I met Oleksii near the entrance of the hospital where he was undergoing a medical examination. Silent as usual, Oleksii looked particularly exhausted on that day. He told me that some element in a metal mechanism that was implanted into his knee had “popped” the previous evening. Oleksii, who hadn’t particularly enjoyed walking on crutches through all the barriers of the less-than-accessible old Soviet hospital building even before his knee had “popped,” now had to deal with a horrible pain in his body as well. He dealt with it by swallowing Nimesil painkillers like candy, one by one, and looked even grayer than the sky on that sunless fall day.
A man in his early 40s who volunteered to join the Ukrainian National Guard at the beginning of the full invasion in 2022, Oleksii now looked as if something was weighing heavily on his mind. He looked tired, tense, and anxious. “Did you see a doctor to check on your knee?” I asked Oleksii, worried that taking so much Nimesil might not be the best solution. Nimesil, after all, is a brand name for a painkiller nimesulide that is forbidden in numerous countries due to liver toxicity. “Later.” His response was terse, as always. “I mean, how did you even get here? Could you drive a stick with a knee like that? How will you get back?” I continued, pointing to the visibly swollen part of his leg. “I’ll manage… I want to finish this,” Oleksii was short again.
By “this” Oleksii meant Viis’kovo-likars’ka commisiia (Military-Medical Commission) or VLK that I came to observe as part of the research project for the Ukrainian veterans’ advocacy NGO “Pryncyp” (fall and winter 2023). VLK was a mandatory medico-bureaucratic procedure required after any serious traumas or wounds that soldiers received during combat or beyond. Going through VLK was often an extremely long and tiring experience. Dark narrow hospital halls were packed with wounded soldiers, leaning against the walls and forming horrendous lines. Some waited patiently, if not happily. Others assumed a more active role, trying to get to the needed doctor faster than everyone else (after all, many of them were under time pressure from their commanders). The recently introduced digitized appointment system, specifically designed to improve flow and reduce waiting time, failed to fix anything. The halls were still full of anxious soldiers. In the tense air of those narrow corridors, conflicts erupted from time to time. Occasionally, when yet another soldier-patient tried to hack the system and get into one of the offices faster than the others, someone would express their dissatisfaction in not-so-pleasant words.
The last time Oleksii and I were in the hospital, we stood in that corridor for a long while. First entered those who didn’t make it inside the doctor’s office on time (everything was delayed due to the long lines and many soldiers missed their appointments); then came those soldiers whose appointment it was at that particular moment; and then I simply stopped understanding why people entered before Oleksii. He and I still leaned against the wall, waiting. Eventually, Oleksii became tired and simply decided to try next time. “Next time” was the day when he arrived with a bad knee and a lot of Nimesil in his pocket. It was our fifth attempt at VLK and Oleksii was determined to complete the examination at any cost. Hence, his previous answer to me: “I’ll manage… I want to finish this.”
The main function of VLK is to determine if a soldier is fit for service after the wounds or traumas they received in the army. This very issue weighed heavily on Oleksii’s mind. His primary concern was not that he had to drive dozens of kilometers every time he came to the hospital or that he needed to stand in the hospital halls for hours to see a doctor. Even his knee and the pain he felt in his body were secondary. What bothered him the most was his future, which remained unknown, until the black box of VLK was finally opened and the decision about his fitness to continue service was revealed.
Regulations that applied to the military medical bureaucracy were unimaginably complicated and decisions of VLK were undetermined. Few soldiers, if any, could understand how the medical bureaucracy worked in practice. Even lawyers and human rights activists who made it their job to help those soldiers were confused. The uncertainty created by this complexity and indeterminacy caused pain that sometimes was more intense than a swollen knee with an inserted metal mechanism that “popped” inside. And there seemed to be no Nimesil for the pain of uncertainty.
Oleksii’s life was not the only one affected by an intense feeling of uncertainty and the pain it caused. Uncertainty was omnipresent and pervasive in the Armed Forces and other units that were frequently referred to by the generic “Ukrainian Forces of Security and Defense” (these are the governmental agencies that take part in the fighting, including National Guard, National Police, Border Services, Security Services of Ukraine, and the Main Directorate of Intelligence). Everything from a soldier’s place of service to his time, payments, and even health, was subject to frequent and unpredictable change. This was true both for combat-related situations and for daily activities that were not directly impacted by the unpredictability of the battlefield.
Ruslan, whom I interviewed during my dissertation research on the Ukrainian military (2022-2024), described how uncertainty crept into even the smallest aspects of daily life in the army. Ruslan was serving in a unit that was stationed deep inside the country at the time, mostly unaffected by the unpredictability of the frontlines. He explained:
It was a chaotic thing. I mean we had… breakfast, lunch, dinner, and the lineup in the evening that were fixed in time. Everything else was unpredictable […] You could be sitting somewhere and then suddenly [someone shouts]: “There is a lineup in 10 minutes!” If you are late – you’ll be punished. That was incredibly annoying. You are constantly on tenterhooks.
Ruslan claimed that uncertainty was also present in other areas of the unit’s life, such as when his unit moved from place to place, both when the movement was the result of the ever-changing situation on the battlefield and when it was most certainly not. There was something inside the workings of the Armed Forces themselves that produced a lot of unpredictability.
There was never certainty in terms of unit movement at all […] It is always like that, I mean, [we could be told]: “We are moving in the next couple of days. Be ready.” And that’s it, you are on tenterhooks for a couple of days. You are fully packed and you are just sitting like that for a day, and then two, and then three… And then someone arrives and says: “You have twenty minutes, we are moving.” That’s it. We get our stuff inside [the bus] and we leave.”
And sometimes [it is like that]: “That’s it! In twenty minutes we are moving!” We [hastily] pack our things into the bus only to simply sit there for two or three hours. And there is a lot of that in the army.
The most intense pain that uncertainty created, however, was arguably in the area where soldiers generally expected to be cared for and to be able to rest after the stress of participating in combat: the medical sphere. Wounded soldiers who filled the wards and halls of military and civilian hospitals often couldn’t focus on their health and instead tried to figure out what the future held for them. Would they be treated properly? How long are they going to stay in the hospital? Would they be paid? Are all the documents in order or did someone make a costly mistake while spelling their name again? Would they be transferred closer to their loved ones for the continuation of medical treatment? What are they supposed to do to achieve that? Would they ever walk again? And if not, would they receive appropriate services and help from the state? Dozens of such questions tormented thousands of wounded soldiers throughout the country every day.
Mykola, a participant in the study I conducted for the Veterans Human Rights Organization “Pryncyp,” said the following about the uncertainty that he faced after he was wounded:
To be honest, I couldn’t understand anything. You don’t even understand what that VLK is and what you should do. In the hospital that is run by the AFU [Armed Forces of Ukraine], they just brought me a document that contained a decision [regarding my condition]. There was no [real] commission, no one said anything [to me]. […] I mean, they gave you the paper, you went to see all those doctors, they wrote something in there [without explaining anything to me] and stamped it. You then give that paper to [another] doctor and [at the end] he just brings the final document when they are signing you out of the hospital. The first time I went through this, I hadn’t even understood what happened […]
[The hardest thing for me was] obscurity of what the future holds. You… you never even knew how long you would be treated [in a hospital…]. I mean, you are lying [in a hospital ward], and lying, and lying… and then they come suddenly and tell you that you are leaving tomorrow morning. You can’t plan anything. You don’t know what to expect. You don’t understand if your treatment will be completed or not.
Wives and mothers rushed to help fight this obscurity and uncertainty. In their sometimes desperate attempts to gain some clarity and therefore restore some agency, they spent days inquiring, knocking on doors, waiting for hours, delving into thousands of pages of complicated laws and regulations, demanding, insisting, begging, writing letters, exchanging contacts of military officers, lawyers and doctors, sharing information on specialized chats, and asking relatives and friends to help transfer their loved wounded soldier closer to home or to the place where they would get better help.
Those wives and mothers described their horrendous experience of never knowing what is going to happen; where to look for their sons, daughters, brothers, sisters, and fathers; or how to get the proper information on rehabilitation. Tina Polek and Pryncyp documented some of those experiences in their study:
No one is taking care of what’s next. Only loved ones do that. That is, if a wounded soldier actually has them [relatives and other loved ones] and if they are ready to fight for the soldier. If they are not ready to fight, you can forget about everything — about rehabilitation, about medical treatment, about everything. (Oleksandra)
No one is going to tell you: “Look, girl, you have a person that is constantly lying down. You need to turn him this way. Look, girl, he may have problems with swallowing reflexes. Take this hand, this leg that doesn’t work, and knead it until your own hand is in pain.” I mean… you have to learn it all by yourself and to get that information somewhere. And first of all, this takes time. And secondly, [it creates] this kind of feeling that you don’t know what is going on and how everything is happening […] (Veronika)
We spent one day trying to find him because we had no information from the unit or his fellow soldiers. We simply had information that he had been evacuated, that he was handed over to doctors, and we didn’t know where he was, where to look for him, whether he was in the hospital, or what had happened at all. (Ol?ha)
He was evacuated to Lviv. I arrived literally the next day in the morning. I went to all the doctors that I could visit, and before I could return to him, he was already moved further to Uzhhorod [over the Carpathian Mountains, five hours drive away]. Literally, I was away just for three hours […] So, I came back [to his ward] and my husband was gone. He was just packed up and sent to Uzhhorod [while I was gone]. (Maryna)
As Niklas Luhmann wrote, the promise of law is the promise of ontological security. That is, law promises that once the world is governed by formalized rules, it becomes predictable. After all, if a regulation prescribes the behavior of a doctor or a military officer, then a) everyone can read that regulation and should know what to expect, and b) every doctor in every hospital (at least, in one single state) should have to behave in the same manner while operating in similar situations.
In reality, of course, laws and other formal norms are subject to a very dark Wittgensteinian logic: rules require more rules to clarify them. And then new rules require other rules, and then some more, and then some more. It is a perpetual process of self-replicating in which clarity is perpetually expected and yet never arrives, like Godot in Samuel Beckett’s famous play. Instead of clarity, everyone finds themselves confused and overwhelmed by thousands of pages of conflicting laws, regulations, and court decisions that no one could possibly comprehend. Even lawyers who specialize in a particular area of law barely know and understand all of it. Those who haven’t spent hundreds of hours sweating over the laws and regulations can hardly hope to get it all right. Instead of clarity and certainty, therefore, law creates a world in which few people understand what the future holds for them.
That is precisely what happened with wounded soldiers and their loved ones in Ukraine. The particular organizational arrangements of the Ukrainian Armed Forces and complicated military and medical regulations coalesced with the stress of the full Russian invasion into a particular amalgamation of intensive pains that soldiers experienced. The pain of the uncertainty was one of them. Ironically, it was most intensely felt in those places that were supposed to be the places of care. Hospitals became places of intense anxiety, fear, tears, and sleepless nights for wounded soldiers and their loved ones who actively tried and often failed to understand what the future held for them.
When the medical commission made its decision and we left the hospital, Oleksii was a different man. I could hardly recognize the person I had seen so many times before. Instead of being short in his responses, he was as chatty as it gets. It was as if he was reborn: energetic, full of life, and confident in every move and every word. Oleksii was done with his VLK — and it changed him. He knew what his tomorrow would look like. Even though his knee was still swollen, he looked as if, in just a second or so, he would finish the coffee in his hand and begin running around happily, like an overjoyed kid.
Ivan Shmatko is an Assistant Professor of Sociology at Washington & Lee University.
Acknowledgements
The research on which this piece is based was possible due to the generous support provided by Neporany Fellowship of the Canadian Foundation for Ukrainian Studies, the Helen Darcovich Memorial Doctoral Fellowship, the Tatiana Romanyshyn Memorial Graduate Scholarship in Ukrainian Studies, the Mykola Klid Memorial Endowment Fund of the Canadian Institute of Ukrainian Studies, and research support from the Renaissance Foundation provided to the Ukrainian Human Rights Center for Servicemen and Veterans “Pryntsyp.”