Dara Massicot on dealing with trauma in Ukraine

The military, economic and diplomatic cost of Russia’s invasion of Ukraine has been evident for nearly two years now. But there are many other unseen costs of the fighting, including the mental and physical scars of high-intensity combat accumulated by combatants on both sides.

As Ukraine and its supporters make long-term plans for their country’s reconstruction, the Ukrainian government is pursuing policy solutions for the care of its soldiers to help them heal and cope. It will need help to provide trauma-informed care on a large scale.

There are many groups in Ukraine experiencing different types of trauma: millions of soldiers and their families; health-care providers and other first responders exposed to combat conditions and casualties; internally and externally displaced persons; and prisoners of war.

Ukraine faces several challenges in supporting the mental-health needs of its citizens, and will need a great deal of external help in order to do so. First is the scale of the problem: the government estimates that it will have a veteran population of 1.8m by the end of the war, or 5m if immediate families are included. This means that around 11% of Ukraine’s pre-war population will have been directly affected by combat trauma.

Officials estimate that, since 2014, a quarter of veterans have developed post-traumatic stress disorders (ptsd) of some sort. Yet because every last soldier is needed, even those experiencing severe mental distress are often given only a short break before being sent back to their unit.

The bureaucratic process for wounded Ukrainian soldiers and their families to access care and benefits is cumbersome. There are not enough specialised clinicians to provide therapy.

The second challenge is the severity of the trauma caused by the nature of the war itself: the intensity and duration of combat, the prevalence of injuries from artillery and landmines, and systemic war crimes committed by Russian forces. These circumstances create complex and intertwined physical and mental trauma for Ukrainian soldiers and civilians. Treating physical polytraumas (amputations, burns, traumatic brain injuries, loss of hearing or eyesight, and spinal injuries) is resource-intensive and Ukraine does not have sufficient capacity.

The Ukrainian government is raising domestic awareness of these challenges and the importance of seeking help, but there is still a social stigma about getting support for mental-health disorders. Even after Russia’s invasion of Ukraine in 2014, ptsd was not commonly treated, partly because soldiers viewed military psychological support with suspicion—an echo of Ukraine’s Soviet past.

It is encouraging that Ukraine has an emerging societal openness to caring for veterans. Mental-health awareness is growing, partly because of generational change and partly from the war itself.

The government and ngos are actively seeking support to improve care for veterans and their families. For example, they want to use modern technology such as smartphone apps to ease veterans’ access to care.

Many international partners are willing to provide this type of help and share best practices. With financial support and knowledge transfer during international exchanges under way since the war began, Ukraine is trying to bring best practices for trauma-informed care back to the country.

In contrast, Russia lacks partners to assist with veteran care, and secrecy impedes appropriate policy development. While discharged Russian veterans are few at present, doctors quietly warn that those returning home lack support and abuse drugs and alcohol. Some commit violent crimes.

Providing trauma-informed care is an essential part of Ukraine’s recovery. Governments assisting Ukraine’s reconstruction can codify this support for the long term by including it in their recovery packages.

International organisations and ngos play an important role already, working with their Ukrainian counterparts in raising awareness, providing support and continuing to train Ukrainian medical professionals, at home and abroad. Together, we can help Ukrainians affected by the trauma of the war to rebuild their lives, even as they look to rebuild their country. ■

Dara Massicot, Senior policy researcher, Carnegie Endowment