Ukraine: “Your entire universe falls apart”
Despite the back-to-school ceasefire – an agreement signed in September to guarantee a safe environment for children to attend school after the summer – shelling continues in many villages located near the line of contact in eastern Ukraine. After almost three years of conflict, civilians are still bearing the brunt of the ongoing violence with more than 1.7 million people forced from their homes.
Elena Pylaeva, a psychologist working with MSF, explains the effects of this protracted conflict on the mental health of the population.
How is the conflict affecting people's lives?
The conflict is breaking communities and families apart. This is very visible in the locations we visit every day: the majority of our patients are elderly women, often widows whose children and grandchildren have fled to find a safer place to live or a job. There are people who have been left behind in their villages near the contact line, living with the fear of shelling and being cut off from basic services, including healthcare. Then there are people who have fled to these places, who have to come to terms with a new environment and start from zero.
In many cases, people who decided to stay lost their jobs. They were working in places such as schools, supermarkets or kindergartens that had to close because of the conflict. How can a school operate with shells falling nearby? So there are people in their 40s or 50s who have been forced to retire. There is a strong work ethic in eastern Ukraine, so this sudden inactivity is perturbing for many people.
Is there a particular impact on women?
Women in Ukrainian society work hard, and at the same time have a central role in the family caring for the children, taking care of the house and bonding family members together. This leaves little to no time to look after themselves.
Family plays an essential role as one of the first places where you can find support.
However, when your children have fled and you suddenly find yourself unemployed, your entire universe falls apart. In addition, in some cases the conflict has generated an increase in alcohol consumption, particularly in men. Pressure on women thus becomes higher and often they've had to take over their husband's role providing for the family.
An important part of our mental health support is to share ways in which people can start addressing their own needs. This is particularly important in such an unstable and insecure situation: while it's not possible to change the daily reality of the conflict, there are changes that women can make for both their physical and mental health.
What are the main symptoms you are seeing among mental health patients?
The main issue we keep seeing is related to stress, either acute or chronic. Around half of patients suffer from anxiety symptoms. This is of course directly related to the conflict: people have lost relatives or friends because of the conflict; and many had to flee because their houses were damaged.
People live with the daily fear of shelling, and this affects both their mental and physical health.
How do you support displaced people and people living near the contact line?
Through our mobile clinics, we offer individual mental health consultations. We also carry out mental health awareness presentations that help inform people about stress and anxiety symptoms and how to cope with them in daily life.
In addition, we have started group support sessions for the elderly population in Mariupol. These groups include people who fled to Mariupol, as well as people from the city. Having both groups – displaced and host communities – facilitates integration into a new environment, and creates a space to exchange on feelings linked to the conflict. Our goal is to provide the participants with emotional coping mechanisms that will have a positive effect on their physical health and psychological well-being.
Is coming to the mobile clinic also a way to create exchange and break isolation?
Indeed, coming to the mobile clinic is a first step for patients to feel less isolated. Many elderly people, suffering from chronic diseases, come to see our nurses and doctors to check their physical condition and receive their treatment. While waiting for their medical consultation they chat with each other.
What seems to be just an everyday moment is on the contrary a real opportunity to support and listen to each other, and to share feelings related to similar experiences. This is a way for people to understand that they are not alone and are not the only ones experiencing distressing feelings linked to the conflict.
What advice do you give people to take care of themselves?
The priority is to take time to look after their health and well-being, and ensure as much as possible that they have a healthy lifestyle. It is also good to undertake 'normal' activities. For some this is cooking, for others it might be gardening.
We have seen an increase in violence and violations of the ceasefire. How does that impact your work?
In places where there has been an increase in shelling over the past few weeks, we are seeing more people coming for support. Houses continue to be damaged, people still have to hide in their basements, and families keep leaving everything behind to move to safer places.
People are scared and tired.
What is the impact on the population of almost three years of violence?
Life in remote villages is tough. When the conflict started, many people had already lived a challenging life and knew how to deal with it. However, coping with such a volatile environment for so long isn't the same.
In the past few weeks, I have seen families who can't cope with the situation anymore. There are people who have slept in their basement for more than two years and with the shelling continuing, they now need support to get through what has become a new reality.
People are tired of the conflict. They often ask me: when is this going to end? Their energy to be able to face this situation comes from their hope. Hope for a return to a peaceful life. But after so long coping with that much uncertainty and insecurity, it looks like we are talking about the last few drops of energy.
 Ministry of Social Policy of Ukraine; IOM; May 2016