Ukrainian mental health at home and abroad

By William Ackroyd

Image: Getty images, Omar Marques

On the 24th February 2022 the Russian Federation began a full scale invasion of Ukraine, yet this was not the beginning of a ‘new’ war, the Ukrainian people have battled with overt Russian aggression in the Eastern provinces of Donetsk and Luhansk since 2014 and endured persistent Russian interference in their politics. Yet the full-scale invasion represents a much larger immediate and long-term threat to the prosperity of Ukraine. As Russian army spilled into Ukraine early last year, many Ukrainians were forced to abandon their homes and attempt to find refuge within Western Ukraine or wider Europe. The exodus of civilians during the first months of the invasion presented the largest refugee crisis in Europe since WWII. According to the UN Office of the High Commissioner on Human Rights (OHCHR) by 7 November 2023 there were 5,850,100 refugees from Ukraine in European countries and a further 3,674,000 internally displaced people (IDPs). This article will look at how the mental health of children is fairing during the conflict, but also that of wider Ukrainian society which inevitably impacts how children cope.

Factors influencing the Ukrainian mental health situation

As the charity World Vision points out, Ukrainian children face three stressors which can contribute to poor mental health, these are: witnessing violence and experiencing loss in their homeland, making a stressful and uncomfortable journey to refuge, and the strain placed by proving asylum claims and integrating into their new home (World Vision, p10).One of the foremost negative influences on children’s mental health has been the experience of violence, torture, abuse, bombing or the loss of loved ones. The impact of Russia’s willingness to target civilian infrastructure has been to propagate constant fear in Ukrainian children, as demonstrated by a study that found 55% of Ukrainian mothers reported their child were at least occasionally troubled by loud noises (Gottbrath, 2023). Unfortunately among the estimated 27,149 civilian causalities confirmed by the OHCHR it is estimated children constitute over 1,700 of the total. The fear and anxiety experienced by Ukrainian children can have severe long-term mental and physical impacts particularly if they are subjected to toxic stress.

Familial separation and the strain on caregivers

It is undeniable that Ukrainian society is placed under immense strain. In the traditional understanding of family, husbands has been mobilised for war service and therefore are taken away from their family for extended periods of time, while also experiencing harrowing combat experiences which take a heavy mental toll on even the most stoic individuals. The mother is therefore often left with a dual burden of working full time and raising children along of courses with the difficulties of living in a war-torn country. In the case of refugees in Europe or IDPs, families have often had to make the decision to leave behind serving age men, along with Grandparents, who often are reluctant to leave their permanent residences. Therefore many children’s primary group is reduced to a single parent, which can have significant development consequences. Stable relationships with adults are vital for children’s mental development (World vision, p8). Alongside changing family relations, the number of children living in poverty has also increased so that UNICEF now estimates 82% of Ukrainian children live in poverty. Following the disruption of violence and separation, whether they are refugees who travelled to a European country or internally displaced, Ukrainian children then have to integrate, which in itself can bring about a great deal of mental anguish. Even when children have been found a place to go to school in their new neighbourhood, missile strikes and other disruptions as a result of the war deny them a “sense of structure, safety, normality and hope” (UNICEF, 2023).

The inadequacy of the current Mental Health and psychosocial support (MHPSS) provision in Ukraine

It is inevitable that a conflict of such magnitude will cause substantial mental health issues, with research suggesting more than 22% of conflict-affected people end up developing some form of mental health disorder (World Vision, p.4 2022). At present the Ukrainian MHPSS structure does not seem adequate for the future work it has ahead, in 2020 it received 2.5% of the total health budget. The Ukrainian health infrastructure was inherited from the Soviet system known as the Semashko model which provided “centralised, impersonal and inflexible” services (Bandura and Reynal, p.1 2023). While efforts have been made to reform healthcare including the 2018 establishment of a Ukrainian National Health Service, the current system is already under strain from the heightened demands of war but also the fact that Russian armed forces have perpetrated over 1,000 attacks on on healthcare personnel, equipment and facilities according to the WHO.

Cultural stigma

Another issue that is likely to impact the delivery and uptake of MHPSS is the cultural stigma attached to both the mental heath services and to mental illness as a whole. During the time of the USSR, many dissidents were hospitalised in psychiatric institutions and so there is a continuing distrust. It also appears that the Soviet method of institutionalisation has left Ukrainians with the belief that ‘the mentally ill should be handled like young children’, according to a 2021 study, 86% of respondents agreed with the above statement. These perceptions are understandable when considering how much emphasis the system previously placed on more invasive methodologies; in 2017 Ukraine had 11.6 psychiatrists (medical doctors) per 100,000 people, but had only 0.56 psychotherapists (non medical doctors) per 100,000 people in 2016. This demonstrates a neglect of less invasive talking-therapy methods which could help de-stigmatise mental health treatment.

Potential long term-implications

The problem presented by the deterioration of Ukraine’s mental health is a long-lasting and concerning one. Especially for the children of Ukraine, war-induced trauma and distress as a result of displacement could have lasting negative effects on their emotional development, future relationships and employment. As Banduara and Reynal argue, “mental illness leads to job absenteeism and a loss of productivity and economic growth”, therefore the future of Ukraine depends upon a strong mental recovery whenever the current war ends. The findings from the first year and nine months of conflict suggest citizens are struggling, but not collapsing under the strain of the war. In regards to the affect on children, a study found that 35.9% parents reported their child ‘worries a lot’ and 25% reported their children were more easily distracted (McElroy et al, 2023). Another study 6 months into the war found that the age group showing the highest levels of anxiety, depression and stress was the 26 to 40 age group. This is important for children as adults within this age range constitute many of their primary care givers, and if the Family Stress Model (FSM) is consistent, this could have worrying effects on child mental health, education and emotional development. 

Keeping positive for the future

Despite the immense strain placed on Ukrainian society, there have been some positive indicators including:

• The prioritisation of mental health by the First Lady of Ukraine Olena Zelenska and WHO, with a national program of MHPSS established.

• Over 300 charities and institutions providing mental health support in Ukraine so far, including Sane Ukraine and Lifeline Ukraine, not to mention the well known Red Cross and UNICEF. 

• Ukraine’s national cohesion has allowed people to gain strength from ad hoc communities.

Overall, Ukraine faces a significant challenge to appropriately treat those suffering with mental illness as a result of Russia’s illegal invasion. There are several factors working against the mental health of children in particular, both those who are internally displaced within Ukraine and those who made the journey to Europe. The stressors presented by war-induced trauma, displacement, integration, family separation, constant or persistent fear and the mental strain placed upon caregivers presents a substantial threat the mental health of Ukrainian children. However, with continued international support, charity intervention and institutional reform, the obstacle is not insurmountable.

Bibliography:

Romina Bandura and Paula Reynal, ‘Investing in mental health will be critical for Ukraine’s Economic Future’, Centre for Strategic and International Studies (CSIS), published August 1 2023

Kristina Bohdanova, Marina Weiss and Samantha Weckesser, ‘Lessons from Ukraine on protecting mental health during conflict’, STAT, Published September 22 2023, https://www.statnews.com/2023/09/22/sane-ukraine-mental-health-during-conflict/ , accessed 13 November 2023

Anton Kurapov et al, ‘Six months into the war: a first-wave study of stress, anxiety and depression among in Ukraine’, Frontiers in Psychiatry, Volume 14 (May 2023),

Eoin McElroy et al, ‘Change in child mental health during the Ukraine war: evidence from a large sample of parents’, European Child and Adolescent Psychiatry, (8 July 2023),

Bunny Nooryani, ‘Ukrainian children at risk of long-term mental health problems’, Norwegian Refugee Council, published 24 August 2022, accessed 13 November 2023

Nicole Tung, ‘The Hidden Trauma of Ukraine’s Soldiers’, New York Times, published August 15 2023, https://www.nytimes.com/2023/08/15/world/europe/ukraine-war-soldiers-trauma-therapy.html#:~:text=There%20is%20a%20crisis%20of,that%20most%20civilians%20never%20do , accessed 13 November 2023

‘Ukraine: civilian casualty update 11 September 2023’, OHCHR, published 11 September 2023, https://www.ohchr.org/en/news/2023/09/ukraine-civilian-casualty-update-11-september-2023#:~:text=Total%20civilian%20casualties,9%2C614%20killed%20and%2017%2C535%20injured , accessed 14 November 2023

Ukraine situation flash update #59, OHCHR, published 10 November 2023,

https://data.unhcr.org/en/documents/details/104674 , accessed 14 November 2023

‘No Peace of Mind: The looming mental health crisis for the children of Ukraine’, World Vision, published 5 July 2022