Oleg Chaban, a Ukrainian psychiatrist, has witnessed at close quarters the emotional devastation caused by Russia’s war against his country.
The head of psychology and psychotherapy services at Bogomolets National Medical University in Kyiv recalled a recent patient who just two days earlier saw her only child, a toddler daughter, die when the bus on which they were attempting to escape from the suburb of Irpin was shelled.
“I was trying to help her find another reason to live because, of course, she lost a sense of life with her daughter,” he said.
For the millions still in Ukraine whose lives have been thrown into turmoil since Russia’s invasion on February 24, the immediate fight for survival centres on the most basic needs of food, shelter and medical aid. But the history of mass trauma suggests the need for psychiatric support will inexorably grow after the acute phase of the emergency subsides.
“In disasters of all kinds . . . the psychological needs and the psychological impact almost always vastly exceed the medical needs,” said Joshua Morganstein, chair of the Committee on Psychiatric Dimensions of Disaster at the American Psychiatric Association.
“We often find there’s a lengthy tail of mental health needs that extend long beyond the time when wounds are treated and scars are healed,” he added.
For some, the need for help is immediate. Chaban said he and colleagues had noted a rise in stress-related conditions such as anxiety and sleep disorders, as well as a range of symptoms affecting children such as incontinence.
The news that has emerged in recent days of the massacre of civilians in the town of Bucha near Kyiv had caused “a new powerful trauma to the entire population”, he added, speaking through an interpreter. The number of requests for help from those subjected to violence, including some who had been raped by soldiers, had “risen sharply”, he said.
Pre-existing mental health conditions have also been exacerbated since the war began. “I prescribe antidepressants twice or even three times more frequently than before, because of anxiety and insomnia and fear,” he said.
Ukrainians were contending with the convergence of multiple disasters, according to Morganstein, who noted that the fighting was “taking place under the shadow of nuclear, chemical and biological threats in a country that has yet to recover from the two-year Covid-19 pandemic.” This made the response more complex “and will impact the ability of communities to recover,” he said.
Valeriia Palii, president of the National Psychological Association of Ukraine, said she and colleagues had treated people who were dealing with “acute stress and trauma reactions” to loss in all its forms.
This had worsened as the war went on, as people witnessed atrocities and suffered anguish about the unknown fate of friends and relatives. “Many people are in shock, many people are in despair and hopelessness,” she said.
Women and girls who have experienced sexual violence by Russian soldiers were now receiving psychiatric help in hospital. “The girls are very emotionally traumatised, many of them find it difficult to communicate at all,” she said.
Neil Greenberg, professor of defence mental health at King’s College London, who specialises in post-traumatic stress disorder, said some of the immediate impact on mental health could be diminished by a national sense of unity as people coalesced behind the fight against a clear enemy.
But the challenge will be finding the staff and facilities to help the nation recover from its wartime experience once a sense of esprit de corps faded. Palii said: “The problem is that our psychologists are also . . . under stress. Some are under occupation or they are hiding in basements.” Her association had set up a website to raise money for a telephone hotline staffed by professionals.
In the longer term, Ukraine is likely to look to European neighbours for support. Chaban said Ukrainian mental health experts were turning to Sweden, which had experience in treating young refugees from Syria and Afghanistan, as they sought to deepen their understanding of the prevention and treatment of childhood trauma, especially for orphans.
A broad approach will be needed to treat the inhabitants of an entire country ravaged by war, according to Greenberg. “If you have 2mn people who have been traumatised, you can’t, and nor should you, be giving 2mn people 12 sessions of talking therapy,” he said.
Other techniques, such as neighbourhood discussion groups, would be needed to help build “community resilience”, he said. They could be facilitated by a volunteer who, with the right training, could be “better than a mental health professional. They understand the local context better,” he added.
Palii doubted Ukraine’s resources would be sufficient to treat emotionally scarred inhabitants. The country’s mental health workers would need “strong support from colleagues in other countries” with the treatment and rehabilitation of war victims.
“When the war is over, and we come out of our hiding places, we will see all that horror and realise the losses,” she added.