Aleksandr had only two weeks of training in Russia before being sent to the front lines in Ukraine in the summer of 2023. About a month later, he became an amputee.

Learning to live without your left leg takes much longer than two weeks.

“There was a lot of pain in the beginning,” said Aleksandr, 38, who was referred to only by his first name in accordance with military protocol. But, he added, “eventually, your brain just rewires and you get used to it.”

Aleksandr spoke in an interview at a sanatorium in a Moscow suburb as a doctor refitted his prosthetic leg. He is one of hundreds of thousands of Russian soldiers returning home after the third year of war to government institutions and a society struggling to care for veterans in a time of sanctions, and to the parallel reality of the seemingly unchanged bustle of big cities and hardships on the front.

Veterans have visible and invisible needs that they bring back to their families who have lived through the trauma of waiting for them to come home alive and now have to learn to care for them.

There are at least 300,000 seriously injured veterans, according to calculations by independent Russian media outlets Mediazon and Meduza, as well as the BBC, all of which use open-source statistics to calculate the war’s death and injury toll. The authorities have made it difficult to estimate the number of seriously injured from 2023 onward because they have marked many statistics as confidential, journalists said.

Aleksandr said this after he was sent to suburb of Kupianskain the Kharkiv region of Ukraine, he was ordered to dig trenches in the area where the soldiers had laid mines the day before. He doesn’t know if the mine he stepped on was Ukrainian or Russian, but his left leg was amputated below the knee and he was driven from hospital to hospital for half a year before being fitted with an artificial limb.

Back at work as a welder in Russia, he now endures 12-hour shifts that require him to stand the entire time, even though amputees are advised not to wear their prostheses for more than a few hours. However, he is grateful to be alive and considers himself lucky.

Alexander’s prosthetist, Yuri A. Pogorelov, said the Rus sanatorium, a health and recreation facility where the former soldier received treatment, had made about 100 prosthetic limbs in the past year, relying on imported materials from Germany as well as some domestic technology . Only a few prostheses were for veterans of the war in Ukraine.

The sanatorium, built in the Soviet days for the country’s political elite, offers a wide variety of physical and psychological therapies. Demobilized veterans from all recent Russian wars and their relatives can come for rest and treatment for two weeks a year. About 10 percent of patrons are Ukrainian war veterans.

Late last year, Moscow estimated that Russians would need a record 70,000 prosthetic limbs a year, a drastic increase. That number includes civilian casualties and those who lost limbs due to causes unrelated to the conflict. But the Deputy Minister of Labor estimated last year that more than half of the martyred veterans were amputees.

Aleksandar said that he was grateful for the free medical help he received, but emphasized that he was not struggling mentally.

“Thank God, I have preserved my mental health in my own way,” he said. “I survived all those explosions and bombings and I’m normal.”

But many veterans return with post-traumatic stress disorder, psychologists and experts say.

“Everybody here has a little bit of post-traumatic stress disorder, whether they’re wounded or psychologically injured, or families whose brothers and sisters, sons and fathers died,” said Col. Andrei V. Demurenko, 69, who served as deputy commander of the volunteer brigade for months Battle for Bakhmut. In May 2023, after suffering a fractured skull, he returned to Moscow to find that veterans lacked psychological support.

“Unfortunately, we don’t have a system, at least not a neat one built on an organized, understandable system of psychological recovery,” he said.

Currently, there are not enough professionals trained to treat veterans or provide regular consultations for them, said Svetlana Artemeva, who is working on a project to train dozens of therapists in 16 Russian regions to help soldiers struggling with post-traumatic stress disorder.

“You have to teach them how to live from scratch; they have to learn how to sleep again because they don’t sleep at night,” said Ms Artemeva, who works with the Union of Special Military Operations Veterans, a non-profit group. “They shouldn’t flinch at every sound, don’t shake, don’t be suspicious of everyone.”

At the Rus sanatorium, psychologist Elena Khamaganova said that every soldier who fought in Ukraine undergoes a psychological examination upon arrival, and then goes to group and individual counseling. Many will be fighting for their lives, she said, mentioning a recent patient, a veteran with a spinal cord injury who will have to urinate in a bag for the rest of his life. A man struggled to be intimate with his wife; despite sharing a child, they discussed divorce.

After leaving the sanatorium, veterans can visit other centers, but are not allowed to visit it again for at least a year, which means they will not see the same mental health professionals over and over again.

“Rehabilitation cannot end with two, 10 or even 15 visits to a psychologist,” said Mrs. Artemeva. “Rehabilitation of a person must last a lifetime, because the experience will reverberate for the rest of his life.”

Just convincing veterans to talk to therapists is a big part of the struggle. One machine gunner from the western Kursk region, who gave his call sign as Tuba, said he had bad experiences with two therapists and did not want to talk to them anymore.

Tuba (34) was sweating profusely during the interview and seemed excited. His mother and sister did not agree with his choice to volunteer for the army, and he was not in a romantic relationship. All he wanted, he said, was to heal the arm injured by a drone in Ukraine’s Zaporizhzhia region so he could return to his comrades in the trenches. He said he disliked the contrast between his arduous life as a soldier and what he saw as the decadence of big cities, where everyday life seemed almost unaffected by the fighting.

“I didn’t meet a single Muscovite there,” he said mockingly, referring to the front lines. “They are busy with concerts – it is rude and out of place.”

Some civilians have a a different viewciting cases where returning veterans — some of them are ex-prisoners released to fight in Ukraine — committed heinous crimes

On a train from the western city of Rostov, a hub for soldiers passing through the long front line, women recently spoke out about being paid extra to sleep in women-only sections, citing unpleasant experiences with drunken veterans who indulged in sex and inappropriate comments.

At the sanatorium, many soldiers who fought in the Soviet invasion of Afghanistan or the wars in Chechnya said that Russian society has become more accepting of veterans than in previous conflicts. In Afghanistan, the men were mobilized – and brought back in coffins – largely in secret, a stark contrast to the way the Kremlin has sought to celebrate new veterans on television shows, billboards and special leadership programs.

President Vladimir V. Putin visited rehabilitation centers and directed subordinates to create more opportunities for injured soldiers — a contrast, experts say, from previous Russian wars.

“The coming home of a large number of Afghan soldiers happened after the collapse of the Soviet Union and, to put it mildly, the whole society had no time for them,” said Mr. Pogorelov, the prosthetist who fitted Alexander’s artificial leg.

“The economy was in shambles,” he said. “What kind of rehabilitation or pensions could there be in a country that was waiting for food donations from George Bush Sr. like manna from heaven?”

But like some veterans, he said he was pleased that Russia’s economy felt much more stable than it did in the tumultuous 1980s and ’90s, allowing civilians to “go shopping even though the country is at war.”

Aleksandar was in the sanatorium with his father Vyacheslav, who was wounded in Afghanistan. As his father explained what he claimed was Washington’s fault for the Ukraine war, echoing the Kremlin’s narrative, Alexander made it clear he was not angry with Mr. Putin due to the loss of his leg. Instead, the two expressed their gratitude to the leader who has been at the head of Russia for 25 years.

“Thank God we have Putin,” Vyacheslav said, while his son nodded his head in agreement.