Displaced by war, Ukrainians accept trauma care – warily

Social worker Marina Kucherenko cradles a cup of coffee, sitting at a table in a spacious, sparsely furnished room decorated mainly with large houseplants. The greenery is soothing, and it needs to be; this is the headquarters of Zaporizhzhia’s mobile mental health unit, and Ms. Kucherenko knows she will soon be called on to help someone in deep distress.

On a recent visit, she and her psychologist partner encountered a heavily inebriated mother. “When we asked her why she drank so much, she said it was the stress of war,” Ms. Kucherenko says.

She recalls the mother’s rationale for being drunk. “I can’t watch television. I can’t read the news. I can’t even listen to the sound of sirens going off four times a day. I can’t handle it when the sirens go off in the middle of the night.’’

In Zaporizhzhia, 25 miles from the front line, as in much of Ukraine, such pressures are compounded by economic hardships: Gross domestic product has dropped by more than 30% since the war began eight months ago, inflation is running at 23%, and both well-paying jobs and housing are in short supply as people flee from Russian occupiers or artillery duels to the city’s relative safety.

That means that when Ms. Kucherenko or her colleagues knock on doors, “the first reaction is often aggressive,” she says, and the mobile team needs to show a mix of assertiveness, empathy, and tact.

Those are qualities needed across town, as well, where another team of psychologists and social workers has transformed a commercial exhibition hall into an intake hub for people displaced by the war.

Most disembark from rescue vans and buses with only a few items of luggage. Some appear stoic, while others wear exhausted, bewildered expressions on their faces. All of them have been streaming into the city from the 600-mile front line, a zone of active rocket duels stretching from the eastern Donbas territory, the southern part of the Zaporizhzhia region, and areas around the embattled city of Kherson, closer to Crimea.

A Soviet-era stigma

Psychologist Nadezhda Galash describes how she and other experienced colleagues can often identify the most traumatized newcomers as soon as they walk through the door.

“I see the fear in their eyes. I can just look at a person and see that he or she really needs help,” says Ms. Galash. She knows, too, the range of traumas that people have endured, and how difficult it is for the survivors to begin describing their ordeals. Like most of her team, she herself fled from the Russian-occupied east of Ukraine.

“We work first and foremost with people who have suffered from sexual violence,” explains Alyona Orel, a psychologist who used to work in a shelter for battered women. “This is a difficult topic, so naturally during the first or second session a person may not open up. This could be a lengthy process.”

“Sometimes we have to bring people around,” adds Ms. Galash. “We can’t just ask people directly, ‘Were you the victim of sexual violence?’”

In addition to juggling high caseloads and steering displaced people toward available services, Ukraine’s psychologists find themselves struggling to dispel a lingering Soviet-era stigma attached to mental health counseling. Raised in a spirit of stoic endurance, many older citizens who grew up in the USSR view therapy as taboo and are reluctant to seek help when they need it.

In a culture that prizes such stoicism, Ms. Orel encourages her patients to unlock the doors of their steely exteriors.

“Maybe it will only be one time, but a person needs an opportunity to cry,” she says. “I can’t tell you how often this happens, but my patients still apologize for their tears, for even having come to see me and, as they put it, wasting my time.”

“What people need now is information ... to help them overcome their own feelings of fear and shame,” says case manager Ekaterina Kutyeva.

“The main thing is that people should not shut themselves off from help,” she adds.

Trauma: best dealt with now

Psychologist Oksana Mykhaylenko runs the Perspektiva Center for Social Partnership, one of Ukraine’s leading nongovernmental organizations working with wartime survivors of sexual violence. When Russian troops seized Novaya Kakhovka, where the NGO had its base, Ms. Mykhaylenko’s group moved out and dispersed its operations throughout the rest of Ukraine.

These days she and her team do much of their therapeutic work with survivors online. In her case that means communicating remotely with patients and colleagues from the western Ukrainian city of Chernovtsy.

Fortunately, the logistics underpinning their work remain intact, for the time being. The country’s information technology sector is still quite robust, and the COVID-19 pandemic, which forced many companies and schools to work online, served as a dress rehearsal for new wartime challenges.

But Ms. Mykhaylenko says that the biggest challenges are neither technical nor logistical, but psycho-emotional, particularly when it comes to the extremely sensitive issue of wartime rape.

Ms. Mykhaylenko is especially concerned about the physical safety and psychological health of people living behind Russian lines.

“A large number of doctors fled Russian-controlled territory,” she says, and Ukrainian mobile emergency units cannot get past the Russian checkpoints.

Online and telephone consultations may be options in most of the country, but in the Russian-occupied regions, this type of communication is fraught with risk.

“There is a big problem of confidentiality,” says Ms. Mykhaylenko, who points out that the few remaining available phone lines and even internet channels can be monitored, making victims of sexual violence even more unwilling to talk about it.

Though it is hard to predict how long Ukraine’s psychological troubles will last, experts agree that the sooner people are treated, the better. 

Repressing painful memories will only make it harder for society to heal later, says Ms. Kutyeva. The time to begin addressing these problems, she argues, is right now.

“This is the only way forward to creating a healthy society,” she insists. “Otherwise, what kind of society will we have in the future? We all need to think about what we will be facing once the war ends.”