Ukraine, the uncertain mental health of warring people. international

39-year-old Olena Kozak’s life changed forever on the night of May 30. She, her husband, her mother and others were preparing to sleep when the rumble of an explosion broke the silence in their neighborhood of Kharkiv, in northeastern Ukraine. Shout. In the absence of time to reach underground shelter, seek a safe place indoors. Suddenly, everything went black. The second shell had fallen on his house situated on the fourth floor of a five-storey building. Kozak’s husband’s body was found the next day. This woman, who was the last of the nine dead, recovered by rescue services “under a mountain of debris in the middle of the road,” says this woman, surprisingly safe in terms of her physical health, with a broken voice. . His mood did not deteriorate.

Grief over the death of loved ones, uncertainty over the loss of a home, worry about a family member in the army, panic over a bombing…these are all emotions that affect the Ukrainian population. The World Health Organization (WHO) estimates that about 9.6 million people in this country (42 million lived in Ukraine before the 2022 Russian invasion) have mental health problems and 30% of the population – almost all soldiers – has post-traumatic stress. Due to the effects of the Russian invasion two and a half years ago.

Attacks are often directed against civilian targets, and health infrastructure bears the brunt, according to WHO, which has verified 2,047 attacks against buildings, transport and health workers from February 24, 2022 to September this year. Thousands of people have been left without access to health care, and this includes mental health in a country where there were already shortages, as according to the latest government estimate from 2017, there was only one specialist in this specialty for every 100,000 inhabitants. Is professional. Health Minister Viktor Lyashko predicted that about 15 million Ukrainians would need psychological support and up to four million would need prescribed medical treatment.

“My husband went into our bedroom for a moment because he wanted to get his cell phone back. My mother went to the balcony to see what was happening. When I came to, half of my apartment no longer existed. The memories make Kozak cry, sitting on a bench in the park that used to be her neighborhood. When she was rescued from the ruins of her home, she was terrified, but from the very first moment she was helped. “Undoubtedly, psychologists have been essential, especially when we celebrate funerals.” That, and the anxiolytic medications they gave her during the early days in which she had to absorb the deaths of her mother and her husband, “the two most valuable people in my life”, she regrets. Almost five months have passed since then and she at least feels more calm.

War is a source of tragic events that affect the emotional state, and it has consequences, warns Jarno Habicht, WHO representative in Ukraine: “From lack of sleep and decreased productivity at work to the appearance of mental disorders or To the former’s intensity. existing ones. The WHO estimates that 22% of people who “have experienced war will develop depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia.”

Veronika Amrakhova is a psychologist at an assistance center for displaced people managed by the High Commissioner for Refugees (UNHCR) in Kharkiv and the NGOs Prolinska and Right to Protection, to which she belongs. Adults and children come to her for consultation, and fear, depression and anxiety are three emotions that this professional mentioned. “They seek help because they feel so stressed,” he says.

Stress is a common trend for Ukrainians as daily bombings have turned the lives of millions of people into a lottery that ends with death. Air raid sirens sound every day from speakers on the streets and through the application that everyone has installed on their cell phones. In Kharkiv, near the front, it is easy for a telephone to honk loudly 35 times in 24 hours.

As the war goes on, Ukrainians are relaxing and no longer almost ever hide in shelters because otherwise they would do nothing but hide, which is why UNHCR worker Victoria Tyutyunyk has also been displaced from Lugansk. “You can never go to work, or study, or see your family, or have fun… They can bomb us, but they’re not going to take our lives away from us and Nor will we allow ourselves to be overcome by fear; For this they will have to kill us,” he says. But this desire to continue is not incompatible with the decline in mental health of people living in these circumstances.

child care

The rain in Kharkiv is getting worse. There is a sound of thunder on the other side of the window and seven-year-old Valeria jumps. She looks carefully at the road and hugs her Alyssa doll, the only toy she has. Next to him, on the bed, is his mother, Katerina Avramenko, who soothes him. “The bombing was becoming very intense and the children were very scared; “They even hid under the table,” he describes to justify Valeria’s fear of storms. Avramenko (30 years old), her husband and their two children lived in an apartment in Vovchansk, a city in the north of the province, where fighting was taking place between Russian and Ukrainian troops, until they were evacuated.

Amrakhova emphasizes children, like Valeria, who are experiencing “terrorist” situations. But not only this. One side effect of the stress of war is the deterioration of family relationships. “I am very worried about the relationship between parents and children because of the problems of coexistence that arise because of the war…everyone is under a lot of stress,” he laments.

According to UNHCR, the Avramenko family now lives in a room in one of the reception centers for people displaced by the war in Kharkiv, where more than 200,000 people are already taking refuge. The huge room has butane orange walls full of chips that Katerina has tried to hide with small stuffed animals hung from thumbtacks. “We were more scared when we were in Vovchansk, but somehow you get used to it. It is even worse with children,” admits this mother.

Avramenko also appreciates the psychological help he receives. “At first I didn’t realize that the sessions were useful, but after going to several sessions I feel more relieved, I’m in a better mood and I can do more for my family and myself.” There are also different activities for children and Valeria loves going as they draw “little pictures”. He likes to paint animals, especially horses. my little Pony,

Dealing with chronic stress is not easy. Amrakhova addresses this with individual and group therapy. “There are specific protocols that try to get control of our emotions,” he explains, although there is no magic formula. “The basic thing is not to be afraid. It’s normal to have problems and get help. And they are not alone.” Kozak, above all, values ​​his therapist’s availability, knowing how much he still depends on that support. “I know I can call anytime if I’m scared, having nightmares, having a bad time…” he says. That thought calms him down.

Be your own psychologist

It is a reality that the Ukrainian health system is broken. As there has been a shortage of professionals in the field of psychology and psychiatry since before the war. Recognizing the shortcomings, Dr. Jarno Habicht is committed to increasing the availability of services as well as promoting self-care. “People in Ukraine demonstrate a high level of resilience. Most people can deal with stress on their own, but we need to spread the necessary knowledge to help them,” he says.

Habicht also defends that Ukraine has made “significant progress” since 2022. Among the measures implemented, the Pan-Ukrainian Mental Health Program launched by the First Lady of Ukraine Olena Zelenska stands out, which integrates mental health in different areas, teaches a culture of self-care and offers online or at-home psychological services. Provides assistance.

Another resource is the MHGAP program, which aims to guarantee access to mental health services in primary care, training health workers. So far, 6,540 professionals have received this knowledge and Health has also enabled a map with specialized medical centres. According to the ministry, more than 17,000 Ukrainians have received free psychological assistance since 2023.

Kozak has found another way to avoid work. She is a cashier at a supermarket and decides to return to her job because being there distracts her and her coworkers console her. He is also close to his remaining family – his brother and nephews, with whom he lives – and to his Orthodox Christian faith. But despite so much help, his daily life is a battle against the dark thoughts that attack him from time to time. “Everything reminds me of my husband. There’s even a customer in the supermarket who looks like him,” he says, crying. Her eyes water again and it becomes difficult for her to speak, but she finds strength: “I shouldn’t be sad because if they saw me, they would be sad. I must live for them.”