No end in sight to war for overwhelmed Ukraine psychologists dealing with the mental health fallout

IVANO-FRANKIVSK, Ukraine — Susanna Anhelova’s heart aches as she looks out at the 70 sombre souls waiting to start the support program for women she is leading in western Ukraine. Anhelova has worked for 25 years with victims of trauma but says this is the hardest work she has ever faced.

One of the women in the room, barely past her teens, stares despondently at her phone. Another bows her head as her child whines. All are looking to Anhelova to help them recover. All have survived unimaginable abuse and torture as Russian prisoners of war.

Anhelova prays the electricity will stay on long enough for her to offer words of comfort and tries not to think of her own children near the shelling at their home in Kyiv.

“I must help these women learn to live again, so we can win this war,” she says.

The war in Ukraine has brought pain and hardship to millions of civilians since Russia invaded on Feb. 24. The European Union estimates that 20,000 Ukrainian civilians have been killed, with many more injured and millions left homeless. An estimated 15 million Ukrainians now need mental-health care, according to the Ukraine ministry of health.

But Ukraine health-care workers like Anhelova struggle between the work that inspires them and their own tortured doubts that they will emerge intact from the chaos.

They also can’t help taking on emotional burdens from the stories they hear. Anhelova says she is overcome with grief for a four-year old girl who spent two months in the bunker of the Azovstal steel plant during one of the war’s most bloody battles and was separated from her mother, who was held as a Russian prisoner for six months.

The mother, Anhelova says, was shuttled among three different prisons in eastern Ukraine and western Russia and was in a nearby cell at the Olenivka prisoner camp on July 29 when the Russians killed more than 50 Ukrainian prisoners of war with an explosion. She also suffered beatings, hunger, torture and sexual humiliation. Mother and daughter were reunited just days before coming for treatment in Anhelova’s program.

“My maternal heart breaks,” Anhelova says. “For me the war will never be over because I work with the consequences of this war.”

Anhelova leads a team of almost 100 psychologists in western Ukraine who are helping women and child survivors of Russian violence. But elsewhere in the country, mental-health-care professionals are scarce. Ukraine had just 10 per cent of the number of psychiatrists and psychologists per capita that Canada had in 2020.

Iryna Krasutska, a community centre worker, and Dr. Hanna Kalchenko, a general practitioner physician, who provide support to survivors of the Mariupol siege, say they have to fight their own pain to keep working.

“We need more help to diagnose and treat these people,” Kalchenko says.

More than 75 per cent of their patients suffer from acute post-traumatic stress (PTSD) triggered by the horrors they endured, Kalchenko says. Between treating cases of high blood pressure and ordering prosthetic limbs, Kalchenko helps patients cope with panic attacks, insomnia, flashbacks, anxiety and depression.

She has no psychological training, she says. “I try to make them feel comfortable. I try to offer empathy.”

Kalchenko, a survivor of the atrocities in Mariupol, says she almost quit her job last summer because her memories and losses eroded her energy to help her patients. But she found a psychologist to treat her own mental health and now musters the strength to soldier on.

Several trained psychologists who spoke said they need substantially more training to cope with the inhumanity they witness. Ukraine is taking steps to modernize its institutionalized psychiatric system, which was inherited from the Soviet era, according to the World Health Organization, and is training mental-health professionals to offer support in the community.

But the work in a community overwhelmed by the fallout from the Russian invasion is more challenging than many could have envisioned. Psychologist Olena Stolyarenko says she finds it difficult to comfort patients whose loved ones have gone missing since she has seen too many unidentified dead bodies. Others say they are unable to treat rape victims because they have been raped themselves.

Psychologist Oxana Troyan worries about her husband, who she says still bears physical and psychological scars from deadly clashes between protesters and security forces in the 2014 Maidan Revolution in the Ukrainian capital of Kyiv. He’s now fighting on the war’s eastern front so she rarely gets a chance to speak with him.

Stolyarenko and Troyan both say that if the international community wants to end the war in Ukraine, it must offer more than just bullets and bombs — psychological ammunition is needed as well. While Canada has provided more than $400 million in humanitarian and development resources to Ukraine, just $7 million is earmarked for women’s mental health.

Irnya Beldiy, another psychologist in western Ukraine, provides therapy to the war’s youngest victims helping child survivors through art therapy, movement routines and visualization techniques. But Beldiy still suffers from her own trauma as a survivor of Russian-occupied Donetsk.

The basement refuge she shared with 10 others was so cramped that when Beldiy’s mother suffered a stroke, there was no room for her to lie down, she says. And they were bombarded by constant shelling.

“I tried to apply my professional skills to distract people’s attention,” Beldiy says “but it was not successful.”

“We prayed. We cried.”

Beldiy can’t shake images of corpses freezing on the streets and under the rubble of collapsed buildings near her home. She remembers the bitter cold, constant hunger and fear of death. She weeps recalling men forced by Russian soldiers to stand naked in the snow, her teenage son dodging gunfire, and having to leave her injured parents behind when she escaped and fled to safer parts of Ukraine.

But working with child trauma survivors also gives her the will to live.

“I adore children,” she says. “They give me faith for a better life. I teach them it is OK to cry.”

Anhelova cries, too, for women beaten, tortured and raped by the Russians.

“The devastation of the war is like the rings of a stone thrown in the water,” she says. “Larger and larger circles ripple forever.”

When Anhelova’s waves of memories threaten to overwhelm her, she reminds herself that her work is important.

“This is my front line, my struggle. This is what I can do for our victory.”

With files from Michael Parfit and Vlada Polishchuk

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