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. 2026 Mar 22;17(1):2641410. doi: 10.1080/20008066.2026.2641410

Volunteering for Ukraine: scoping the operational experiences and impacts among UK and US veterans

Voluntariado para Ucrania: análisis de las experiencias operativas y el impacto entre veteranos del Reino Unido y EE. UU

Victoria Williamson a,b,CONTACT, Gavin M Campbell c, Nadav Liam Modlin d, Walter Busuttil a, Neil Greenberg a, Dominic Murphy a,c
PMCID: PMC13007463  PMID: 41865761

ABSTRACT

Background: Since the armed conflict in Ukraine escalated in 2022, UK and US military veterans have volunteered in substantial numbers to support the Ukrainian Armed Forces. They are operating in an exceptionally intense and technologically advanced environment, often exposed to high levels of combat. Little is known about the health impact of this voluntary service.

Method: We carried out a mixed-methods observational study of UK and US military veterans who self-reported travelling to Ukraine to support the Ukrainian Armed Forces. Participants were recruited between October and December 2025. Measures assessed probable post-traumatic stress disorder (PTSD), common mental health disorders (CMD), alcohol misuse, moral injury, and health-related quality of life. Open response items were used to qualitatively explore motivations for volunteering, experiences of service in Ukraine, and access to healthcare.

Results: Thirty-one UK and US military veterans completed psychometric measures and 21 provided qualitative data. High levels of probable PTSD, CMD alcohol misuse, and moral injury-related distress were identified, alongside low health-related quality of life. Veterans described extremely intense combat exposure, including drone warfare and trench fighting, and frequent physical injury. Physical healthcare was often described as poor or inadequate. Mental health care was widely sought but rarely accessible, both in Ukraine and after return home, with veterans reporting being turned away from support services. Consequently, emotional support primarily came from peers rather than formal care systems.

Conclusions: This study provides early evidence on the experiences and health needs of UK and US veterans who volunteered in Ukraine, an under-researched group falling outside existing military care structures. Many report significant unmet mental and physical health needs and face barriers to care both in Ukraine and after returning home. Without targeted support, these veterans risk remaining invisible within health systems, highlighting the need for coordinated pathways and prioritised clinical care.

KEYWORDS: Trauma, military, Ukraine, combat, health, drone

HIGHLIGHTS

  • UK and US military veterans who volunteered to fight in Ukraine reported extremely intense combat exposure, limited training and support, placing them at risk of physical and psychological harm.

  • Many veterans reported serious mental and physical health difficulties, including trauma-related distress, alcohol misuse, and untreated physical injuries, yet struggled to access appropriate healthcare both while in Ukraine and on their return home.

  • Current military and civilian support systems may be ill equipped to recognise and respond to the unique needs of these veterans returning from voluntary service in Ukraine, highlighting an urgent need for better coordinated care pathways.

The ongoing conflict in Ukraine has led to widespread destruction, death, and suffering. To date, the United Nations estimate there have been 53,006 civilian casualties (Ukrainian Civilian Casualties, 2025). Up to one-third of the country has been contaminated by landmines and ordnance (Harm to the Civilian). There have been at least 790 attacks on medical facilities (Harm to the Civilian). The Ukrainian conflict is notable for the speed and scale of technological innovation in its weapon systems. This includes the use of artificial intelligence (AI) and the rapid adaptation of commercial ‘off-the-shelf’ technologies such as consumer first-person-view (FPV) drones, satellite internet and smartphones (Chatham House, 2025; Williamson & Murphy, 2025). Amid mounting Russian aggression across the EU, Ukraine’s war effort offers the Western world insight into the likely future of warfare, at a scale not seen before.

Since the outbreak of the conflict, individuals from diverse national backgrounds have volunteered to join Ukraine’s war efforts, often motivated by political or personal convictions. Reports suggest that nearly 20,000 foreign nationals applied to join Ukraine’s Armed Forces (Cancian, 2022; Habtom, 2022; Lipin, 2022). Among them are a considerable number of military veterans from the UK and USA, with an estimated 3,000 Americans applying to join the International Legion (Lipin, 2022). While the precise composition and size of the Ukrainian international volunteer force is unclear, available data suggests that this is not an insubstantial phenomenon.

Foreign volunteers have been operating in Ukraine amid an exceptionally violent and volatile conflict with limited training and support. US and UK personnel who deployed to Iraq and Afghanistan on Ops TELIC and HERRICK received extensive pre-deployment preparation, including battlefield medical training, improvised explosive device (IED) recognition, and weapons proficiency. They served within organised command structures, air support and access to necessary equipment/medical treatment. Their service was underpinned by legal protections, rules of engagement, and post-deployment decompression (Ministry of Defence, 2011). By contrast, volunteers in Ukraine are effectively self-deployed, often entering a far more chaotic operational environment, with variability in training, command structure, and support (Cancian, 2022; Habtom, 2022).

Despite the number of UK and US veterans reportedly volunteering in Ukraine, little is known about the health consequences of their service. These individuals have been exposed to a form of warfare unprecedented in modern Western experience. Clinicians may be encountering veterans whose experiences fall well outside the scenarios traditionally addressed in military or trauma-informed clinical training. Consequently, health and support services in the UK, USA, and elsewhere may not be equipped to recognise or respond to the distinctive needs of those returning from Ukraine – or adequately prepared to support personnel/veterans with similar experiences in future conflicts. This study aimed to examine the lived experiences and impact of voluntary service in Ukraine among UK and US military veterans.

1. Method

1.1. Ethical approval

Approval was granted by King’s College London Research Ethics Committee (HR-24/25-51681). All participants were provided with a detailed information sheet. They were asked to acknowledge that they had read and understood the study-related information and agreed to participate. All participants were provided with a signposting booklet.

1.2. Participants

Participants were recruited between October 2025 and December 2025. The study was open to individuals who self-reported being UK or US military veterans aged 18 years or older who had travelled to Ukraine to support the Ukrainian Armed Forces in some capacity. Only UK and US military veterans were included as funding constraints prevented translation and broader inclusion. Respondents were recruited using social media (e.g. X, Reddit, LinkedIn) and snowball sampling. Participants were not asked to provide personally identifying information (e.g. name, contact details). No financial incentive for participation was offered.

1.3. Materials

1.3.1. Psychometrics

Basic demographic information (e.g. age, LENGTH of UK/ US military service) was collected. Exposure to potentially morally injurious events (PMIEs) and moral injury-related distress were assessed using the Moral Injury Outcome Scale (Litz et al., 2022), with PMIE exposure indicated by endorsement of the first item and scores of ≥43 reflecting severe distress. Probable post-traumatic stress disorder (PTSD) was assessed via the six-item PTSD Checklist (PCL-6; Weathers et al., 1993) with a score of ≥14 used to indicate probable PTSD (Sudom, 2020). Probable alcohol misuse was assessed via the three-item AUDIT-C (Babor et al., 2001) with a score of ≥8 used to indicate high-levels of alcohol use. Common mental health disorders (CMD, e.g. anxiety, depression) were assessed using the four-item Patient Health Questionnaire-4 (PHQ-4) (Kroenke et al., 2009) with a cut point of ≥6 used to indicate probable CMD.

The EQ-5D (Rabin & De Charro, 2001) was used to assess health-related quality of life (HRQoL). EQ-5D responses are transformed into a weighted index ranging from −0.594 (death or worse than death) to 1 (full health), based on standardised norm values in the general population (Dolan, 1997). A thermometer scale with endpoints of ‘worst possible health state’ set at 0 to ‘best possible health state’ set at 100 was used to assess self-rated health status.

1.3.2. Open response items

Open-response items included questions about their motivations for serving in Ukraine, the impact of service on their health, their experiences of healthcare and support whilst in Ukraine and on their return to the UK/US.

1.4. Data analysis

1.4.1. Quantitative

Descriptive analyses were conducted (Table 1). Pearson correlations were used to examine associations between symptom severity of PTSD, HRQoL, alcohol misuse, CMD and moral injury-related distress. Prior to analysis, data were screened for missing values, data entry errors and outliers. While 63 participants initially consented, a proportion dropped out or did not complete measures in full. Where more than 50% of psychometric data were missing, participants were excluded from final analyses. This resulted in 32 participants being excluded. Consistent with previous research, for the remaining participants, we replaced missing values on the psychometric scales with the lowest possible value if 25% or fewer items were missing (Fear et al., 2010). Where more than 25% of items were missing, the response for that specific psychometric measure was counted as missing. Therefore, demographic information, psychometric, HRQoL and moral injury outcomes are reported for fewer veterans (PHQ-4 n = 23; MIOS n = 31; AUDIT-C n = 20, EQ-5D n = 22; PCL-6 n = 26).

Table 1.

Participant demographic characteristics.

Index Total sample (n = 31)
Mean age, M(SD) 30.9 (8.7)
Male gender, n (%) 29 (93.6%)
Marital status, n (%)  
Single 19 (61.3%)
In a relationship 8 (25.8%)
Separated/divorced 3 (9.7%)
Widowed 1 (3.2%)
Ethnicity, n (%)  
White / White British 25 (80.7%)
Mixed/multiple 1 (3.2%)
Asian / Asian British 2 (6.5%)
Other racial and ethnic minority group 3 (9.7%)
Branch, n (%)  
US Army 8 (25.8%)
US Marines 10 (32.3%)
British Army 13 (41.9%)
Service branch, n (%)  
Regular 25 (80.7%)
Reserve 6 (19.4%)
Reasons for leaving, n (%)  
End of service 12 (38.7%)
Premature voluntary release 7 (22.6%)
Medical discharge 7 (22.6%)
Administrative discharge 3 (9.7%)
Other, reason not disclosed 2 (6.5%)
Education, n (%)  
School until 16-years 7 (22.6%)
School until 18-years 11 (35.5%)
Higher education 10 (32.3%)
Postgraduate 3 (9.7%)
Met case criteria, n (%)  
PTSD 16 (51.5%)
Alcohol misuse 12 (60.0%)
CMD 23 (100.0%)
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Note: Reasons for leaving = Reasons for leaving the UK/US Armed Forces. Higher education = undergraduate degree. Completion of psychometric measures: CMD using PHQ-4 n = 23; alcohol misuse using AUDIT-C n = 20; PTSD using PCL-6 n = 26.

1.4.2. Qualitative

Nvivo 15 (QSR International) was used to organise the data and facilitate analysis. Open response data were analysed using thematic analysis (Clarke & Braun, 2017). Peer debriefing was used, with feedback incorporated from co-authors with expertise in military health and qualitative methods (NG, WB, DM, NLM, GC).

2. Results

Participant demographic information is reported in Table 1. Of the participating veterans, 58% (n = 18) were US military veterans and 41% (n = 13) were UK veterans. Veterans had served in the UK/US military for between 1 and 32 years (mean = 7.0, SD 7.7). The majority were male (94%, n = 29), White (n = 25, 81%), single (61%, n = 19), and 30.9 years old on average (SD 8.7). 45% (n = 14) reported being deployed during their UK or US military service, primarily to Iraq, Afghanistan, or Syria.

A number of participants met criteria for probable mental health problems on the psychometric measures. All participants who completed the PHQ-4 (100.0%, n = 23) met criteria for likely CMD, 60% (n = 12) met criteria for likely alcohol misuse, and 62% (n = 16) met criteria for likely PTSD. Of the 31 participants who completed the MIOS, 42% (n = 13) reported PMIE exposure and nine had severe rates of moral injury-related distress. Participants had a mean EQ-5D-3L UK index value of 0.7 (SD 0.3) which falls below HRQoL population norms (typically 0.85–0.90 in UK adult samples) (Dolan, 1997). Associations between health outcomes are reported in Table 2.

Table 2.

Associations between MIOS score and measures of health.

  1 2 3 4
1. MIOS total score - - - -
2. Alcohol −0.09 - - -
3. CMD 0.22 0.46* - -
4. PTSD 0.49 0.36 0.71** -
5. EQ-5D total −0.44 0.23 −0.25 −0.44*
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Note: CMD = common mental disorders as assessed via total score on PHQ-4. MIOS = Moral Injury Scale total score. EQ-5D = total EQ-5D score. PTSD = total score on PCL-6. Alcohol = AUDIT-C total score. * p ≤ .05, ** p ≤ .01.

2.1. Qualitative findings

Twenty-one participants completed the open-response items. Three core themes were developed, reflecting: (i) veterans’ motivations for serving in Ukraine; (ii) the intense nature of their service; and (iii) their experiences of medical care and ongoing support needs.

2.1.1. Veterans’ motivations for serving in Ukraine

Many veterans volunteered due to strong feelings of moral obligation to help Ukraine and its people. Veterans reported wanting to ‘do my part’ (PID 11) to stop a terrible injustice and the need to defend western democratic values from Russian oppression. Veterans felt that they had something to offer in this conflict given their previous military experience.

PID17: To stop what I saw as an injustice … Later, seeing terrible things that Russians did gave further reasons to stay.

Several commented that their US/UK military service had been during peace time. They volunteered in Ukraine as they had not experienced combat and this was an opportunity to test themselves. Others described that they volunteered because they had ‘nothing to lose’ (PID 15) and wanted to leave roles they did not find fulfilling.

PID9: Fighting for what was right and didn’t want to drink myself to death in the States.

PID13: To kill communists and get out of my shitty civilian job.

2.1.2. Military service in Ukraine

All veterans described that their military service in Ukraine was more intense than their previous roles in the UK and US military, including those veterans who had previously deployed in combat roles. Veterans reported being quickly deployed to the frontline and feeling ‘way over my head’ (PID14). Some recounted receiving limited training by the Ukrainian forces, and, to address this, courses in first aid and tactics were delivered spontaneously by those with experience. Their service in Ukraine was reportedly hampered by poor supply lines and veterans faced a lack of basic necessities, including access to food, water, transport and safety equipment.

PID15: The British Army was very disciplined … in training. They sought to make us “The Best.” I was taught everything from how to use and maintain our kit, to international law, to a high standard. Ukraine doesn't need “The Best.” They need hundreds of thousands of boots filled, quickly … All they actually taught us was how to operate and clean the rifle. Recruits with prior military experience spontaneously improvised first aid courses, did tactical drills … with those who came totally untrained. We continued this practice into deployment, as official training was nearly non-existent for us … . Overall, it felt like being on a runaway train.

Russian forces were considered to have more resources and fire power, and veterans described having to adapt quickly to the new technology, such as drones being used in warfare. Many veterans spoke of experiencing extremely high-levels of ongoing combat exposure, including being under enemy fire, witnessing atrocities, exposure to chemical agents and being ‘hunted by drones’ (PID15). Most reported being physically injured in combat and the deaths of colleagues on the frontline.

PID1: I was on the front line within a week of arriving … The combat is 10,000 times more intense in terms of absolute casualty rate. Not having any kind of medevac chain or air support … Fighting in trenches is up-close and personal. You see the faces of those trying to kill you. Stacks of corpses … and the fear of having no-one around to help [you] like in Afghanistan.

Several veterans described issues with alleged corruption within the Ukrainian chain of command as well as ‘Ukrainian command incompetency’ (PID5) and poor communication which could have serious, or even fatal, consequences for troops. Equally, veterans also felt they had more autonomy, including having the freedom to purchase and use their preferred (rather than issued) equipment and did not face disciplinary action for minor infractions compared to service in the US or UK military. Many felt their service in Ukraine had made a meaningful difference.

PID6: It was much more intense, more dangerous and difficult, but also felt more meaningful and valuable than my prior service.

PID17: No stupid online safety courses and endless mandatory training. No getting yelled at for the slightest crease in your uniform … No ridiculous [rules of engagement] like in the Middle East, here a threat is a threat, and it is until they are dead … Some officers use Soviet Doctrine which gets people killed.

2.1.3. Experiences of medical care and ongoing support needs

The majority of veterans self-reported physical injuries, including broken bones, damaged lungs and traumatic brain injuries. Experiences with Ukrainian-based physical healthcare varied, and few reported positive experiences. Most felt the care received was substandard, with injuries either overlooked or inadequately treated. Some veterans described being required to pay for their medical treatment for physical injuries incurred during combat, others reported having to return to the UK or US for ‘proper care’ (PID10).

PID17: … You are expected to pay your own medical bills or at least pay if you want good treatment. I blame most of this on leftover soviet bureaucracy and corruption … in the medical system … they try and save money (so that they keep it for themselves) and expect payment/bribes to make things work “smoothly”.

PID5: Get any vets out of this country if they need medical treatment. Their hospitals are more inhumane than any trench I've ever been in.

All veterans stated that they did not receive mental health support or treatment while in Ukraine. Some felt a debriefing would have been valuable and observed that senior officers’ enquiries into mental health were usually reactive and not followed by meaningful support. Many stated that they felt that their service in Ukraine had taken a substantial negative toll on their psychological wellbeing and they wanted to see a mental health professional for support.

PID21: The war is real, really goddamn real. Can't stop thinking about it. How have I survived? … Nobody wants to help us … [I need] help getting my head straight.

Despite this, mental health care was often unavailable in their home countries, either because of long waiting lists or because veteran-focused providers reportedly declined to offer treatment, viewing their difficulties as unrelated to their UK or US military service. Others reported that their Veterans Affairs (VA) benefits had been terminated due to their service in Ukraine. Many reported that their emotional support during and following service in Ukraine came from friends, family, and fellow soldiers.

PID10: The VA doesn't wanna help me see a shrink … I need to see a shrink for sure.

PID15: Scarred lungs … Brain damaged from explosive blasts. Unhealed broken [bones]. Probably PTSD. I've been on NHS waiting lists for … 8 months. Not had a single x-ray, MRI, or therapy session … The only [emotional] support I ever received was from my fellow soldiers. Occasionally officers would inquire about our mental health, usually in response to someone cracking, but there'd be no further action taken … Veterans charities are trying to pick up the pieces, but this outside their comfort zone … We're vanishing out there and nobody seems to care.

3. Discussion

This study aimed to examine the experiences of voluntary service in Ukraine among UK and US military veterans. Psychometric measures indicate participants report poor physical health and meet criteria for alcohol misuse, PTSD, and CMD, with moral injury – related distress also evident. Three qualitative themes were identified: motivations for volunteering; the intense nature of voluntary service; and the impact of service on health, including challenges accessing care.

A considerable proportion of veterans met criteria for likely mental disorders. Whilst clear limitations exist regarding the representativeness of this sample, these prevalence rates appear to be significantly higher than studies examining wellbeing in community samples of UK and US personnel/veterans (Hotopf et al., 2006) The burden of health difficulties reported within this study appear more similar to those observed within treatment-seeking, clinical samples of veterans (Murphy et al., 2019). The findings are also consistent with studies of private security contractors who report high rates of mental ill health (Dunigan et al., 2014). Qualitative findings highlighted the high levels of self-reported exposure to combat trauma, including encounters with drones and trench warfare. Reported issues relating to the Ukrainian chain of command may be experienced as a betrayal and make these veterans vulnerable to moral injury (Williamson et al., 2020). Many reported that they believed their service in Ukraine negatively impacted their mental health. This is consistent with research that has found that veterans who served in a combat role have higher rates of mental ill health compared to those who do not deploy (Stevelink et al., 2018), and with reviews showing that combat-related PTSD is strongly linked with direct combat involvement, witnessing injury/death, and discharging a weapon (Xue et al., 2015). The nature and magnitude of war fighting in Ukraine differs substantially from other recent conflicts, such as Iraq and Afghanistan. Research on drone warfare has largely focused on the psychological effects on drone operators rather than individuals targeted by drones (e.g. Armour & Ross, 2017), as occurs on the Ukraine front line. Consequently, clinicians and veteran services in the UK, US and elsewhere may be unprepared for trauma presentations involving this scale of combat and experiences involving sustained drone-related threat and pursuit. Intentional, interpersonal trauma is a recognised risk factor for complex PTSD (American Psychiatric Association, 2025), veterans exposed to this form of combat may require more intensive, specialised interventions.

Consistent with previous research, most emotional support came from informal social networks, particularly peers they deployed with (Greenberg & Jones, 2011). Veterans described persistent difficulties accessing mental health care in Ukraine and again on return to the UK and US. Untreated serious mental disorders are associated with adverse outcomes, including suicide, homelessness, substance abuse, and worsening physical health (Iversen et al., 2005; Williamson et al.). Reports of needing but being unable to access mental health care align with findings that few veterans with serious mental ill health successfully reach specialist care (Iversen et al., 2005). As these veterans also reported experiencing physical injuries in Ukraine, alongside mixed experiences of medical care and generally poor physical health, concerns arise regarding their access to appropriate support. Several described losing their veteran-related benefits or being turned away from services. This group may be at substantial risk of falling through gaps in care, both within Ukraine and upon returning home, underscoring the need for coordinated pathways that recognise their unique circumstances and ensure appropriate support.

The majority of participating veterans reported volunteering due to moral obligation and felt that their contribution made a meaningful difference to the conflict – indicating possible post-traumatic growth (PTG) (Mark et al., 2018). It is also possible that this process of meaning-making reflects a ‘sense of coherence,’ which has been linked to more positive adjustment following trauma (Bond et al. [2022], [31, 32]). Reviews suggest that repeated conflict exposure can enhance coping capacity, increasing the likelihood of positive adjustment (Mark et al., 2018). Consistent with this, veterans in the present study primarily relied on fellow soldiers for emotional support, aligning with evidence that social support can facilitate post-trauma coping (Mark et al., 2018). Together, these findings suggest that, despite considerable adversity, many veterans drew on interpersonal and experiential resources that may support adaptive responses. However, some individuals reported volunteering because they felt they had nothing to lose. Given evidence that military personnel often come from socio-economically deprived backgrounds and can experience adjustment difficulties when transitioning to civilian life (Murphy et al., 2019, [33]), some volunteers may have entered service in Ukraine with substantial pre-existing adversity. The intensity of service in Ukraine may further compound these vulnerabilities, increasing mental ill health risk. Ukrainian, UK and US military and healthcare services should remain attentive to the potentially heightened support needs of this population.

3.1. Strengths and limitations

A key strength was the mixed methods approach with open response items to explore veterans’ experiences of voluntary service in Ukraine. The anonymous, confidential design may have facilitated disclosure of distressing experiences. However, the cross-sectional nature of the study, the opportunity sampling and reliance on self-reported veteran and volunteer status meant that service histories could not be independently verified and it is possible that some experiences could potentially be overreported. The sample size in the current study limited the ability to investigate significant differences in mental health outcomes between UK and US veterans. Given that previous research has identified notable differences in PTSD between deployed US and UK personnel [34], this warrants further exploration in future studies. In addition, translation was beyond the scope of this study, which prevented the inclusion of veterans from a wider range of countries who may have volunteered. Veterans from other cultural contexts may have different experiences of service and experiences of accessing care. The generalisability of the findings to the broader population of international volunteers is uncertain. Participating veterans were also of limited demographic diversity (e.g. largely male). Future research should recruit a more diverse group of veterans to examine whether experiences of voluntary service and post-deployment health needs vary.

Despite these limitations, this study is among the first to examine the experiences and health needs of international veterans who volunteered for military service in Ukraine, an under-researched group who fall outside existing military care structures. This is a difficult to reach population and this paper aimed to scope the potential impact on health and functioning within this cohort. The findings indicate that many may be experiencing significant and untreated mental and physical health problems, yet are not routinely offered support in Ukraine and often struggle to access appropriate care on their return to the UK or US. Without targeted recognition of their needs, these veterans risk remaining invisible within both systems and may face worsening outcomes over time. Further understanding of these veterans’ needs may provide the opportunity for clinicians to develop further clinical competence in managing potentially challenging presentations associated with contemporary high intensity combat. Addressing their unmet needs will require coordinated pathways that acknowledge their unique circumstances and ensure they receive timely and comprehensive care.

Acknowledgements

The authors would like to thank Mr Philip Hanson for his assistance with this study.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributors

Authors VW, NLM, GC contributed to the study concept and design. VW led data collection and analysis. Data interpretation was undertaken collaboratively. All authors contributed to drafting and critical revision of the manuscript, and approved the final version.

Declaration of interest

NG runs March on Stress Ltd which is a psychological health consultancy.

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