The life of Olena Kozak, 39, changed forever on the night of May 30. She, her husband, her mother and were preparing to go to sleep when the silence was broken by the roar of an explosion in their neighborhood of Kharkiv, in northeastern Ukraine. Shouting. The search for a safe place inside the house, in the absence of time to reach an underground shelter. Suddenly, everything went black. A second projectile had hit his house, on the fourth floor of a five-story building. The body of Kozak’s husband was found the next day. Her mother’s was the last of the nine dead that the rescue services recovered “under a mountain of rubble, in the middle of the street,” says this woman, who emerged amazingly unscathed in terms of her physical health, with a broken voice. His mood did not escape unscathed.
The grief over the death of loved ones, the uncertainty over the loss of home, the worry for a family member in the army, the panic over bombings… All are feelings that hammer the Ukrainian population. The World Health Organization (WHO) estimates that around 9.6 million people in this country (42 million lived in Ukraine before the Russian invasion of 2022) have mental health problems and 30% of the population – about all soldiers—suffers from post-traumatic stress due to the impact of the Russian invasion two and a half years ago.
The attacks are often directed against civilian targets, and health infrastructure has borne the brunt, according to the WHO, which has verified 2,047 against buildings, transport and health personnel from February 24, 2022 to September of this year. Thousands of people have been left without access to health care, and this includes mental health in a country where there were already deficiencies, since there is only one professional in this specialty for every 100,000 inhabitants, according to the latest Government estimates, from 2017. The minister Minister of Health Viktor Liashko predicted that some 15 million Ukrainians will need psychological support and up to four million will require prescribed medical treatment.
“My husband had gone to our bedroom for a moment because he wanted to get his cell phone back. My mother went out to the balcony to see what was happening. When I regained consciousness, half of my apartment no longer existed.” Memories make Kozak cry, sitting on a park bench in what was once her neighborhood. When she was evacuated from the ruins of her home, she panicked, but from that first moment she received help. “Without a doubt, psychologists have been essential, especially when we celebrate funerals.” That, and the anxiolytics they gave her during the first days in which she had to assimilate the death of her mother and her husband, “the two most valuable people in my life,” she laments. Almost five months have passed since then and she at least feels more serene.
War is a source of distressing events that affect the emotional state, and this has consequences, warns Jarno Habicht, WHO representative in Ukraine: “From lack of sleep and reduced productivity at work to the appearance of mental disorders. or the exacerbation of pre-existing ones. The WHO estimates that 22% of people who “have experienced war will develop depression, anxiety, post-traumatic stress disorder, bipolar disorder or schizophrenia.”
Veronika Amrakhova is the psychologist at a help center for displaced people in Kharkiv managed by the High Commissioner for Refugee Assistance (UNHCR) and the NGOs Prolinska and Right to Protection, to which she belongs. Adults and children come to her consultation, and fear, depression and anxiety are the three emotions that this professional mentions. “They ask for help because they feel under great tension,” he says.
Stress is the usual trend for Ukrainians because the daily bombings have turned the lives of millions of people into a lottery that ends with death. The air raid sirens sound every day from the speakers installed in the streets and through the application that everyone has installed on their cell phones. In Kharkiv, near the front, it is easy for the telephone to honk shrillly 35 times in 24 hours.
As the war has gone on, Ukrainians have relaxed and almost never hide in shelters anymore because otherwise they would do nothing but hide, reasons Viktoriia Tiutiunnik, an UNHCR worker also displaced from Lugansk. “You could never go to work or study, or see your family, or have fun… They may bomb us, but they are not going to take our lives from us nor are we going to let ourselves be overcome by fear; For that they will have to kill us,” he says. But this desire to continue is not incompatible with the deterioration of the mental health of those who live in these circumstances.
Child care
The rain is getting worse in Kharkiv. Thunder sounds on the other side of the window and seven-year-old Valeria jumps. She looks cautiously down the street and hugs her Alyssa doll, the only toy she keeps. Next to her, in bed, is her mother, Katerina Avramenko, who calms her down. “The bombings were becoming very intense and the children were very scared; “They even hid under the table,” he describes to justify Valeria’s fears of the storm. Avramenko (30 years old), her husband and their two children lived in an apartment in Vovchansk, a city in the north of the province where fighting is taking place between Russian and Ukrainian soldiers, until they were evacuated.
Amrakhova emphasizes children like Valeria, who are experiencing “terror” situations. But not only that. One of the side effects of war stress is the deterioration of family relationships. “I deal a lot with the relationships between parents and children because the war causes problems of coexistence… Everyone is very stressed,” he laments.
The Avramenko family now resides in a room in one of the reception centers for people displaced by the war in Kharkiv, where more than 200,000 people are already taking refuge, according to UNHCR. The spacious room has butane orange walls full of chips that Katerina has tried to hide with small stuffed animals hung with thumbtacks. “When we were in Vovchansk we were more scared, but somehow you get used to it. Children do have it worse,” this mother acknowledges.
Avramenko also appreciates the psychological help they are receiving. “At first I didn’t realize that the sessions were useful, but after going to several I feel more relieved, I’m in a better mood and I can do more for my family and myself.” There are also separate activities for children and Valeria likes to go because they make “little drawings.” He likes to paint animals, especially horses. my little pony.
Permanent stress is not easy to deal with. Amrakhova addresses it with individual and group therapy. “There are specific protocols that seek to gain control over our emotions,” he explains, although there is no magic formula. “The fundamental thing is to say not to be afraid. That it is normal to have problems and receive help. And that they are not alone.” Kozak, above all, values his therapist’s availability, knowing how much he still depends on that support. “I know I can call at any time if I have fear, nightmares, a bad time…” he says. That thought calms him.
Become your own psychologist
That the Ukrainian health system is deteriorated is a reality. As is the lack of professionals in the fields of psychology and psychiatry, even since before the war. Given the shortcomings, Dr. Jarno Habicht is committed to increasing the availability of services, but also to promoting self-care. “People in Ukraine demonstrate a high level of resilience. Most can cope with stress on their own, but to help them we need to spread the necessary knowledge,” he says.
Habicht also defends that since 2022 Ukraine has made “significant progress.” Among the measures implemented, the Pan-Ukrainian Mental Health Program stands out, initiated by the First Lady of Ukraine, Olena Zelenska, which integrates mental health in different sectors, teaches a culture of self-care and provides psychological help online or at home.
Another resource is the mhGAP program, whose objective is to guarantee access to mental health services in primary care, training health workers. So far, 6,540 professionals have received this knowledge and Health has also enabled a map with specialized medical centers. More than 17,000 Ukrainians have received free psychological help since 2023, according to the ministry.
Kozak has found another escape route at work. She is a cashier at a supermarket and decided to return to her job because being there distracts her and her co-workers comfort her. He also clings to his remaining family – his brother and nephews, with whom he lives – and to his Orthodox Christian faith. But despite all that help, his daily life is a battle against the dark thoughts that attack him every now and then. “Everything reminds me of my husband. There is even a customer at the supermarket who looks like him,” he sobs. His eyes have watered again and it is difficult for him to speak, but he gains strength: “I shouldn’t be sad because if they saw me, they would be sad. I must live for them.”