Living with trauma amid conflict in eastern Ukraine

Nadiia, 79, from Mariupol listens to MSF nurse Tetiana as she goes over new treatment options.
UKRAINE 2018 © KENNY KARPOV
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“I could never leave this place. It's my home, and my son and husband are buried here. I cannot leave them. I’d rather die here than anywhere else.” – Mariia, a patient at MSF’s mobile clinic in Opytne, Ukraine

Four years of conflict have severely altered the lives of people living in eastern Ukraine. More than a million people have been forced from their homes by a lack of security, loss of livelihoods, and damage to their property. Partially abandoned villages are now home mostly to elderly people living in relative isolation, struggling to afford daily necessities as they cope with rising prices and insufficient pensions.

Many of these people are in desperate need of medical care to treat chronic diseases and psychological support to help them cope with their stress and loneliness, which are exacerbated by the conflict. Unfortunately, health care is often out of reach both physically and financially. Most medical personnel have fled the fighting in the region, and many hospitals and medical clinics were damaged or destroyed.

Doctors Without Borders/Médecins Sans Frontières (MSF) runs mobile clinics in 28 locations across Ukraine’s Donetsk region from bases in Mariupol and Kurakhove. The clinics provide primary health care and mental health consultations. Teams also supply medical facilities in the area with drugs and equipment and conduct mental health support training for teachers and government health care professionals still living or working in the conflict zone.

It is clear that some medical conditions—such as hypertension and diabetes—are related to the stress people are experiencing due to the conflict. Accordingly, MSF has bolstered its medical services with mental health support ever since it began working in this region. Among the patients receiving care from MSF, more than half are affected by anxiety. Other common conditions include psychosomatic disorders and depression.

The greatest challenge for MSF’s mental health team gaining the trust of people living in the region. Most had never spoken with a psychologist and did not understand how the consultations could help them. MSF’s team explained about psychological care and how mental health is linked with physical health. They focused on stress-related problems and the symptoms that indicate when someone needs help. Gradually, the team earned trust in the areas they visit.

People began to share their feelings and experiences more readily and started to come to MSF mental health consultations regularly. Those who had been helped through the mental health consultations began to share their experiences with others. Step by step, the trust between MSF and the communities has grown.

Here, MSF patients and staff share their experiences coping with the mental and physical effects of the ongoing conflict.

MSF doctor Sergienko Iryna

MSF doctor Iryna from Kurakhove waits for a patient who is on her way to an MSF mobile clinic in the village of Vodiane.
UKRAINE 2018 © KENNY KARPOV

 “I love working in these villages. We've been getting some great results with our patients. It feels good to offer them free care during such a difficult time for many of them, being out of work with no pension, being forced from their homes. It's all so horrible to even think about. Our patients are typically elderly people who have been abandoned by their families and close friends. They're very lonely.

“It is very important for us to work with psychologists. Stress, caused by the conflict, has a severely negative impact on chronic disease management and causes the health of the patient to deteriorate over the course of the disease. Furthermore, it can trigger the development of new diseases, such as type II diabetes. Stress can also cause headaches, muscle pain, insomnia, and rapid heartbeat.

Moreover, we have seen stress become a chronic condition, leading to depressive disorders. This can make people become apathetic and forgetful, lose interest in self-care, and stop following treatment instructions for their diseases or skip doses. This makes their health condition even worse.

“People are gradually getting used to life under chronic conflict. However, their bodies still feel the negative impact, even once people have learned to hold back their strong emotions. Many of our patients believe their health will never improve. However, after we see them three or four times, we really start to see a difference—their mental and physical health improves, and they have more hope.

It's almost like they're a completely different person. The people we meet are very open to speaking about the conflict with us. Many say we are like family to them, sometimes their only family, so they are comfortable sharing something so personal. The first time we visited Opytne, we did our usual medical history and examination. Afterwards, instead of going home, everyone there just wanted to be around us and to share stories about the conflict, their grandchildren, and the vegetables they grow.”

Oleksii, 90, from Vodiane

Oleksii waits outside of an MSF run clinic.
Kenny Karpov

 “I've been visiting this clinic since the war started. I come here for treatment for diabetes. I'm very grateful for the staff. The other nearest clinic, which I visited before coming here, is 30 kilometers [nearly 19 miles] away. The medicine there is too expensive for me, so it makes sense to come here, as I can walk and the treatments are free.

Before the war, I used to visit a hospital for my treatments, but it was destroyed by an explosion. If MSF were not here, I would likely be dead by now. I try to keep active as much as I can at my age. I work in the garden a lot and tend to my chickens and other animals. I always try to be in movement with anything I do. I exercise at dawn each day in my garden or around the house, depending on the weather.

“I remember when the conflict started. It was 2014. I could hear shooting and explosions throughout the day and night. I was away one afternoon when an explosion hit so close to my house that it blew the windows out and damaged the sides. The same day, the roof was destroyed by another blast. When I came back, I couldn't believe what I saw. My house! It made me depressed.

Now, life here is hard, as little remains intact. Some of the buses have started running again, so people can travel to other villages. I don't travel much due to my health, as I cannot walk or stand for too long. I try to sell the vegetables I grow I try to earn some money, but, as this is a small village, almost everyone grows their own produce and no one is buying them from me.

It's a very hard life to make ends meet, but I never thought of leaving. I was born in this village and have spent all my life here. I couldn't see myself someplace else. I am afraid every day that something might happen to me, but I have no other place to go. Most of the friends I had are now buried at the local cemetery.”

Yelyzaveta Rychak, 62, from Mariupol

Yelyzaveta Rychak lives in the center of Mariupol with her husband. She has had ten operations on her body since the start of the war in 2014.
UKRAINE 2018 © KENNY KARPOV

 “My husband and I are renting an apartment in the center of Mariupol. We used to live in a small village near Luhansk, but our home was bombed, and we were forced to flee. Life was fine before the war. My husband was a miner for over 40 years. When the war began, it was so sudden. No one expected this to happen.

When the shell hit our house, the explosion threw me across two rooms and into a wall. At first, I couldn't move, and I lost my hearing for a few weeks after the explosion. I thought that might be permanent, but luckily it went away. The fear, though, does not go away. That day will always remain with me. I live in constant fear, even now.

“These days, we live pension to pension. It's very hard to survive like this. I have had 10 operations since that day—on my heart, my spine, and my belly. I come to the MSF clinic for medicines that will help with my pain. My pension is 1,430 UAH [about $52] a month. It's not enough to buy medicines. One trip to the pharmacy and you have spent all of your pension.

I worked for 38 years at one job, and this is all I receive. My husband worked 48 years, but his pension is not that much. After working for so long in the mines, he has issues with his back, his sight and his lungs.”

MSF psychologist Artem Tarasov

MSF psychologist Artem conducts a consultation with Iryna, 66, at an abandoned kindergarten in Avdiivka
Kenny Karpov

 “The majority of the patients I see are elderly people, mainly women over the age of 50. The women who attend the counseling sessions are not used to talking about their feelings, let alone their mental health issues. I mainly offer one-to-one counseling sessions alongside a few group sessions where patients are able to share similar types of traumatic stories.

It feels good for them to share with people who have had the same experiences. In the one-to-one sessions, I teach various techniques to cope with trauma, like breathing exercises, stress-reduction techniques, and cognitive and behavioral therapy. I have a different approach for each patient. Many of the people I meet have symptoms related to anxiety, psychosomatic problems and depression caused by the current situation or due to something that has happened during the conflict.

“There's a link between mental and physiological problems. During the sessions, I look at physical conditions first, outward expressions of emotional distress. After that, I look for psychological symptoms, for example changes in their daily habits or mood, distressing memories, anxiety, and flashbacks. Most of the people I speak with tell me about their personal problems and how the conflict affects their social and family lives.

They are very lonely. They feel left out from society. Their children and grandchildren, friends and relatives all moved to other cities. They now live alone in houses or apartments without physical or psychological support. They speak about traumatic situations, about hiding in basements, hearing or seeing shooting and explosions close by; some actually watched their homes be destroyed while they hid with neighbors.

“All psychologists have different techniques that we use to cope with the emotional aspect of our jobs. I have breathing and visualization techniques for coping with fear and anxiety. I usually like to head home straight after the clinic to work on those techniques and relax, to try and turn off for a while. All my patients have lived through horrific events over the last four years. It's difficult. I remember all of their faces and stories.”

 Kozhura, 56, from Lebendynske

Kozhura, 56, from Mariupol waits outside the consultation room to be seen by an MSF staff member.
UKRAINE 2018 © KENNY KARPOV

 “I never thought the war would start. It was a very unexpected moment for everyone. Even when the fighting began in Luhansk, I thought it was so far away that it would never reach us.

In the summer of 2014, at the height of the conflict, I lost my two grandchildren. My granddaughter was about to start school for the first time, but she never did. Nikita was 10, and Karolina was six. It was very hard for me afterwards. I cried all the time. I had many thoughts about suicide.

There are not many things in life that offer happiness now, and I still think about suicide because I blame myself for what happened to my grandchildren. It's been four years since I lost them. It's still very difficult.

I first heard about MSF and their medical treatments in 2016. That’s when I first saw an MSF psychologist. It has helped, but I still feel guilty. I should have left the house with my grandchildren. I didn't know the war was going to hit us. I didn't even have a basement where I lived for us to hide in. They went out to play and then it happened.

Many people don't understand the situation here. They have no idea what we have been through. I hope the conflict will end soon so the people who left can come back and the buildings can be rebuilt.”

Mariia, 79, from Opytne

The MSF medical team speaks with Mariia in the home of a fellow resident who offers up one of her rooms to MSF to run a mobile clinic in the village of Opytne.
Kenny Karpov

 “October 2015 was the worst month of my life. There were shootings and explosions happening all around my house. I was terrified. I hid in the furthest room from the noise. I remember seeing one huge attack that killed my dog.

Two more explosions damaged a lot of my house, so now there is no electricity, gas, or water. My windows are all broken, and I have had to cover them with cardboard. I hope someone will come here and help fix some of the issues since winter will be here soon. I may freeze to death.

“I remember hiding in my back room and getting horrible news. My neighbor ran into my house and told me my son was badly injured. He had a large wound in his head from a piece of shrapnel. I started crying, seeing him outside with his wounds. Then a group of military officers came running over and said they would take him to the hospital. At the hospital, the doctors removed the shrapnel that was lodged in his head. Everything seemed quite normal. We walked out of the hospital and returned home.

“After a few hours, he suddenly fell to the floor. He was taken to the hospital again, but the doctors didn't do much. They looked at him, gave him some medication and sent us away. Once we were back home, he couldn’t move and, some time later, he died. He died right in front of me. I was helpless. I couldn't save my son. My son had a child of his own. I didn’t know what to do with him, so I asked a neighbor to look after him for a while. After my son’s death, my nerves were destroyed. I was shaking a lot. I couldn't eat. He was my helper, my everything.

“My sister has tried to get me to leave Opytne. I told her I could never leave this place. It's my home, and my son and husband are buried here. I cannot leave them. I’d rather die here than anywhere else.

I've been visiting the MSF clinic for a while now for treatment with my nerves and high blood pressure. Before my son’s death, I didn't have such problems. But I enjoy coming here. The doctors talk and joke with me all the time. It feels like family here. There’s only about 20 people left in this village. You still hear fighting from time to time. It's sad that this has become so familiar to my life now.”