How War and Displacement Affect Mental Health of People in Ukraine and Why We Should Address This

Life will never be the same. This is the prevailing opinion that I have been hearing from colleagues and other people in Ukraine, be it government officials, those staying in war-affected areas or the displaced, since the very first morning of the full-scale war in Ukraine.

They say it with sadness and courage at the same time, demonstrating fierce resilience to endless stressors that Ukrainian people have been enduring for almost ten months. The shock from the invasion of the Russian Federation was followed by fear, grief, exposure to atrocities and loss in all its forms — of loved ones, homes, belongings, savings, and plans for the future. The normalcy of life is gone, and yet efforts to preserve some normalcy help Ukrainians get through this crisis.

“Where can I buy an ice cream — the same one, as I used to buy at home? Is it even normal to enjoy ice cream when the war is raging around us?”, a woman, displaced from a heavily affected town in eastern Ukraine, once asked IOM psychologist during a group session in Vinnytsia. I was told this story by a colleague, who helped this woman find the sort of ice cream she was looking for, and then the two of them sat outside, enjoying the sun and discussing why allowing ourselves to experience joy and do the things we used to love doing is crucial for our mental health and well-being.

Responding to the mass forced migration inside Ukraine and across its borders has been at the centre of IOM’s efforts since the onset of this unprecedented humanitarian crisis. As we mark International Migrants Day, it is crucial to reflect not only on the scale of displacement and destruction. The majority of those who left will eventually return. Buildings, homes and infrastructure can be repaired or rebuilt. While the number of casualties is yet to be determined, the impact of the war on mental health will likely remain its most damaging and lasting legacy.

According to the IOM recent study, over 15 million Ukrainians reported that they have experienced the deterioration of their mental health since the start of the war. Fleeing homes in search of safety and living through repeated displacement, being a refugee in a foreign country without knowing the language, hiding in the basements from shelling, trying to provide for families after losing a job, being separated from loved ones, facing outages of power and electricity — all these stressors contribute to anxiety, panic, mild or severe depression, insomnia and other stress-related disorders that are a normal reaction to an abnormal situation, but if not addressed timely might cause  irreversible impact on public health.

While the greatest needs are in the areas most severely affected by the war, people in relatively safer parts of the country also experience stress, and the lives of those who fled abroad are often overshadowed by guilt over leaving their homeland at this critical time.

It is not a secret that in some situations, people resort to negative coping techniques, such as substance abuse. However, a rapid situational analysis revealed that the feeling of connectedness with people, a sense of national identity and pride, selflessness and supporting others, religion, as well as humour and laughter, have contributed to the collective resilience of Ukrainians.

This resilience also motivates us, humanitarian workers. We feel humbled when we bring shelter materials to a remote village and an elderly woman greets us with food, cooked on a stove in her yard near piles of bricks that were once her home. When an owner of a café in Irpin, destroyed in the early days of the war, starts receiving visitors again. When displaced persons in collective centres volunteer to help our mobile teams with repair works.

The latest IOM general population survey showed that every fourth respondent (23 per cent) needed mental health and psychosocial support (MHPSS). IOM has been providing these services since the start of the full-scale war to support people in Ukraine, including internally displaced persons, returnees, foreigners and host communities. These activities aim at helping people to regain a sense of safety and human security, encouraging the creation or reactivation of social networks, and developing tools for affected communities to deal with the past and ongoing stressors. Since 24 February, IOM has reached over 19,000 persons in Ukraine with individual counselling, trainings, group sessions, and consultations provided through the Emotional Support Hotline 0 800 211 444, as well as creative community-based psychosocial activities for children and their parents. In neighbouring countries, over 27,000 services were provided. 

Operating in an ever-changing context, IOM tries to adjust its activities to the daily challenges: following one of the first massive attacks on energy infrastructure, we introduced longer working hours for our Hotline, so people could call and talk to specialists when feeling overwhelmed. In addition, we increased the number of psychologists working for the Hotline and extended its work to five other countries, making counselling available in Ukrainian, Russian, English and Arabic.

Sometimes, our psychologists act as first responders. Once a woman from Mykolaiv called the Hotline during a missile attack on the city — she was at home alone and could not get to a bomb shelter as an elevator did not work. Using stabilizing breathing techniques, our psychologist guided the woman to a two-walled safe space in her apartment and stayed with her on the phone until the air raid was over.

IOM supports the Government-led efforts aimed at addressing the long-term impact on mental health, including the National Programme on Mental Health and Psychosocial Support that was launched in June under the leadership of the First Lady of Ukraine Olena Zelenska. Alongside other UN agencies, representatives of the public sector, and international and national organizations working in  development and humanitarian response, IOM supports the operational roadmap titled “Ukrainian Prioritized Multisectoral Mental Health and Psychosocial Support Actions During and After the War”. This document sets out priority actions and principles for mental health and psychosocial support in different sectors – including health, social work and education. It also supports the development of the mental health system in line with the best global practices. The IOM Manual on Community-Based Mental Health and Psychosocial Support in Emergencies and Displacement was translated into Ukrainian and will serve as an important reference for community-based activities to all organizations aligning their work with the roadmap.

Yesterday, today, and tomorrow, IOM will stay and continue to deliver assistance in Ukraine and contribute to strengthening mental health service provision together with partners. The recovery of Ukraine and its long-term development will only be possible when the invisible and internal wounds of the war are healed — for displaced persons, veterans and their families, people with disabilities, those who have experienced gender-based and conflict-related sexual violence, and others.

All should be enabled to find their own “ice cream” and start feeling joy, optimism, and drive to fulfill their dreams and potential without fear or guilt. Life might not be the same, but it is worth living to the fullest.

The op-ed was originally published by Ukrainska Pravda