating bottleneck, miraculously held together by overworked doctors, pitiful budget limits, and the banal mercy of specific people.

The Illusion of Miracle: The Poison of False Expectations

To understand the depth of the failure, we must first look at how the system sells rehabilitation. Rehabilitation is not a magical procedure. It is not the promise of “getting back on your feet” that politicians and ignorant officials are so fond of handing out. It is a long, tedious, bloody, and painful work to return a person to the maximum possible independence within the limits of their irreversible trauma. It is a process where a person learns to eat independently again, transfer to a wheelchair, adapt their housing, master new skills, and re-create the meaning of life from the mutilated body left after the front.

That is why the phrase “they will put you on your feet there,” which patients and their relatives hear from everyone before they even get to the rehabilitation center, works like pure, concentrated poison. It forms false, completely unrealistic expectations. The state (in the person of its various representatives) first sells the illusion of a miracle. And then, when the miracle does not happen, the entire colossal weight of disappointment, rage, and despair falls on the shoulders of doctors, who must look the patient in the eye and honestly tell the cruel truth. As a result, we get rehabilitation departments overflowing with anger and total distrust of the system that promised a fairy tale, but gave out a wheelchair.

A meat grinder for doctors: a system on the verge of collapse
But even this honest and difficult medical work has been organized by the state as if medical personnel were immortal cyborgs with no limits to their physical endurance. According to the approved protocol, a doctor of physical and rehabilitation medicine should have a caseload of no more than 12 patients. In reality, some doctors are responsible for as many as 25, twice the official norm, which was not designed for sanatorium-style rest but for demanding, intensive work.
Doctors now openly report extreme levels of burnout. They also speak about a critical shortage of psychologists who are confronted with such levels of trauma that many simply cannot cope with the workload and are ready to quit. This is not merely a staffing problem at a single hospital. It is a systemic failure. It means that the care system for the most severe cases is currently operating under chronic strain. In designing this model of care, the state has effectively built in not a reserve of capacity or a financial cushion, but a system built on the self-sacrifice of Ukrainian doctors.

Some of the vital drugs for psychological, psychiatric care, and the treatment of specific neuropathic pain are not on the National List of Essential Medicines. Even though these drugs are officially part of approved treatment protocols, patients often cannot access them.
What do doctors do? They go with an outstretched hand. These medicines have to be obtained with volunteer funds and through charitable foundations. Let me emphasize: we are not talking about additional vitamins or improved nutrition. We are talking about basic, critical elements of medical care for people with torn nerves, phantom and neuropathic pain that drive people crazy. If the system is already being propped up by volunteer contributions at this, purely inpatient stage, it means one thing: the state has still not managed to build a self-sufficient medical support network for the most difficult and painful cases. Historically, it has simply relied on the assumption that someone more humane than the Cabinet of Ministers will always plug the administrative gaps at the bottom.

Hostages of empathy: when the patient has nowhere to go

And this is where the most uncomfortable, darkest part of the story begins — the part officials prefer to keep quiet about in their briefings. The problems faced by seriously injured veterans do not end after they are discharged from the hospital or upon completing another, limited cycle of rehabilitation.

According to doctors, there are dozens of patients in every major center who, after all stages of treatment, cannot take care of themselves. Among them, the most tragic, absolutely defenseless group stands out – those who either have no family at all or, relatively speaking, have one old mother somewhere in the village who is physically unable to turn, wash, catheterize, and feed an adult paralyzed man every day.

Such people are not palliative patients in the classic, terminal sense. They can live for decades. But there is no way to physically “discharge them home.” For them, a home without proper care means death from bedsores and sepsis in a few months.

What does the state do? It simply turns away. And then the most humiliating, ugliest mechanism for compensating for state impotence is activated: hospitals keep these veterans for years purely out of their own “kindness of heart.”

The general resources of the medical institution, which are financed under completely different packages of the National Health Insurance Fund, are being quietly eaten away. Medicines, three meals a day, the enormous time of nurses and junior medical staff, bed linen, utilities, and the beds themselves — all of this is effectively written off into the shadows, because no one officially reimburses the hospital for these expenses. This is no longer simply about medicine, nor is it about the economics of a healthcare institution. This is about the fact that after all the pathos speeches about the sacred duty to the defenders, the state in the most difficult segment stupidly and shamelessly leaves at the mercy of the chief doctors and nurses, and not on its own institutional capacity.

The Ministry of Veterans Affairs itself has actually signed off on its own incompetence. Their official response states that the long-term medical care regulation covers only the critically important medical component. However, a full resolution of the fate of those veterans who have no housing or relatives and need constant care requires “separate comprehensive social adaptation and accommodation programs.”

Let’s translate this bureaucratic response into plain language: there is no comprehensive path for the most complex patients in Ukraine. There is no system. There is a disparate piece of medical services, and everything else—housing, social support, assistants—is in a vague, uncertain future. A time when it is always easier for an official to make promises than for a veteran to get the help they need survive.

Paper launch: a timeline of the bureaucratic quagmire

Of course, in response to any criticism, the authorities immediately fall back on their favorite argument: “You’re all lying — we launched a long-term care program!”And, as the official record shows, the Cabinet of Ministers “rolled out” Resolution No. 1365 on October 23, 2025. The document introduces a pilot project (valid until December 31, 2026) for participants in hostilities and individuals who have become disabled as a result of the war, whose functional status on the Barthel scale is 30 points or lower. To put this in context: a score of 30 on the Barthel scale indicates deep, almost total dependence on outside help to perform the simplest everyday tasks.
One cycle of care in this program corresponds to one full day of care for a single patient. The package of services prescribed in the resolution looks impressive on paper — like a dream: daily assessment of the patient’s condition; monitoring and treatment; strict prevention of complications (such as bedsores); provision of anesthesia; complete sanitary hygiene; balanced nutrition; supportive rehabilitation; and psychological, social, and spiritual support. In addition, relatives are trained in home care skills. On paper, the document makes it seem as if the state has finally woken up.

But between the government’s “approved” and the real “working in the chamber” there is traditionally an impassable bureaucratic swamp in which the best initiatives drown.

Let’s look at the chronology of this “breakthrough”. The experimental project formally kicked off on January 1, 2026. However, the Ministry of Veterans Affairs was only able to approve the Regulation on the Interdepartmental Commission — without which it is impossible to select project participants or launch the contracting mechanism with hospitals — on January 19. The regulation then went to the Ministry of Justice for registration and was officially registered only on February 10.

The UP journalists recorded in their material the established fact: as of January 19 (when the project had been saving people for almost a month), not a single contract had been concluded with any hospital or individual entrepreneur in the country to provide these services. None.

It was not until March 3, 2026 (in the third month of the program!) that the Ministry of Veterans Affairs finally announced the “start of the process of contracting healthcare institutions with the National Health Service of Ukraine.” At the same time, the ministry cheerfully noted that veterans would be informed about the possibility of using this service “only after the completion of contracting.”

That is, in the fall, the state solemnly, with all the PR fanfare, sold the “launch of long-term care” to society, and then spent another six months slowly completing the elementary operational architecture. For a government official in a warm office, this is called the “technical stage of implementing a regulatory act.” And for a family that does not sleep at night for months, turning over a seriously injured son or husband every two hours so that he does not rot alive, this is a real hell in which they remain abandoned to their fate.

Arithmetic of humiliation: 103 veterans per country

The Ministry of Veterans Affairs has now proudly posted a dedicated section on its website about this care. The process is clearly outlined: an application, proof of status, and a doctor’s referral are required. There is even a separate phone number for the medical support department for inquiries. The access mechanism is, in theory, fully spelled out.

But it is here, behind the facade of tidy algorithms, that the main question hides — the one the authorities categorically refuse to confront. Sure, there is an algorithm. There is a resolution. But what is the actual capacity of this vaunted system? How many of the most seriously ill patients can it realistically support, both physically and financially, over the course of a year

Resolution No. 1365 sets a strict, specific financial limit. It states clearly that in 2026, the total funding allocated to the pilot project is sufficient to cover up to 37,701 cycles of care.

Since we already know that one cycle of care is one calendar day (one person-day), we are talking about 37,701 days of paid care for the entire country.

Let’s take a calculator. Divide 37,701 days by 365 days in a year. We get the equivalent of about 103 veterans for a full year of continuous medical care.

One hundred and three people.

Yes, technically, there may be a few more unique patients (for example, if someone stays in the program for half a year instead of a year, freeing up space for someone else). But this does not change the essence and scale of the number. For a large European country that has been bleeding for four years in the largest continental war since World War II. For a country that receives from the front every month an increasingly large group of people with extremely severe, irreversible injuries. For such a country, this capacity does not just look modest or insufficient. It looks frighteningly, humiliatingly meager.
So, the annual rehabilitation funding will cover just over 100 people. That’s one company. Not a region. Not a network of regional centers. This is a company for the entire country. This is all that the state, which every evening from the screens of a telethon talks about unprecedented respect for heroes, has managed to do.

And to finally shatter the illusions: in parallel, Deputy Minister for Veterans Affairs Ruslan Prykhodko states that the registry of psychological support providers for veterans currently includes… just over 200 psychologists nationwide—two hundred specialists for hundreds of thousands of demobilized, wounded, and war-traumatized individuals. When government officials call these pitiful figures a “system”, one wants to grab them by the lapels and shout: What system exactly are you managing? A system of assistance or a system of total, artificial deficit?

Deficit Management: Get in Line and Pray for a Quota
Another detail that completely shatters the bureaucratic illusion of well-being is embedded in the program. Its internal logic is built not around the concept of a “guarantee for the defender”, but exclusively around shortage management. The regulation explicitly states that services are provided to patients on a first-come, first-served basis and strictly within the allocated budget. The National Health Insurance Fund concludes contracts with service providers within the limits of available budget funds. So what happens if the total projected cost of services suddenly exceeds the allocated budget? Does it look for additional funding for those who gave their health for it? No. An “adjustment coefficient” is applied — in other words, payments are cut.

Simply put: when the demand for vital care exceeds the allocated resources, the system does not magically create new capacity, nor does it pull money from the streets or charity drives to support veterans. It simply rationalizes the shortage. This means that the state model itself is not built from the very beginning with unconditional, 100% assistance to everyone who critically needs it. It is built into it with rigid queue management and a budget ceiling.

For a Treasury official, this is called a fancy term, “financial discipline.” But for a paralyzed veteran, it sounds like a death sentence. It means absolute dependence on whether you are lucky enough to have time to apply before the limit for those same 103 annual places is exhausted.

Lack of a denominator: blind flight of state policy

But the most disturbing and cynical fact in this story is not even that the limit is catastrophically small. It is that the state still does not publicly show a clear denominator of the real need. How many veterans in Ukraine today, right now, need such long-term care? A thousand? Five thousand? Ten thousand? This figure is unknown. It is simply not publicly available.

And if the basic figure of need is unknown, then any government “launch”, even for 100 people, can be sold from the screens as a wild success and a victory for reforms. Because no one asks the main question: dear government officials, what percentage of the real need does your high-profile experimental project cover? A tenth? A hundredth? Statistical error?

Or are you perhaps simply building a beautiful, sterile pilot showcase for a few dozen of the most difficult cases, so that there is somewhere to bring international donors and show the “European level”? As long as the authorities do not have a public, honest, and open calculation of the general need, any talk of “systematicity” sounds exclusively like the state’s narcissistic advertising of itself.

Instead of conclusions

That’s why the topic of rehabilitation and long-term care for seriously injured veterans is so politically explosive. Not because it involves some cheap tabloid corruption scandal or a high-profile arrest, but because it strikes at the central, sacred myth of the modern Ukrainian government.

It tears down the scenery. The country can talk as much as it wants about its deep respect for the defenders. It can launch new digital services, stamp beautiful brands, and multiply the right words on forums.

But veteran-centricity is not when the ministry finally learned the correct Western vocabulary of inclusiveness.

Veteran-centricity is when a person, after the front, does not fall into a black hole between a helpless hospital, an exhausted family (which may not exist), and a state that, in March, is still “finalizing the mechanism” of contracting what it promised to launch in January.
This is when rehabilitation can function properly, without being held back by staff shortages, and doctors are not forced to care for twice as many patients. The psychologists are not working on the verge of a nervous breakdown. When critical pain medications are purchased by the state according to the protocol, and not picked up by volunteers on Instagram for a penny. When dozens of paralyzed patients are not hanging on for years on the “kind soul” and the budgets of chief doctors.

And when long-term care for the most vulnerable is not a narrow experiment with a micro-limit of 100 people, but a powerful, extensive, uninterrupted national infrastructure of care. A real infrastructure with which the state proves that it can keep the word given to its soldiers before sending them to hell.

The state passes its most important historical test not where it can solemnly cut the ribbon to applause. It passes it where it has to drag out the most difficult cases for years, decades, very expensively, and absolutely without media pathos. Long-term care is a boring, exhausting, astronomically expensive policy. That is why it is the true measure of the state.

And if the Ukrainian authorities do not soon learn to build this policy on a real scale for the country, if they are not able to honestly come out and show the real number of needs, the number of billions needed, and the real coverage, then all their talk about “veteran-centricity” should be taken with a very cold correction.

Translated from official, bureaucratic language into the language of reality, this policy boils down to one simple and harsh truth: after the front, a person has no support system waiting for them.

Her turn is waiting.

And the queue is the meanest, most humiliating form of state gratitude that could be invented for those who gave everything for this state.

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