While global leaders praise the resilience of the Ukrainian people, aid organisations warn that without sufficient support, the mental well-being of civilians living inside and outside the conflict zone is at severe risk.
A war can be measured in numerous ways: from mounting death tolls and overcrowded hospital beds to the dwindling size of a military force and kilometres of land captured, recaptured and captured again.
But one consequence of war that makes headlines less often yet has far-reaching impacts on current and future generations is the long-term mental toll inflicted on civilians of the affected countries.
As the world marks World Mental Health Day on Monday, mental health and psychosocial support (MHPSS) experts at The International Federation of Red Cross are calling attention to the devastating psychological impacts of the war in Ukraine.
Psychologist Olga Rusakova, who joined the Red Cross 10 years ago and has been a delegate in Ukraine for the past four years, tells TRT World that the mental health concerns of civilians is a much more urgent issue than people recognise.
“Ensuring early access to mental health and psychosocial support in emergencies is critical. It saves lives and prevents distress from developing into more severe conditions,” said Rusakova.
Civilians across Ukraine report feelings of danger, fear, numbness, confusion and aggression, she said. Common symptoms of the war include lack of concentration, sleep problems, withdrawal and denial of the situation.
This “enormous stress and uncertainty” exists regardless of whether people “are still in their homes and dealing with the unpredictability of conflict or have fled to neighbouring countries and don’t know when they’ll be able to return home,” Rusakova adds.
In Ukraine, 6,114 civilians have died and 9,132 people were injured as of last week, according to figures by the Office of the United Nations High Commissioner for Human Rights (OHCHR).
Fearing for their lives and the well-being of their loved ones, the Ukrainian Ministry of Health estimates that 15 million people may need psychosocial support because of the armed conflict.
As people are exposed to many different traumatic events during war, they are at risk of developing mental health disorders such as anxiety, depression, substance abuse, and post-traumatic stress disorder.
While around 7.6 million refugees have left Ukraine, many more have stayed and a further 7 million have been displaced within the country, according to the UN Human Rights Council.
Red Cross Red Crescent volunteers provide immediate psychological first aid to those in need on the ground, such as reuniting family members, creating safe spaces for children, establishing support groups and ensuring access to information about trauma and good coping mechanisms.
Meanwhile, the Ukrainian Red Cross has also been operating a mental health support hotline across the country.
However, Rusakova says it is important to recognise that the need for mental health support goes far beyond the end of the conflict as “affected people need support for a long time to rebuild their resilience and come to terms with what has happened to them.”
“Governments and international organisations need to prioritise this support to ensure a well-functioning society that can contribute to the rebuilding of the country and their future.”
Impact on age, gender
One in five people in conflict settings has a mental health condition, according to findings by the UN.
The long-term impacts of war on mental health also affect people of different ages in various ways and can affect the well-being of future generations who grow up in families where adults have been severely impacted.
Since the war began on February 24, an average of five children have been killed or injured in Ukraine every day, according to Save the Children organisation. In total, at least 372 children have been killed and 635 injured.
“Ruthless violence, including the use of explosive weapons in urban areas, has taken a big toll on children over the past six months,” said Sonia Khush, Save the Children’s Country Director in Ukraine calling for an end to the fighting.
Young children also “experience a lack of attention from caregivers due to the high levels of stress in the family, can sense the fear and anxiety of the adults and have a hard time being separated from loved ones,” Rusakova reports.
With more than 2,400 education facilities damaged or destroyed as of last month, according to Ukraine’s Ministry of Education and Science, teenagers are also among the most vulnerable groups, forced to move and “find new friends and new interests.”
“Often, they withdraw into themselves and isolate themselves. They also lose hope for their future,” said Rusakova.
Meanwhile, the war’s impact on the elderly is often exacerbated by health problems. They also often opt to stay in their country even during war “because they can’t flee or because they cannot imagine leaving their homes at their age.”
Aside from age, military conflict also impacts gender differently, Rusakova explains. War is “always associated with high levels of violence and aggression and has a significant impact on the changing social roles of men, women, boys and girls.”
“Women are often required to take on the role of heads of households, make life decisions for themselves and fight for the safety and psychosocial well-being of their families.”
Meanwhile, “it is important for men to show their role as protector and there can be a lot of psychological tension and aggression behind this,” Rusakova adds.
This may be one of the driving forces behind why sexual and gender-based violence and domestic violence is known to increase during times of conflict with women and young girls usually among the most vulnerable, Rusakova points out.
But while the world turns its focus to Ukraine, wars continue to rage across the globe from Syria and Yemen to Ethiopia and Somalia.
Pia Lorenzen, IFRC Regional MHPSS Coordinator, has more than 20 years of experience from working with the Red Cross across various regions in the world, including Ethiopia, Iraq and South Sudan.
While war causes a “devastating impact on the mental health and wellbeing” of people “regardless of where that situation occurs,” some countries have more resources available to aid their people, Lorenzen tells TRT World.
“The feelings of despair, anxiety, loss, grief and trauma are the same anywhere in the world. Lorenzen said, especially emphasising the plight of “those who remain behind…who for some reason were unable to leave.”
However, people may have different coping mechanisms in terms of opportunities and resources to flee, their resilience in terms of building a new life, and the resources available to the host communities in neighbouring countries,” said Lorenzen.
“People leaving Ukraine have mostly been well received by neighbouring countries and have possibly had more resources to establish a new life outside of their country. In other parts of the world, this is not always the case unfortunately,” said Lorenzo.