Ukraine: The mental health crisis in Europe’s forgotten war
After seven years of conflict, the mental health needs of people living in towns and villages near the ‘contact line’ in eastern Ukraine remain high.
Many have lived with the constant risk of violence since 2014, as well as the more recent additional strain of the COVID-19 pandemic.
But, despite the impact on their mental health being severe, seeking care can be difficult. Mental health care services remain centralised and concentrated in urban areas of Ukraine, making them difficult to access.
"I am a strong woman but at that moment I broke. There are no words to explain it, that feeling of fear. Safety didn’t exist at all."
Now, Médecins Sans Frontières / Doctors Without Borders (MSF) and other organisations are empowering family doctors and community nurses to provide the basic mental health care that patients so desperately need.
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It’s easy to forget the psychological impact of a conflict that has been going on for a long time.
But, for people still living through it, the trauma – both of the initial fighting and of the ongoing threat of explosions, shooting, bombing and landmines – is part of daily life.
“My daughter was just in front of me, ten meters away. I was at the doorstep,” remembers Tetiana Karadzheli, who lives in Kamianka village, Donetsk region.
“Suddenly, the shooting started. I just remember being hit on the head. Smoke was everywhere, windows smashed.
“I woke up [with] my grandson hugging me: ‘Granny, we are alive, we are okay.'
“That was it – the last straw. I am a strong woman but at that moment I broke. There are no words to explain it, that feeling of fear. Safety didn’t exist at all.”
In these traumatic circumstances, MSF psychologists and the doctors and nurses we work with in eastern Ukraine see many patients struggling with depression, anxiety and other common disorders.
Help us prepare for the next emergency
“Most frequently it’s acute stress and grief for the loss of their loved ones and homes,” says MSF psychiatrist, Tetiana Azarova.
“In addition, anxiety-related conditions are widespread. For example, insomnia.
“We are aware of multiple cases when grandparents witnessed their grandchildren die or where people have lost almost all family members.”
In numbers: Our work on mental health
1 in 5
PEOPLE EXPERIENCE MENTAL HEALTH ISSUES DURING A HUMANITARIAN EMERGENCY
MENTAL HEALTH CONSULTATIONS PROVIDED BY MSF TEAMS IN 2020
COUNTRIES WHERE MSF PROVIDES MENTAL HEALTHCARE
However, people living in small towns and villages often can’t afford to travel to cities or pay private mental health care providers. This is if they can even overcome the stigma associated with mental illness and seek treatment.
“In villages, no one usually pays attention to [mental health]. They think that nothing will help them and they just need to live through it and endure it,” says Natalia Khatsko, an MSF health educator.
The first point of contact
To improve access and awareness around mental health care, MSF’s project in Donetsk Region has partnered with the Ministry of Health and other organisations to provide training and supervision to family doctors and nurses.
This is done using the World Health Organization’s ‘mhGAP’ approach – designed to enable non-specialist doctors and other healthcare workers to address some mental health needs.
“We are the first ones on everyone’s way – COVID-19 patients, patients with mental health disorders. They always meet us first,” says Halyna Mohylevska, a family doctor from Chermalyk village, Donetsk Region.
“That’s when we decide on whether we can handle it ourselves or refer [the patient] to a psychiatrist or a psychologist, or we prescribe medicines.”
Oleksandr Vlasenko, Director General of Family Health Care Centre No. 1 in Kramatorsk City, Donetsk Region, explains:
“There are two reasons why patients don’t want to see a doctor [about mental health]. Either because they do not understand that doctors can provide such assistance to them; or because the doctor is not able to provide this assistance in a qualified manner.”
Family doctors and nurses have not previously been recognised as a part of the mental health care system, which has in the past prioritised centralised psychiatric care, particularly in institutions.
Training and supporting family doctors and nurses is an example of the new approaches MSF and others are implementing to make mental health care services available for conflict-hit communities in eastern Ukraine.
More support and more programmes like this are needed to ensure that patients are no longer left to suffer in silence.
MSF and mental health
Our teams provide emergency medical aid in catastrophes all over the world — armed conflicts, natural disasters, famines and epidemics. However, for people who have lived through these traumatic events, survival goes beyond ensuring physical wellbeing.
Worldwide, around one in four people will suffer from a mental health problem during their lifetime, yet roughly 60 percent will not seek help. These figures dramatically increase when factors such as violence, persecution, the need to flee, disasters or a lack of access to healthcare are involved.