After 100 days of war in Ukraine, Médecins Sans Frontières/Médecins Sans Frontières (MSF) mental health teams across the country are sounding the alarm about the disturbing psychological symptoms they are seeing. Although the mental health consequences of conflict are often invisible, the strain of fleeing combat, living with war wounds or worrying about loved ones takes a heavy psychological toll.
“I feel fear in my soul. My fingers and hands are starting to feel cold,” says Vira, an elderly woman who fled fighting in Ukraine’s Donetsk region and is now seeking refuge in Ivano-Frankivsk, in the southwest of the country.
“I worry about my loved ones, who are still at home, my son who still lives where there is fighting. I don’t feel any heartache, it’s deep in my soul and it immediately brings me to tears. I can’t describe how it is.
After 100 days of war in Ukraine, our mental health teams across the country are sounding the alarm about the disturbing psychological symptoms they are seeing.
“Many of the children we saw who were victims of bomb explosions suffer from insomnia, bedwetting and nightmares,” explains Oksana Vykhivska, MSF mental health manager in Kyiv. “The elderly, who often find themselves alone after being separated from loved ones, are constantly anxious and burst into tears.”
Our teams provided mental health support in shelters for displaced people, in 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, despair and panic attacks.
Normal reactions to an abnormal situation
Our teams supported 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 neighbors and loved ones who have formed a support network. During this time, children often feel the stress that the adults around them feel.
“One of the issues we face is trauma-related stress: for example, memories that people hid in basements during heavy bombardments can be triggered by words, sounds, smells or scenes reminiscent of the initial trauma,” says Vykhivska.
“We also see people with many anxiety-related symptoms, such as insomnia and constant worry about the future. People who are normally unaffected are now stressed.
“Fighting the Fear of Death”
Kateryna had to flee her home in Irpin with her mother when their village was attacked. They were evacuated and now live in a shelter in Mukachevo, in the far west of Ukraine. Here, Kateryna sees an MSF psychologist to help her deal with the panic attacks she has been experiencing since running away from home.
“One of the things I struggle with is the fear of death,” she says. “I’m afraid of failing to do something, or doing something wrong and not succeeding. I think about it over and over again, and it stops me from doing anything.”
These reactions are not unusual when living through war, explains Lina Villa, head of MSF’s mental health activities in Dnipro and Zaporizhzhia. Our teams here visit shelters where hundreds of thousands of people escaped the fierce fighting in eastern and southern Ukraine.
Here, psychologists try to stabilize patients by identifying the problems they are facing and then help them find coping mechanisms.
“We try to help our patients regain some control in a very uncontrollable and uncertain situation, by understanding and expressing how they feel,” says Villa. “We try to reassure them that stress, fear, anxiety, [and] insomnia are normal reactions to this abnormal situation. It is vitally important for people to be able to express and exercise their feelings and emotions after coping with traumatic situations. If left untreated, these emotions can snowball and become more serious.
Tailor-made 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 of the trauma they suffered 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,” explains Kucheriaviy Valerii, an MSF psychologist in Berehove.
To help them cope, psychologists have different hands-on methods that they use with children. One is to make paper birds: children cut them out and fold in the wings while putting their emotions and positive thoughts into the process.
“I recommend that they sleep with this bird; it can help them calm 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. “The national health system and other organizations must ensure that the response to mental health needs and the resources that support it reach the most vulnerable people, especially in rural areas, where people are often isolated and have no access.”
It is crucial that this support is provided to people where they are and that it involves working closely 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 observed by our psychologists are chronic stress, anxiety, panic attacks, sleep disturbances, insomnia in adults, fear of loud noises, loss of appetite, as well as nocturnal enuresis and nightmares in children. Additionally, our teams have provided more than 100 mental health trainings to healthcare providers across the country to support those affected by war.