DNIPRO, Ukraine — The artillery blast took Oleksandr Zaichenko off his feet and surged through his brain and spine like a thunderclap. But his only priority, as the dust and confusion swirled around him, were his men who lay wounded at their howitzer position.

Zaichenko, a 58-year-old company commander, oversaw the medical evacuation of his soldiers last month near Pokrovsk, following the Russian artillery barrage. But soon after, his eyes lost focus. He stumbled and vomited. It was no mystery what was happening. He was experiencing his fourth concussion, perhaps not even his worst, he later recalled.

Zaichenko is among legions of Ukrainian soldiers straddling the middle ground of injury: He took serious wounds in battle, but — with some rehabilitation — can still return to duty. So far, 16,000 soldiers have gone through 13 rehabilitation centers established since 2022, said Olha Rachyba, the director of one such facility in Dnipro.

It is unclear how many soldiers have been wounded since 2022 and how many have returned to duty following rehabilitation. Ukraine’s General Staff did not return a request for comment.

The industrial-scale war in Ukraine, from artillery to attack drones, is wrecking bodies with explosions and fragmentation unlike anything seen since the 1940s. Soldiers with pulverized bones, gunshot wounds and sheared body parts have come through these facilities, requiring significant care, Rachyba said. A significant number, however, are focused on getting back to the front, motivated by the need to keep staving off the Russian advance or just not let their comrades down.

She described how one memorable soldier wanted to stay in uniform to exact his revenge. An eye for an eye — or in his case, a leg for a leg.

The centers were initially funded by a billionaire couple’s auction of sculptor Jeff Koons’s magenta balloon monkey for more than $12 million and were designed to handle the wounded after they’d been through surgery.

Rachyba said the staff had some wartime experience from treating soldiers fighting in eastern Ukraine before Russia’s full-scale invasion, but the descent into total war brought hard and fast lessons with a high number of complicated injuries. Staff had to go study on their days off to learn more about treating traumatic brain injuries, abdominal wounds, severe infections and other serious wounds.

“As a result, both doctors and physical therapists, as well as occupational therapists, had to retrain to handle this combat injury rehabilitation,” she said. While there doesn’t seem to be long waits to begin treatment, Rachyba and others are concerned Ukraine will be not able to absorb the costs of treating profound wounds of many thousands of soldiers in the years and decades to come.

The rehab facility pulsed with activity on a recent afternoon in Dnipro. Soldiers with amputated legs practiced navigating on their new artificial limbs. Others lay in harnesses to help realign their spines after blast injuries. One soldier stood in a corner with a virtual reality headset, navigating a program only he could see.

There is no guarantee wounded soldiers will come out on the other end of care with a green light for continued service. Depending on the severity of their injuries, some may be able to rejoin their unit and resume the same or a similar job. Others may be forced to learn another position that takes their new reality under consideration.

Then there are soldiers who receive what is often a disappointing decision — a medical discharge from the service, sending them on a search for what to do in their post-military life.

Oleksandr Kelbas, regaining his ability to walk, is in that last category.

In the tough fight for Mariinka last year, a sniper zeroed in on Kelbas as he settled into his front-line position. The rifle round tumbled through his right leg, and Kelbas crawled out of the kill zone, waiting to evacuate under covering fire from his comrades. He hobbled more than two miles to safety.

Kelbas, 42, gripped two parallel bars and stood on a rubber dome in the rehabilitation center, an exercise to help him improve his balance, and explained the long process to get there. He finished his surgeries in April, he said, and has worked ever since with physical therapists on his recovery.

Vladyslav Solopii, a young physician, watched Kelbas gingerly keep his foothold on the dome. An important requirement for patients entering the program is a goal they want to accomplish so doctors can help them work toward a tangible outcome. One wounded soldier was fond of his job as a grenadier, Solopii said, so the program worked to ensure he could build enough strength back to manipulate a grenade launcher.

For Kelbas, married with children, his objective was independence at home, he explained, so he could remain the patriarch without assistance.

But others would have a say in what came next. Officials at a medical council weighed his prospects for going back to the military, Kelbas said, and they decided he would need to leave. He had worked as a metallurgist before his service, but thought it was unlikely he could return to that profession.

So what will he do now?

“Continue living,” he said. “What else?”

The everyday part of living with permanent injuries is a key aspect to the program.

One room in the recovery center offers stations to regain motor skills, tailored to real tasks. The kitchen allows soldiers to go through the process of working a stovetop. For soldiers with children, a corner provides practice swaddling toy infants and placing them in a crib. Two soldiers sat at one table that had devices like remote controls and calculators to work small buttons.

Nearby, a 52-year-old soldier had endured numerous surgeries to repair his left arm, which had been shredded in a mortar attack in 2022. It was nearly nonfunctional, he said, and the prospects were dim that he could ever return anywhere close to his original dexterity.

He could only move his arm about four inches from his body, said Oleh, providing only his first name, in line with military protocols.

A mechanical device strapped to his arm went through a raising motion to work his muscles. Oleh had waited a long time to begin treatment after his surgeries, and had only been at the center a week, he said. He was already increasing his range of motion. He hoped it can get to a point where he can return to duty and man a machine gun once again.

Zaichenko, the commander, is nearly done with his month-long rehabilitation — a remarkable achievement after repeated head injuries that once threatened to cut off blood supply to his brain. He is still working on his coordination, but stood tall as he described his waiting assignment as the deputy commander of his brigade’s artillery training unit.

He credits his recovery to doctors who take a holistic view of patients and the support of his wife and children, who live in the United States. It also helps that he is a lifelong athlete, he said, and once was a weightlifter who wore the colors of the Soviet Union.

“The country no longer exists,” he said, “but I do.”

previous coverage

• Pentagon puts Russian casualty toll in Ukraine at 600,000 after new monthly peak