War in Ukraine

The psychological toll of violence.

Mariupol, Ukraine AP 13 March

Ukraine 2022 © Evgeniy Maloletka/AP Photo

Alert is a quarterly magazine published by Doctors Without Borders/Médecins Sans Frontières (MSF-USA) that features ground reporting from our work around the world. This article appears in the Spring 2023 issue (Vol. 24, no. 1), Healing Mind and Body.

Just over one year has passed since Russia launched a large-scale military operation in Ukraine that quickly escalated into war across the country. The fighting has taken a heavy toll, displacing millions of people and pushing the health system to the brink as hospitals struggle to care for large numbers of war-wounded patients. But for many people living through the crisis, the most painful wounds are invisible.

“I feel fear in my soul. My fingers and hands begin to get cold,” said Vira, an elderly woman who fled the Donetsk region of Ukraine last winter and sought shelter in the southwest of the country.

“I’m worried about my relatives, who are still at home—my son is still living where there is fighting. I don’t feel heartache; what I feel is deep in my soul and it immediately brings me to tears. I can't describe how it is.”

Doctors Without Borders/Médecins Sans Frontières (MSF) teams have been providing medical and mental health support to people affected by the conflict since it began in eastern Ukraine in 2014. As the war escalated, we’ve adapted and scaled up our work to meet the growing humanitarian needs. During April and May 2022 alone, MSF conducted more than 1,000 individual and group mental health sessions in Ukraine. By 2023, in places like Kirovohrad oblast, MSF teams conducted group psychoeducation sessions for nearly 10,000 people.

We’ve cared for people suffering from intense fear, constant stress, persistent worry, hopelessness, and panic attacks. Many of the most vulnerable, such as the elderly, are isolated and separated from their neighbors and relatives who were their support network before the war. Our teams also work with children who often pick up on the stress that adults around them are feeling.

"One of the things I'm struggling with is the fear of death. I'm scared that I will fail to do something, or that I'll do something wrong and won't make it."

Kateryna, MSF Patient

Providing outlets of expression

“One issue we deal with is trauma-related stress,” said Oksana Vykhivska, MSF mental health supervisor in Kyiv. “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.” MSF provides mental health care in 10 different locations outside Kyiv. In 2022, our teams provided almost 1,000 individual mental health consultations and 184 group therapy sessions.

“We also see people with a lot of anxiety-related symptoms, such as insomnia and constant worrying about the future,” she said. “People who normally are not affected are now stressed.”

Kateryna is one of them. She fled her home in Irpin with her mother when their village was attacked. They were evacuated to a shelter in Mukachevo in the far west of Ukraine. There, Kateryna saw an MSF psychologist because she suffered from panic attacks since escaping her village.

“One of the things I’m struggling with is the fear of death,” she said. “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.”

MSF psychologists work to stabilize patients by identifying the issues they are facing, and then help them 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,” said Lina Villa, MSF mental health activity manager in Dnipro and Zaporizhzhia.

Mental health issues across Ukraine
Lina Villa, MSF’s mental health activity manager in Dnipro and Zaporizhzhia, counsels a Ukrainian person displaced by war.
Ukraine 2022 © Pau Miranda/MSF

“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,” she said. “If not addressed, these emotions can snowball and become more severe.”

Our teams have cared for displaced people in Berehove, Kharkiv, Chernihiv, Vinnytsia, Ivano-Frankivsk, Uzhhorod, Kropyvnytskyi, Dnipro, and Zaporizhzhia. From March to December 2022, MSF provided 41 training sessions attended by 764 people in Zakarpattia oblast and 69 sessions in Ivano-Frankivsk oblast, with the participation of 1,146 people.

In Kirovohrad oblast, from April to December 2022, we provided 146 training sessions for health professionals, psychologists, and first responders on things like managing influxes of war-wounded people, decontamination, trauma, and mental health. A total of 2,301 people participated. Since April, our mental health team has seen 299 patients in individual sessions and 9,463 patients in group psychoeducation sessions.

Mental health issues across Ukraine
Mental health issues across Ukraine

MSF psychologist Yevhenia Stupnik runs a group session with children in Berehove. Ukraine 2022 © Nadia Voloboieva/ MSF.

The children of the war

Living through conflict, displacement, loss, and the constant terror of the unknown has a devastating impact on the psychological development of children.

“Seeing the children of the war, I can divide them into two categories. The first one includes emotionally unstable children who are hard to communicate with and are often distressed,” explained Stanislav Kramskyi, a nurse who worked in MSF’s mobile clinics in Zaporizhzhia.

“The second category includes children who had to grow up prematurely. Their eyes, behavior, and thoughts are [those] of an adult.”

"Living through conflict, displacement, loss, and the constant terror of the unknown has a devastating impact on the psychological development of children."

As a nurse, Kramskyi works alongside psychologists like Marina Popova in the mobile clinics. “She sees pediatric patients with their parents and adults separately,” he explained. “I can see how women are coping despite all the hardships. They are hiding their problems behind a smile. Marina helps them to overcome these negative emotions.”

In Berehove, MSF psychologists work with children who have been evacuated from conflict areas. From April 4 to May 20, 2022, 375 children participated in group and individual mental health sessions here. Children 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,” said Kucheriaviy Valerii, an MSF psychologist in Berehove.

Supporting older people 

“I am sleeping very badly—I am exhausted,” said 70-year-old Valentyna, from Vasylenkova, whose son Roma was killed by a landmine. “I wake up horrified and see him in front of me.”

Valentyna receives general health care to help with her sleeping problems and our team of psychologists provide her with mental health support. Anxiety can also exacerbate chronic health conditions such as high blood pressure, so MSF teams provide patients with tools to help control stress, like coping mechanisms for acute stress reactions and panic attacks.

"Our presence can provide hope, peace, and a sense of security. It is a concrete symbol that we care." 

Dr. Morten Rostrup

“This war took my health and my son,” she said. “I am crying and screaming. Now he is gone, and my life is over.”

Many of the older women who come to MSF’s clinics feel isolated, abandoned, and lonely.

“For these older women, the feeling of having lost their purpose in life causes anxiety, and the feeling of having to rebuild a new purpose for the last years of their lives causes hopelessness,” said MSF Mental Health Activity Manager Camilo Garcia. “We hear elderly women tell us that they feel like the last years of their lives have been stolen from them.”

Psychological first aid in Zaporizhzhia
MSF psychologist Marina Popova provides psychological first aid to a woman who just arrived by bus at the reception center in Zaporizhzhia.
Ukraine 2022 © Pau Miranda/MSF

"The fact that you are here has a calming effect on us."

Olena, Ukranian clinical psychologist

When the bombing first started in Kharkiv, Ukraine’s second largest city, many people took refuge in subway stations. Trapped underground, they were cut off from essential services, including health care. Dr. Morten Rostrup was one of many MSF staff who set up mobile clinics in various stations, carrying out dozens of consultations through the evening and then pulling out his own sleeping bag to stay the night.

“I have seen the despair, the lack of hope, the confusion, the inability to comprehend how they have ended up in this situation: losing family members and friends, losing their homes, losing the future they had envisioned for themselves,” he said. “I have seen the constant fear experienced by so many, and how some people collapse in terror when the sound of airstrikes fills the air.”

Before he set out to the mobile clinics, he met with a Ukrainian clinical psychologist, Olena, who said she could no longer work under the traumatizing conditions she was actively enduring. Looking at Dr. Rostrup, she said, “It’s good to meet you. You are so calm. You don’t have the stress and worries that we have. The fact that you are here has a calming effect on us.”

Olena Ponomarenko, the head of the village
Halyna Peretiata is from a village in the Kherson region that had its electricity cut off for over four months. She has two sons in other cities whose homes were severely damaged by shelling.
Ukraine 2022 © MSF

For Dr. Rostrup, this showed the importance of his work in stark relief.

“Medical humanitarian work is not only about the concrete help we provide in the form of medicine and treatment,” he said. “It’s also about the presence of people from other countries and how they stand alongside those who are experiencing this crisis firsthand. Our presence can provide hope, peace, and a sense of security. It is a concrete symbol that we care.”

April 03 10:26 AM

Alert Spring 2023: Healing mind and body

How MSF provides mental health care to people caught in crisis.

Read More
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