When I came to Norway, I was met with good attitudes from everyone who helped me: nurses, doctors, social workers and others. I am very grateful to this country for what it has given me and continues to give me. After several operations at Ullevål Hospital and Rikshospitalet, I ended up in a fantastic place, Sunnaas Hospital. Here I received high-quality rehabilitation and met many great people.
This is what Serhii Pashkovskyi, a combat medic from Ukraine, says.
The full-scale invasion of Ukraine has resulted in enormous human suffering. Daily drone and bomb attacks have led to gunshot wounds, burn injuries, and shrapnel trauma to the body. Many people need critical medical treatment.
Norway contributes through MEDEVAC, the EU's program for medical evacuation of injured Ukrainians. The patients come to Sunnaas Hospital for rehabilitation.
"Those who come to us are trauma patients with various war injuries. Many have needed to have their limbs amputated," says Frank Becker, professor at the Department of Clinical Medicine at the University of Oslo and clinical medical director at Sunnaas Hospital.
In the field of rehabilitation after serious illness or injury, the professionals working at the hospital were already highly accomplished. An ongoing war, however, was something they had little experience with.
How does rehabilitation work when patients arrive straight from the frontlines, with their home country still at war?
This was investigated by Becker and colleagues in a new study, published in the Journal of Rehabilitation Medicine.
Rehabilitation of trauma patients is meaningful work
In the study, the researchers share important insight into cultural differences, treating unfamiliar injuries, trauma, and isolation. Nevertheless, they show that rehabilitation in Norway is both feasible and valuable.
"It is very important and meaningful work, and the staff, too, had good experiences," Becker says.
The Ukrainian patients demonstrated a high level of trust in the treatment providers, and were also satisfied with the rehabilitation afterwards.
"Both the patients and the staff adapted to the difficult situation. All the patients have experienced improvement and regained function, so there is something good coming out of this," he says.
Talking to both patients and healthcare professionals about their experiences
The study included 14 Ukrainian patients, mainly men, aged 26 to 48. Most of the patients were military personnel, but not all.
In addition, the study included 15 healthcare professionals who work in multidisciplinary teams.
The researchers used patient records and questionnaires from patients, and conducted focus group interviews with staff about their experiences.
Cultural differences in the understanding of what rehabilitation is
The cultural differences were clear from the beginning.
The Ukrainian patients were used to a more authoritarian healthcare system and had different expectations of what rehabilitation entailed. This created misunderstandings in the rehabilitation process. Much seemed foreign to them.
"Eastern European countries have a much more passive attitude towards rehabilitation, which can be traced back to the former Soviet system," Maria Ryssdal Kraby, a specialist doctor and researcher in the project, says. "They are used to the patient lying down, receiving treatment and massage."
The rehabilitation process in Norway, on the other hand, is based on international classification and works very differently.
"In Norway, we use active rehabilitation. This means that we involve the patients, ask about their goals and what they want to achieve, and then we create a plan together," she says.
Employees who spoke Ukrainian or Russian built bridges
Language also turned out to be a major challenge. The Ukrainian patients wanted to use interpreters at the hospital.
"The translation and interpretation were interesting and perhaps a bit surprising. We offer interpretation during visits and interdisciplinary meetings, but we don't have interpreters available around-the-clock," Kraby says.
"But in a rehabilitation process, there is a lot of communication all the time."
The saviors? Multilingual staff with Russian-Ukrainian knowledge. They became bridge builders who contributed psychological support and cultural guidance to the Ukrainian patients.
"A couple of our health personnel turned out to be extra valuable to us here. They became cultural mediators and could explain things to the patients," says Becker.
Antibiotic resistance is a major challenge in Ukraine
All patients had to be isolated due to antibiotic-resistant and multi-resistant bacteria. There was a fear that such bacteria could spread in Norwegian hospitals. Patients who are potential carriers must therefore be isolated due to the risk of infection.
"To begin with, Ukraine has a good health system. But it is one of the countries in the world with the most antibiotic- and multi-resistant bacteria. The patients bring these bacteria with them from surgeries there. This poses major challenges and causes the wounds to not heal," explains Kraby.
Several of the patients have received new implants after amputations and have had long-term infections.
"Some have been hospitalized at Ullevål Hospital for five or six months with repeated surgeries before they were even ready to come to us," she says.
Hospital isolation causes increased psychological strain
The isolation was the hardest aspect for the medical team. What were patients allowed to do and what could they not do? Healthcare personnel at Sunnaas had repeated discussions about infection prevention and control.
"The staff were concerned about the extra psychological strain that isolation caused for the patients," Becker says.
A rehabilitation process also stirs up many emotions, both for patients and for healthcare personnel. There is hope and joy in events of progress, but there is also frustration, anger and fear tied to what is happening in their home country.
"These are people who lie awake at night to follow what is happening back home in Ukraine. We must also take that into account," he says.
Steep learning curve, important lessons
How can the experiences from the rehabilitation at Sunnaas help others? The experiences provide valuable knowledge in the form of increased competence among the staff working with rehabilitation of war casualties.
"It has been a steep learning curve. We are not used to treating people who have been injured in war. And there have been so many traumatic injuries and amputations," Kraby says.
The knowledge obtained from the study can help develop better methods and practices in Norway for treating patients with war trauma. It can help strengthen our civil protection for similar crises in the future.
"These are important experiences for us. It is very educational for health personnel in Norway who are not used to treating such war injuries on a daily basis," Becker says.
Reference
Kraby, M. R., Toropchyna, M., Holtan, A., & Becker, F. (2025). Ukrainian war trauma patients abroad: the rehabilitation process in light of language barriers, cultural differences, war, and infection isolation. Journal of Rehabilitation Medicine, 57, jrm42929. https://doi.org/10.2340/jrm.v57.42929
