Press play to listen to this article
Millions of Ukrainian refugees have poured into Eastern Europe over the past six weeks, their lives uprooted and their loved ones left behind.
Many will need specialist help to come to terms with the move and cope with anxiety, depression and post-traumatic stress disorder (PTSD). For those who lived through the fighting and witnessed the atrocities perpetrated by the Russian invaders, the need for therapy will be greatest.
Yet they will rely on an already shaky mental health infrastructure, in a region where psychological wellbeing has suffered from decades of neglect and where depression and trauma have been stigmatized under communist rule.
“This is a crisis on top of a crisis,” said Natasha Azzopardi Muscat, director of health policy and systems for the Europe region of the World Health Organization.
Mental health workers, like their medical colleagues, are suffering from burnout and overwork related to the coronavirus pandemic, she added. Rates of anxiety and depression have increased over the past 18 months, brought on by isolation and fear of infection.
Nearly 5 million people have fled the war in Ukraine, most to Eastern Europe, estimates the United Nations High Commissioner for Refugees. At least 7 million more people are internally displaced, according to sister agency the International Organization for Migration.
Not enough resources
The WHO is hard at work trying to build capacity quickly, creating ‘psychological first aid’ toolkits – information materials for schools and social workers to help provide an initial buffer.
“It may not be enough for everyone,” explained Azzopardi Muscat. “Then there’s a process of identifying people at increased risk to make sure you have a system in place to refer them to services.”
However you add up the numbers, there is no way to compare them to the projected needs faced by women and children leaving their home countries, now a war zone.
“We don’t have psychosocial services that can cover even Slovaks. There is no way to cover Ukrainians,” said Andrej Vršanský, general manager of the League for Mental Health in Slovakia.
Slovakia, which has taken in more than 300,000 Ukrainian refugees, has only 45 child psychologists to cover the whole country, according to the mental health NGO. It takes an average of three months to get an appointment with a psychiatrist.
The region as a whole lags behind Western Europe in the attention and money it invests in psychological help – and it shows in the numbers. A 2016 survey by the EU’s statistical agency in the region found that Poland – the country that took in the most refugees from Ukraine – had just nine psychiatrists per 100,000 people. That’s a third of the rate in Germany.
Utilizing a ready-to-use pool of Ukrainian mental health specialists among the refugee population, who have language and cultural skills that their counterparts in host countries lack, will be essential for governments to have even a chance to meet the needs of war-shocked arrivals.
In Slovakia, Vršanský said, the Mental Health League set up a Ukrainian-language helpline and appointed a psychologist with conflict experience from the separatist-controlled Donbass region to lead it. “She had been working as a cleaner in Slovakia for three years,” Vršanský said.
The European Commission has recommended that member countries recognize the qualifications of Ukrainian professionals, which would allow them to quickly join the health services of their host country. Earlier this week, the Commission announced €9 million in EU funding for NGOs working on the subject, as well as to provide support and advice on trauma.
scars of war
But the great wave of needs is yet to come. For now, experts say the refugees are in survival mode, focused on adjusting to their new surroundings. The process of healing and dealing with trauma will only begin once they have addressed more immediate issues, such as finding housing and getting the children to school.
Agnieszka Popiel, a Polish trauma psychiatrist who heads the cognitive-behavioral therapy unit at SWPS University in Warsaw, said it was important to distinguish between help and basic understanding which all refugees need, and the specialized care that can only be provided by a professional. She helped organize PTSD courses for therapists, as well as basic counseling training for psychology students.
“The majority of refugees don’t need a psychologist,” Popiel said. Yet research on previous waves of conflict-driven migration from Syria indicates that a high proportion require psychological care.
“Usually 30-40% is the lowest rate of PTSD in post-war areas,” Popiel said.
The same process is also taking place inside Ukraine, with people fleeing the front lines for the relative safety of the western half of the country.
Child psychiatrist Oleh Romanchuk helps internally displaced Ukrainians. Romanchuk, who heads the Institute of Mental Health at the Ukrainian Catholic University in Lviv, said he was confident in the resilience of Ukrainians to overcome the collective trauma of war.
Already before the war, the government had made strides in modernizing mental health treatment, helping to overcome a legacy of stigma around mental health issues linked to political repression and the country’s communist past. The generation born after the fall of the Soviet Union is much more open, and even willing, to talk about mental health issues, the psychiatrist said.
And treatment can make progress even in the worst cases. He remembered a neat child who witnessed his mother’s death at the hands of Russian soldiers. The child had symptoms of post-traumatic stress disorder, but was responding to therapy. He wrote letters to his dead mother about his hopes and dreams.
“He is more and more filled with light and love,” said the child psychiatrist.
“I don’t think it will be a generation of trauma,” Romanchuk added. “I have a lot of hope.”
This article is part of POLITICO Pro
The one-stop solution for policy professionals fusing the depth of POLITICO journalism with the power of technology
Exclusive and never-before-seen scoops and ideas
Personalized Policy Intelligence Platform
A high-level public affairs network