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MENTAL HEALTH IN WAR, DISPLACEMENT AND MIGRATION _Ukraine

Rebuilding lives damaged by the relentless war in Ukraine

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After two years since the escalation of war in Ukraine, the death toll has surged, leaving hundreds of thousands injured and nearly 10 million displaced. We hear from our patients and teams about the mental health and physical rehabilitation needs on the ground.

“About six months ago, everything was shelled – the medical point, the pharmacy, and all the infrastructure was destroyed… but it wasn’t the end. We built houses, we strengthened our community,” says Liudmyla Karatsiuba, a resident in a village near Kupiansk, one of the most volatile areas on the frontline in Ukraine, in the northeast of the country.

Following the Ukrainian forces’ partial retaking of the Kharkiv region in September 2022 and the frontline shifting further from Kupiansk, a Médecins Sans Frontières (MSF) medical team arrived in Liudmyla's village to offer medical treatment.

The shelling had left no public buildings for the team to set up a clinic, so Liudmyla agreed to let the team use her home, where they provided medical and psychological consultations to people from the entire community.

MENTAL HEALTH IN WAR, DISPLACEMENT AND MIGRATION _Ukraine
An MSF mental health patient crosses through the remnants of destroyed houses from the war. Ukraine, October 2023.
Nuria Lopez Torres

“I still follow the advice given by MSF psychologists, and I teach my neighbours the candle breathing exercise for calmness and balance,” says Liudmyla. “It has helped me remain focused on being useful at the age of 75. Currently, I am engaged in farming and raising rabbits.”

The breathing exercise Liudmyla refers to is a simple technique used to ease stress and anxiety. MSF mobile teams in Ukraine have shared breathing exercises that can be easily passed on to people as part of their work to treat and raise the profile of mental health care. The same teams worked with Liudmyla’s community to rebuild the only local medical point, where Ministry of Health workers have now returned.

“Our medical centre is now referred to as the ‘museum’ because it’s so new. Now there’s somewhere to go when we need treatment or medicine,” says Liudmyla.

Liudmyla is typical of the types of patients our teams see near the frontline. Since the dramatic escalation of the war in February 2022, MSF has been conducting mobile clinics in the adjacent regions.

“Most of our patients have been women over the age of 60, many of them suffering from chronic diseases like hypertension and diabetes,” says Maksym Zharikov, MSF deputy medical coordinator in Ukraine.

“While some were evacuated, others couldn’t leave or chose to remain in their communities. The urgent need remains to provide medical services to patients residing 20-30 kilometres from the frontlines.”

This trend has been a constant since the war began in 2014; villages near the frontline dwindle, with fewer supplies in the markets and medical centres, and fewer people. However, following the war’s escalation, nearly 10 million people are displaced today, either inside Ukraine or as refugees abroad.

Our teams have been able to support some of these communities with supplies, medical care, and reconstruction. However, more often it is the communities themselves, with the aid of local volunteer organisations, that carry out this work. In the last two years, it has become increasingly difficult to reach areas cut off by fighting or close to the frontlines.

Today, we run mobile clinics in 100 different towns and villages near the frontline in the Donetsk, Kharkiv, and Kherson regions. These clinics usually comprise a therapist, a psychologist, a medical doctor, and a social worker.

At the onset of the escalation, we observed symptoms in children such as anxiety, panic attacks, and fear. However, we now notice that children have begun to perceive the abnormal situation as normal. Alisa Kushnirova, an MSF psychologist

Psychological support during wartime in Ukraine

“I can see that my younger son, Vania, needs more care and attention now. He often asks to be hugged and asks how much I love him,” says Olena Beda, who has been living in a shelter for displaced people in the Kirovohrad region for over a year with her two children, after fleeing war in the Donetsk region.

Although they settled in an area relatively far from the frontlines, drones and missiles have become a relentless part of life in the past two years. Vania began to have trouble sleeping, particularly after shelling.

After our team of psychologists started conducting group play sessions for the children at the shelter, Olena felt that Vania’s anxiety began diminishing; he was able to go back to school and  made new friends.

“However, sudden loud noises and conversations about the war can trigger a sudden change in his condition,” says Olena.

In the past two years in Ukraine, our teams have provided 26,324 people with psychological consultations. In shelters for people who have been displaced, the main group of patients consists of mothers with children.

“At the onset of the escalation, we observed symptoms in children such as anxiety, panic attacks, and fear,” says Alisa Kushnirova, an MSF psychologist. “However, we now notice that children have begun to perceive the abnormal situation as normal - they have adapted to the sounds of explosions, though we still observe neurotic reactions.”

Our teams also provide psychological support to families, including adults; the mental health of adults is key in maintaining a positive psychological environment within the family, as parents’ condition is often reflected in children.

MENTAL HEALTH IN WAR, DISPLACEMENT AND MIGRATION _Ukraine
A mental health patient sits in consultation with an MSF psychologist. Ukraine, October 2023.
Nuria Lopez Torres

Emergency evacuations and early physical rehabilitation

“On 18 April 2023, I lost my leg,” says Tetiana Doloza, an MSF patient. “The market where I worked as a salesperson in the city of Ukrainsk, in Donetsk region, was hit by missiles, and I was severely injured.”

It’s been 10 months since Tetiana lost her leg. Today, she walks in Kyiv with confidence, relying on a prosthetic limb and crutches for support. Tetiana was evacuated from the market to a hospital and transported by our medical train to the Lviv region, where doctors and physiotherapists fitted her with a prosthesis.

“When MSF doctors took me to the hospital in the west of the country, I felt lost. I didn't know how I would cope with an amputation,” says Tetiana. “Now, with a prosthetic limb, I live in Kyiv with my son, and at 72 years old, I am happy to have survived.”

“Between March 2022 to December 2023, our medical evacuation train transported 3,808 patients, 310 of whom were in critical condition,” says Albina Zharkova, MSF project coordinator. “In 2022 and early 2023, the evacuation train was essential for referring people to safer locations and hospitals for treatment. Now the needs have shifted, and our ambulances are the ones doing shorter referrals.”

Today, due to a change in the war’s dynamic, patients are now staying in eastern Ukraine, rather than being referred to the West. But our teams continue to operate 15 ambulances that refer people wounded by the shelling or chronically ill patients to medical facilities farther away from the front.

As international attention on the humanitarian consequences of the war in Ukraine diminishes, the fighting on the frontlines remains as devastating as ever. From 2014 to 2022, more than 14,000 people were killed. Since February 2022 this number has multiplied, with hundreds of thousands wounded physically and psychologically, and almost 10 million people displaced.

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Project Update 29 December 2023