Andriy Gurov is conducting a group counseling session for the residents of Zelenyi Hai village. Ukraine, 2023. © Yuliia Trofimova/MSF © Yuliia Trofimova/MSF

Safeguarding the mind: protecting mental well-being amidst the war in Ukraine.

The war in Ukraine has created a huge need for psychological support ranging from psychological first aid to comprehensive psychological care. People have experienced fear, trauma and isolation and are showing symptoms of anxiety, depression and stress.

MSF psychologists are responding to mental health needs of patients with psychological first aid, mental health counseling and comprehensive psychological care. In 2023 alone, MSF psychologists have provided more than 8,000 mental health consultations in seven different regions of Ukraine. Near the frontlines and in areas retaken by Ukraine, MSF mobile clinic reach people in the rural areas – many of whom have experienced months of fighting, violence and hostilities.

“Feb. 25 was my birthday. It was almost my birthday, when the war broke out. We were hiding in cellars. They [Russian armed forces] drove tanks and armoured vehicles through the village”, explains Anatoliy Andriyevsky, 74, from Myrolyubivka village in the Kherson region.

“Of course, it was scary. You lie down and think: ‘who knows what will happen in the morning.’ You don’t know if you will wake up of not. Especially if you are alone. It’s good to have someone to talk to, but I was alone…”

Anatoliy Andrievskyi, 74, who has lived all his life in Myrolyubivka, Kherson region, helps take care of bees as part of group and individual sessions, which helps local people work with anxiety and the effects of stress. Ukraine, 2023. © MSF

Anatoliy heard of MSF psychologists from the community and started to think about getting help. One of the main barriers to access psychological support is the stigma and self-stigma associated with mental health disorders, especially in rural areas. Although MSF counselling is available for everyone, most MSF patients are older women.

“Men also feel powerless, helpless, and it of course affects their mental health. Their emotions need to be addressed, because they affect both the family and the person themself”, explains MSF psychologist Tetiana Baranets.

Supporting mental health with the help of the community

Further away from the frontlines, in Kropyvnytskyi, those who fled the fighting are coping with trauma, fear and anxiety. Predominantly women with children – displaced families – are adapting to their new lives.

“This is Bonnie, from the videogame. He is doing well, and he likes to sleep”, explains Vanya, 8, while showing his toy.

Vanya lives with his mother in a shelter for internally displaced people in Kirovohrad region. MSF psychologist support Vanya share and process his emotions with the help of toys.

In August 2022, his family were evacuated from the Donetsk region in the east. Many of the children who have been internally displaced because of the war, miss their homes, friends, past lives and teachers.

“My youngest son Vanya used to feel very anxious at night, he was afraid of falling asleep. After talking to a psychologist, it became easier”, explains Olena Beda.

Most MSF patients in the Kirovohrad region show symptoms related to anxiety or depression. To support them in developing coping skills, MSF psychologists provide both individual and group mental health sessions for children, while supporting the family members. From January 2023 until April, MSF teams provided over 1,000 group sessions to patients in Kirovohrad region, supporting patients with anxiety, intrusive throughts, trauma, and stress management.

“We work with children based on their individual needs: we play, draw, help them overcome fear and negative emotions related to what they have experienced’, explains MSF psychologist Svitlana Alekseenko.

For internally displaced people and their communities, group psychological support can support the community at large. MSF psychologists educate patients and the community at large on the benefits of psychological aid, which creates a more supportive environment and wider understanding of the benefits of mental health support.

Psychological first aid in the aftermath of a traumatic event

While many have sought safety in the west of the country, missile strikes continue to endanger civilian lives and cause loss of life even far from the frontlines. The physical threat of the strikes is also causing phycological impact on people across the country.

For people facing the aftermath of an attack, psychological first aid is essential to help people cope with symptoms such as shock, panic attacks, changes in appetite and sleep patterns, and withdrawal from daily activities.

In regions near the frontlines such as Zaporizhzhia, Dnipropetrovsk, Donetsk and Kherson, MSF teams have responded to the acute psychological needs in the aftermath of missile strikes or other disasters. For example, in March 2023, MSF psychologists responded to the aftermath of a missile strike in a residential area in Zaporizhzhia.

As the MSF mobile clinic teams arrive on-site after a strike, the first thing they do is identify people facing the psychological impact. Receiving timely and proper support can reduce a person’s recovery time from a traumatic event.

“The most important is to help a become responsive, establish contact with them, and make it clear so that they see you, hear you and that they understand where they are”, explains MSF psychologists Inna Potapenko. “We always pay attention to those who sit in silence, because it’s clear that this is a state of unresponsiveness which a person needs to be brought out of.”

Peer-support and specialized care

For some, one or two mental health counselling sessions isn’t enough. Long-term and specialized care is needed to decrease the chances of developing mental health disorders, preventing further development of symptoms and supporting their abilities to maintain relationships and prevent isolation.

In the Kyiv region, MSF provides comprehensive mental health care to people who have faced torture or ill-treatment. With the help of both group sessions and individual sessions, patients can share their emotions with others who have had similar experiences.

“Psychological violence can be more challenging than physical violence”, explains Andryi Verbich, 52, who faced ill-treatment and torture while being held by Russian armed forces.

“Constant exposure to loud propaganda in the cell, makes it difficult to communicate and overwhelms the mind, it makes it feel like you are losing your sanity.”

In Hostomel, those who have faced violence and trauma often feel excluded from their community and can become isolated. The combination of group and individual mental health sessions can support someone’s sense of self and community.

“As humans, we are unique and not defined solely by our negative experiences. Our impact goes beyond that,” explains MSF psychologist Mariyana Kviatkovska. “However, people often forget this and find themselves living only in their traumatic memories. Life for them, becomes divided into “before” and “after” and they feel trapped in that vacuum.”

Mental health a key challenge for Ukraine’s healthcare

Although Ukraine’s healthcare system is leading initiatives to promote mental health wellbeing and services, the war has had a devastating impact on people’s mental health. Although many people will adapt on their own, the more people are exposed to various traumatic events, the more their chances of developing mental health problems increase.

The lack of psychologists and counsellors, the stigma associated with mental health and the reality of the ongoing fighting in some regions all make it more difficult for people to receive timely care. Without timely and proper psychological support, issues can develop into long-term post-traumatic stress disorders, anxiety and depressions and have a significant impact on a person’s quality of life.