Ukraine is facing a future with upwards of 20,000 amputees, many of them soldiers who are also suffering psychological trauma from their time at the front. Europe has experienced nothing like it since World War I, and America not since the Civil War.

Mykhailo Yurchuk, a paratrooper, was wounded in the first weeks of the war near the city of Izium. His comrades loaded him onto a ladder and walked for an hour to safety. All he could think about at the time, he said, was ending it all with a grenade. A medic refused to leave his side and held his hand the entire time as he fell unconscious.

When he awoke in an intensive care unit the medic was still there.

“Thank you for holding my hand,” Mr. Yurchuk told him.

“Well, I was afraid you’d pull the pin,” the medic replied. Mr. Yurchuk’s left arm was gone below the elbow and his right leg above the knee.

In the 18 months since, the paratrooper has regained his equilibrium, both mentally and physically. He met the woman who would become his wife  at the rehabilitation hospital, where she was a volunteer. And he now cradles their infant daughter and takes her for walks without the slightest hesitation. His new hand and leg are in stark black.

Mr. Yurchuk has himself become the chief motivator for new arrivals from the front, pushing them as they heal from their wounds and teaching them as they learn to live and move with their new disabilities. That kind of connection will need to be replicated across Ukraine, formally and informally, for thousands of amputees.

“Their whole locomotive system has to be reoriented. They have a whole redistribution of weight. That’s a really complicated adjustment to make and it needs to be made with another human being,” said a medical historian at Imperial College who specializes in blast injuries, Dr. Emily Mayhew.

There are not nearly enough prosthetic specialists in Ukraine to handle the growing need, the head of the Superhumans center for rehabilitating Ukrainian military amputees, Olha Rudneva, said. 

Before the war, she said, only five people in all of Ukraine had formal rehabilitation training for people with arm or hand amputations, which in normal circumstances are less common than legs and feet as those sometimes are amputated due to complications with diabetes or other illnesses.

Ms. Rudneva estimated that 20,000 Ukrainians have endured at least one amputation since the war began. The government does not say how many of those are soldiers, but blast injuries are among the most common in a war with a long front line.

While Ukrainian media tend to focus on Russian casualties in the war, which vastly outnumber Ukrainian casualties, Ukraine’s own losses have also been high. American officials estimate that close to 70,000 Ukrainians have been killed and up to 120,000 wounded. 

The New York Times reported that “in a year and a half Ukraine’s military deaths have surpassed the number of American troops who died during the nearly two decades U.S. units were in Vietnam.”

Battle conditions particular to Ukraine have sometimes hampered rapid medical treatment for injured soldiers. According to the same Times report, there is often little capability to  quickly evacuate casualties to well-stocked medical facilities. 

Rehabilitation centers Unbroken and Superhumans provide prostheses for Ukrainian soldiers with funds provided by donor countries, charity organizations and private Ukrainian companies.

“Some donors are not willing to provide military aid to Ukraine but are willing to fund humanitarian projects,” said Ms. Rudneva.

The hardest part for many amputees is learning to live with the pain — pain from the prosthesis, pain from the injury itself, pain from the lingering effects of the blast shockwave, said Dr. Mayhew, who has spoken with several hundred military amputees over the course of her career. Many are dealing with disfigurement and the ensuing cosmetic surgeries.

“That comorbidity of PTSD and blast injury and pain — those are very difficult to unpick,” she said. “When people have a physical injury and they have a psychological injury that goes with it, those things can never be separated. ”

For the severely injured, rehabilitation could take longer than the war ultimately lasts.

The cosmetic surgeries are crucial to allowing the soldiers to feel comfortable in society. Many are so disfigured that it’s all they believe anyone sees in them.

“We don’t have a year, two,” said a facial surgeon, Dr. Natalia Komashko. “We need to do this as if it was due yesterday.”