Shamsullah, 10, waits for dressings on his wounds to be changed. His legs were amputated after he stepped on an improvised explosive device (IED) while walking to school in Helmand province’s Sangin district three months ago. (Holly Pickett/For The Washington Post)

No one knows how many there actually are. Decades of conflict have made tallying Afghanistan’s war-related amputees — the victims of land mines, unexploded ordnance and roadside bombs — essentially impossible, health officials say.

But as the battle between Afghan security forces and Taliban fighters rages, humanitarian workers also say potent improvised explosive devices laid by insurgents are contributing to a significant rise in traumatic limb amputations for Afghan civilians and combatants.

And even as the population of Afghans who are missing limbs grows, amputees face discrimination and the harsh stigma of being disabled. Their families, too, often cannot cope with the strain of caring for severely disabled relatives in a country crushed by poverty and high rates of illiteracy.

Afghan policeman Matiullah, 26, watches Fathi Momand, 50, walk during Matiullah’s first physical therapy session, two days after his legs were amputated. (Holly Pickett/For The Washington Post)

Shah Zada, 25, allows therapist Sardar Wali to exercise the remains of his amputated legs. Shah Zada, an Afghan soldier, was injured by an IED. (Holly Pickett/For The Washington Post)

“Socially and financially, their lives are destroyed,” Emanuele Nannini, program director at the Italian nonprofit Emergency, which operates health-care centers across Afghanistan, said of Afghan amputees.

From January to June this year, Emergency’s Center for War Trauma Victims in Lashkar Gah, the capital of Helmand province in southern Afghanistan, performed 69 amputations. The fiercest fighting between the two sides usually takes place in the warmer summer months.

Emergency then sends the amputees to the nearby International Committee for the Red Cross orthopedic facility for long-term rehabilitation. The patients receive vocational training and other support to reintegrate them into society. The ICRC said that between April and June this year, it admitted 351 amputee patients to its facilities across Afghanistan.

Doctors amputate the legs of Afghan policeman Matiullah, 26, at Emergency Surgical Center for Civilian War Victims in Lashkar Gah. Matiullah stepped on an improvised explosive device, which blew off part of his left leg and shredded the right leg. (Holly Pickett/For The Washington Post)

But for the most part, amputees “are completely dependent on their families, and they become a huge burden,” said Nannini, who is based in Kabul. “The real tragedy starts when they go home. If they don’t have a strong family, they become beggars.”

Indeed, the hardship that comes with the loss of a limb — or limbs — in a country that relies so heavily on agriculture and manual labor is particularly acute. Farmers can no longer toil. A mechanic without an arm loses his ability to tinker. A policeman cannot go out on patrol. When limbs are torn apart, livelihoods are mangled with them.

Daad Mahmad, left, 30, arrives at the Emergency Surgical Center for Civilian War Victims in Lashkar Gah. (Holly Pickett/For The Washington Post)

Mohammad Dawoud is a 22-year-old farmer from a village in southern Afghanistan’s Helmand province — and his father’s only son. He was walking past a police checkpoint on the dirt road near his home this summer when he stepped on a buried IED, he said.

Doctors at Emergency’s hospital in Lashkar Gah amputated both of his legs above the knees. His fiancee knows what happened to him, but he has not yet heard from her, he said. Dawoud knows it is unlikely she will marry him now that he is handicapped.

“Life will pass somehow,” Dawoud said from his hospital bed in Lashkar Gah. “Maybe I will get some money and open a shop for tea and sweets in my village.”

“I used to grow pomegranates,” he said, recalling his life as a farmer. “But I never learned to read or write, because I never imagined I would end up like this.”