Doctor Tancred Stöbe headed the Doctors Without Borders mission in Ukraine. He explains how important early trauma therapy is.

Early therapy is important for trauma: war-wounded soldiers train Jiu-Jitsu in kyiv Photo: Efrem Lukatsky/ap

taz: Mr. Stöbe, you spent many months in Ukraine as a medical project coordinator. What is the situation there?

Tancredo Stöbe: Farther from the front, little is noticed of the war. The closer it is, the more brutal it is. Every day there are serious injuries and dozens, sometimes hundreds, of deaths. What makes this war so special is that there are no concrete casualty figures. I have rarely experienced it like this. The last serious estimate for Ukraine was a total of around 500,000 dead and seriously injured on both sides.

Is this realistic?

Yes. The Americans had these casualty figures in the Vietnam War, which lasted 20 years. And there are as many as in ten years of war in Syria.

What exactly can you do in such a situation?

Tens of thousands of people living on the front do not want to leave. This phenomenon also occurs in other crisis areas, which is difficult to explain. The military would like to clear the villages, but they are not allowed to physically expel the people. There is currently no solution for this.

There is a decree from Zelensky requiring nursing homes to be evacuated. We try to help with that. But some of the residents say clearly: I want to stay here, even if it costs me my life. This is a new task for us: in the other countries where we work there are no nursing homes. In general, the situation in Ukraine is new territory for us.

Because?

There is rarely a comparable healthcare base in other crisis countries. The normal healthcare structure in Ukraine is not bad; There are rural nurses and a network of doctor networks dating back to Soviet times that work well. War surgery is a war secret, isolated from the military, which has gained enormous experience due to the large number of seriously wounded.

It seems that makes their job easier.

It presents us with completely new tasks that we have never faced in any other conflict.

Which are?

Given the enormous number of seriously injured patients receiving surgical care in the country, the quality of post-operative care, in the case of tens of thousands, needs to be adapted. Otherwise, there will be massive long-term disability that would burden society for decades. Our goal is to avoid it.

How does it work?

Today we know with certainty that newly injured people should be treated with physiotherapy within a week at the latest. Otherwise, the joints begin to stiffen and the muscles atrophy. If immediate and concentrated measures are not taken against it, the restrictions will remain in place forever.

But this is usually not done in Ukraine. The old methods of Soviet sanatoriums are no longer enough. The injured do not go to the sanatorium until weeks or months after the operation, where they receive a little massage and stay afloat. This is too late and too vague.

For us this means transferring knowledge to our Ukrainian colleagues. Clinics are slowly realizing that these important components exist after the surgical phase of the war and that they need more space and staff.

Where do you get this cane?

The country needs Ukrainian psychologists and physiotherapists with modern training, of which there are very few. Currently 640 specialists work for us in Ukraine, of which 570 are Ukrainians. As the months went by, we were able to replace more and more international staff with Ukrainian staff.

How do people cope with psychological trauma?

I have been to many hospitals and have spoken to dozens of seriously injured people. Most had nightmares, flashbacks, nervousness, moments of fear. Now the injured often admit it and accept help. But at the same time they also say: I can't tell the family. Even less in society.

How do clinics deal with this?

Mental health didn't play a big role last year. For a long time there was little understanding and willingness to take this seriously. I was in a large psychiatric hospital near the front with 600 beds and many mentally disabled people. There they only receive psychotropic medication, not psychotherapy. That's not enough. They receive pills in the morning and then lie in bed and wait until the next day. There is still little awareness that something is missing. They are happy to have enough beds.

What consequences does this have for those affected?

Those I spoke to varied greatly: some were completely broken, depressed, afraid of having to fight again, that was a minority. Some showed no signs at all. And the third category wanted to return directly to the front.

Voluntarily?

Partly, partly. There is an intrinsic will to do something for the country. But the pressure on the army is also great. Anyone who can be deployed in any way has to return to action; Otherwise, he will not receive any more money. This is not only military heroism, but also a pressure situation.

As a German, are you asked why more weapons are not delivered?

I expected the question, but it did not arise in daily medical practice.

So you will be accepted as a helper?

Yes, but you have to be present on site every day and do a good job. They don't want small talk, they want practical cooperation. Then you will also be able to manage more complex projects. In Kherson, for example, we renovated a hospital bunker. We paid local construction companies, but we also did the concrete planning. Now the clinic can continue operating underground. In the same hospital, a surgeon had already died from a gunshot during an operation. The application of warning in these cases is of no use because the rockets impact too quickly.