KRAMATORSK, Ukraine (AP) — Huddled in the back of a cafe near the train station where a missile killed dozens of people a year ago, Nastya took slow, deliberate breaths to calm herself down. Overnight, her neighborhood had been bombed again and she couldn’t take it anymore.

On the advice of her parents, the 20-year-old had gone that morning to the nearby psychiatric hospital, a place that also bore the scars of war after being bombarded several times, including by a missile. who had destroyed part of the building last September. But staff swept up the shards of glass, shoveled out the debris and kept working, determined to stay in Kramatorsk, in the Donbass region of eastern Ukraine, to help those in need.

For Nastya it was a lifeline.

“After today’s bombing, I couldn’t deal with the anxiety, the constant feeling of danger,” said the speech pathology student, giving only her first name to speak last month about the difficult decision to seek mental health care. The stigma of Soviet-era psychiatry, when dissidents were incarcerated in mental institutions as punishment, still lingers.

“I just realized that my psychological health is much more important,” she said.

There are hundreds of thousands of people like Nastya in Ukraine, experts say, and the number of people in need of psychological help is only expected to increase as the war continues. In December, the World Health Organization said that one in five people in countries that have experienced conflict in the last decade will suffer from a mental health problem and estimated that around 9.6 million people in Ukraine could be affected.

The invasion of Russia in February 2022 led to the displacement, mourning and confinement of millions of people in basements for months due to relentless bombardments or arduous journeys from Russian-occupied regions.

For Nastya, like so many others, the war changed everything overnight. There is a before – a life of simple pleasures, going out for coffee and laughing with friends. And one after.

“You wake up feeling like you’re just surrounded by horrors, anxieties, surrounded by constant air raid sirens, flying planes, helicopters,” she said. “You’re just in a closed circle that’s not filled with the happy times before, but with great fear. Fear of the unknown, fear of dying here and now.

Hundreds of kilometers (miles) to the west, Tatyana, 38, a worker at the Zaporizhzhia nuclear power plant who spent four months under Russian occupation in the town of Enerhodar, trembled as she recounted seeing bombs explode near plant, and how his family endured a 24-hour ordeal to escape to Ukrainian-held territory.

When she went several months ago to a support center in Boyarka, south of kyiv, to register for help, she broke down in uncontrollable tears. The staff called a psychologist.

The therapy helped, said Tatyana, who also asked that her last name not be used to speak openly about seeking mental health care. Her gaze was blank and blurry during breaks as she spoke after a group therapy session last week. She tries to deal with the feelings of living in a war.

“That fear that comes when you realize you could lose everything in an instant,” she said. Life is “like a switch. It can be turned off and never turn back on.

The need for mental health treatment has increased across Ukraine, professionals say, even as they deal with the effects of war in their own lives.

“The demand is huge, and unfortunately it will only grow,” said psychotherapist Pavlo Horbenko, who has worked at a center in Kyiv treating people affected by war since 2014, when Russia annexed Crimea and created two states. proxy secessionists in eastern Ukraine.

He noted a significant increase in the number of patients seeking treatment for sexual violence, grief and suicidal thoughts. “Before it was one or two requests a week, and now there can be 10 a day.”

Judging by other countries that have suffered from conflict, the need for psychological treatment increases rapidly after the fighting ends, Horbenko said.

For now, people are focused on survival. “But when the war is over, …. then we can afford to relax. And when we can relax, the symptoms that have been building up all this time will show up,” he said.

Like a soldier wounded in battle who only feels pain when out of immediate danger, “that’s when the wounds start to hurt. That’s how it is with psychological trauma.

Horbenko said there had been an increase in the number of mental health specialists in Ukraine since 2014, but many more were needed. “Demand still far exceeds capacity,” he said.

Authorities have sought to increase mental health services across Ukraine.

Lebanese psychiatrist, Dr Maya Bizri, recently traveled to Ukraine as part of a program run by the medical aid organization MedGlobal, at the request of the Ministry of Health, to assess needs and train doctors and nurses to recognize mental health problems in colleagues and patients.

“What’s really affected…are healthcare workers,” Bizri said. “There are lots of trainings on how to deal with patients with trauma or physical injuries, but no one deals with the health care of medical professionals.”

Under the MedGlobal programme, doctors and nurses are trained to help themselves and their colleagues deal with psychological pressures, so that they in turn can train others.

“There is acute distress and acute unmet need that is not being met, and if you want a resilient health system, you have to take care of your own people,” Bizri said. “And I think the Department of Health is very aware of that because they’re very committed to doing that.”

The director of the Kramatorsk Psychiatric Hospital, Dr Ludmyla Sevastyanova, said it was the need for mental health professionals that helped them cope.

The war “affects us as much as it affects the patients”, she said. “We are also worried about our families, loved ones and friends. But we do our medical duty, we help.

Sevastianova, a psychiatrist, has made it her mission “to save the hospital so that people can continue to work, to save the hospital so that it can treat patients. That’s the goal and it helps. »

But she is under no illusions about the potential for long-term consequences.

“Things do not pass without a trace. I cut my hand, there’s a scar left. The same goes for our psyche,” Sevastyanova said.

“Now we have to adapt, we have to survive, we have to provide aid, we have to work. … What effects will this have, we will understand in the future.


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