Abstract
BACKGROUND: Ukraine's Ministry of Health formally recognized rehabilitation as an essential component of universal health coverage in 2020. However, services remain fragmented and under-resourced, particularly following the full-scale invasion by the Russian Federation in February 2022. Widespread injuries due to trench warfare, drones, and large-scale ground combat have placed unprecedented strain on the Ukrainian trauma and rehabilitation systems, which continue to lack a cohesive national strategy. This study aimed to (1) assess the trauma and rehabilitation system in Ukraine during the ongoing conflict; (2) identify current needs, gaps, and opportunities for strengthening rehabilitation services; and (3) inform national and international stakeholders-including the United States and NATO-about urgent priorities to support Ukraine's rehabilitation infrastructure, reintegration pathways, and gender-sensitive care delivery. METHODS: We conducted 36 qualitative key informant interviews across all NATO levels of care using an adapted Global Trauma System Evaluation Tool. Thematic analysis focused on rehabilitation-related domains. RESULTS: Respondents highlighted shortages in staff, equipment, and mental health integration. Rehabilitation remains unevenly implemented, with better access for military versus civilian patients. Care for survivors of conflict-related sexual violence and support for women's equitable access were consistently cited gaps. CONCLUSIONS: Ukraine's growing burden of war-related injuries necessitates urgent investment in a coordinated national rehabilitation strategy. Priorities include workforce development, equipment supply, mental health integration, and inclusive care models that address the needs of women and conflict related sexual violence survivors. Evidence-based rehabilitation, supported by validated training for clinicians, is essential for long-term recovery, societal reintegration, and national resilience.