KYIV, Ukraine (AP) — When Alexis Cholas lost his right arm as a volunteer combat medic near the front lines in eastern Ukraine, his civilian career as a surgeon was over. But thanks to a new bionic arm, he was able to continue working in health care and is now a rehab specialist helping other amputees.

The 26-year-old is delighted with his sleek black robotic arm — he described it as “love at first sight” — and realizes how lucky he was to get one.

“There are fewer (bionic) arms available than lost ones,” Cholas said.

Russia’s war on Ukraine has created a massive need for prosthetic limbs. An estimated 20,000 Ukrainians have had amputations since the war started in February 2022, many of them soldiers who lost arms or legs due to blast wounds.

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Only a small number was able to receive bionic prostheses, which are more advanced and can provide greater mobility than the traditional prosthetic limbs.

They are also far more costly than conventional prostheses.

Bionic artificial limbs typically pick up electrical signals from the muscles that remain above the amputation site, thanks to something called myoelectric technology, to carry out an intended motion.

Cholas’ bionic arm was made by Esper Bionics. Before 2022, the Ukrainian startup primarily targeted the United States market, but due to the sharp rise in demand for prosthetic limbs caused by the war, Esper now distributes 70% of its products at home.

The company’s production hub in the capital of Kyiv is working at full capacity, with more than 30 workers producing about dozen bionic hands a month.

In one corner of the factory, a small group of engineers huddle as they program, assemble and test the elegant bionic arms — known as Esper Hand. Each finger’s movement on the robotic hand is accompanied by a soft whirring sound, assuring the engineers of its smooth operation.

Bohdan Diorditsa, head of strategic relations at the company, says that despite ramping up production, Esper Bionics is struggling to keep up with demand, with almost 120 people on the waitlist.

In Ukraine, the company says it provides the bionic prostheses at zero profit for about $7,000 a piece, just enough to cover production costs. In the United States, the Esper Hand sells for more than $20,000.

“We do not consider Ukraine as a market, but rather as an opportunity to help,” says Diorditsa.

Compared to a conventional prosthesis, which is designed to replicate simple basic functions of a missing arm or leg, a bionic one offers the capability to restore fine motor skills.

“Everyone wants them,” says Anton Haidash, a prosthetist at Unbroken, a municipal center in the city of Lviv that focuses on rehabilitation of civilians and soldiers affected by the war. The center has helped provide prosthetic limbs to about 250 people so far, including about 20 bionic arms.

The difference in cost is significant. While bionic limbs can cost up to $50,000, conventional artificial limbs are priced at $800-$2,700, Haidash says.

Ukrainians can get the regular artificial limbs free of charge through the public health care system. However, to get a bionic prosthesis, they normally need additional funding from charities or rehabilitation centers such as Unbroken, which depend on donations.

And while patients can make the final decision about the type of prostheses they want, a variety of factors, including the nature of the injury and the person’s occupation, also play a role.

Unbroken purchases bionic prostheses from German and Icelandic companies as well as Esper Bionics, whose notable advantage is having both a manufacturing and a service center in Ukraine. This means people don’t need to travel abroad when a repair or resizing is required.

Another outstanding characteristic of the Esper Hand, which is powered by artificial intelligence, is its ability to adapt over time, learning the user’s unique interactions with the hand.

After getting outfitted with his bionic arm, Cholas went back to volunteering as a combat medic on the front lines, while in his day job in Kyiv he works as a rehabilitation specialist in a public hospital. Most of his patients are members of the military or civilians who, like him, have lost limbs. He says their shared experience helps him quickly develop a rapport with his patients.

“I now know a lot not only from textbooks but also from my own experience,” he says.

Cholas speaks to his patients encouragingly as he examines their injuries. His movements with the bionic hand are natural and fluid. He effortlessly removes a bandage and dresses a patient’s wounds without the assistance of nurses.

The bionic prosthesis allows him to perform even delicate movements, such as picking up a grape without crushing it, he says.

“I feel uncomfortable when I’m without the prosthesis,” he says. “But when I have the bionic arm on, I feel comfortable. It’s like a part of you.”

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Associated Press photographer Evegeniy Maloletka in Kyiv, Ukraine, contributed to this report.

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Find more of AP’s war coverage at https://apnews.com/hub/russia-ukraine