After 100 days of war in Ukraine, Doctors Without Borders/Médecins Sans Frontières (MSF) mental health teams across the country are raising the alarm on the worrying psychological symptoms they are seeing. Though the mental health consequences of the conflict are often invisible, the strain of fleeing from fighting, living with war wounds, or worrying about loved ones takes a heavy psychological toll.
“I feel fear in my soul. My fingers and hands begin to get cold,” says Vira, an elderly woman who fled the fighting in Ukraine’s Donetsk region and is now seeking shelter in Ivano-Frankivsk, in the southwest of the country.
“I’m worried about my relatives, who are still at home—my son who is still living where there is fighting. I don’t feel heartache, it's deep in my soul and it immediately brings me to tears. I can't describe how it is.”
“Many children we’ve seen who have experienced bomb blasts suffer from insomnia, bedwetting, and nightmares,” says Oksana Vykhivska, MSF mental health supervisor in Kyiv. “The elderly, who often find themselves alone after being separated from loved ones, are constantly anxious and break down into tears.”
Our teams have been providing mental health support in shelters for displaced people, at mobile clinics in remote villages, and in urban metro stations.
From mid-April to mid-May, MSF teams conducted more than 1,000 individual and group mental health sessions in Ukraine. We have observed that people suffer from intense fear, constant stress, persistent worry, hopelessness, and panic attacks.
Normal reactions to an abnormal situation
Our teams have cared for displaced people in Berehove, Kharkiv, Chernihiv, Vinnytsia, Ivano-Frankivsk, Uzhhorod, Kropyvnytskyi, Dnipro, and Zaporizhzhia.
Many of the most vulnerable people, such as the elderly, are isolated. Unable to flee their homes, many are now cut off from their neighbors and relatives who formed a support network. Meanwhile, children often pick up on the stress that adults around them are feeling.
“One issue we deal with is trauma-related stress: for example, people’s memories of hiding in basements during heavy shelling could be triggered by words, sounds, smells, or scenes that are reminiscent of the original trauma,” says Vykhivska.
“We also see people with a lot of anxiety-related symptoms, such as insomnia and constant worry about the future. People who normally are not affected are now stressed.”
"Struggling with the fear of death"
Kateryna had to flee her home in Irpin with her mother when their village was attacked. They were evacuated and are now living in a shelter in Mukachevo, in the far west of Ukraine. Here, Kateryna sees an MSF psychologist to help treat the panic attacks she has suffered since escaping her home.
“One of the things I’m struggling with is the fear of death,” she says. “I’m scared that I will fail to do something, or that I’ll do something wrong and won’t make it. I think about it again and again, and it prevents me from doing anything.”
These reactions are not unusual when living through war, says Lina Villa, MSF mental health activity manager in Dnipro and Zaporizhzhia. Our teams here visit shelters where hundreds of thousands of people have escaped the heavy fighting in the east and south of Ukraine.
Here, psychologists try to stabilize patients by identifying the issues they are facing, and then help them to find coping mechanisms.
“We try to help our patients to regain some level of control in a very uncontrollable and uncertain situation, by understanding and expressing what they feel,” says Villa. “We try to reassure them that stress, fear, anxiety, [and] sleeplessness are normal reactions to this abnormal situation. It’s vitally important that people can express and exercise their feelings and emotions after facing traumatic situations. If not addressed, these emotions can snowball and become more severe.”
Tailoring care for children
In Berehove, MSF psychologists work with children who have been evacuated from conflict areas. From April 4 to May 20, 375 children participated in group and individual mental health sessions here. They show symptoms from the trauma they have experienced both before and during their evacuation, including anxiety, low self-esteem, panic attacks, and grief.
“Many have trouble sleeping, some have started to stutter, some wet their beds,” says Kucheriaviy Valerii, MSF psychologist in Berehove.
To help them cope, psychologists have different practical methods they work through with the children. One is making paper birds: children cut them out and fold the wings while putting their positive emotions and thoughts into the process.
“I recommend they sleep with this bird; it can help calm them down,” says Valerii.
More mental health support is urgently needed
While MSF is providing mental health care and additional training to psychological staff in medical facilities across Ukraine, much more needs to be done.
“We need to see an urgent increase in mental health services across the country,” says Vykhivska. “Both the national health system and other organizations need to ensure that the response to mental health needs and the resources behind it reach the most vulnerable people, especially in rural areas, where people are often cut off and lack access.”
It is crucial this support is provided to people where they are and that it involves close collaboration with communities so that everyone who needs help receives it.
From mid-April to mid-May, MSF mental health teams provided 839 individual mental health consultations and 156 group consultations for adults and children across Ukraine, including in Uzhhorod, Berehove, Dnipro, Ivano-Frankivsk, Kropyvnytskyi, Kharkiv, Kyiv, Vinnytsia, and Zaporizhzhia. The most common symptoms our psychologists see are chronic stress, anxiety, panic attacks, sleeping problems, insomnia in adults, fear of loud sounds, loss of appetite, as well as bedwetting and nightmares for children. In addition, our teams have provided more than 100 mental health trainings to health care providers across the country to support those who have been affected by the war.