Healing Ukraine's Invisible Scars

Since the start of Russia’s full-scale invasion in early 2022, no aspect of life in Ukraine remains unaffected. More than 35,000 civilians have been killed or injured, and 3.7 million Ukrainians are displaced in their own country, with families, homes, education, and careers shattered. Millions more are living abroad as refugees. While Russia’s attacks have left visible scars in the form of destroyed homes and infrastructure, another impact of the war is invisible but equally devastating: the country is experiencing a severe mental health crisis. Even before the invasion, Ukraine grappled with high rates of depression and suicide, but in 2022, the Ministry of Health predicted that 15 million Ukrainians would soon need psychological support. Subsequent surveys revealed that almost 80% of the population is living with constant stress and anxiety and one study indicates that up to 54% of Ukrainians, including those living as refugees in other countries, are experiencing post-traumatic stress disorder.

Overcoming the Soviet Legacy

Unlike many other conflict-affected nations, such as Sudan or Syria, Ukraine already boasts a functioning mental health system. However, this system faces three key challenges left from its Soviet history.

Though reforms to the mental health system had been planned for years, the COVID-19 pandemic and the full-scale invasion accelerated the urgency, and the country is making unprecedented progress.

First, it is institutionalized: long-term inpatient care for the most severe cases of neurological and psychiatric conditions is prioritized over community-based and outpatient services. Second, it is medicalized: psychiatric consultation and medication are often the first line of treatment. As a result, many Ukrainians cannot access or don’t know about alternative or complementary forms of care, such as psychological counseling and social work. Third, it is centralized: mental health services are concentrated within hospitals and cities, rather than integrated with other healthcare services. This means that many people cannot access care if they live in remote or occupied areas, have limited mobility, cannot travel, or lack access to transportation.

The conflict has exacerbated these challenges and heightened the need for significant reform. Mass displacement, the targeted destruction of healthcare infrastructure, and the loss of specialized mental health staff have deepened the existing cracks in the country’s mental health and psychosocial support (MHPSS) services. Of the 1,500-plus attacks on healthcare facilities since February 2022, 773 have damaged or destroyed hospitals and clinics.

Simultaneously, a stigma surrounding mental health persists. In one survey from October 2023, 38% of respondents believed that the main contributor to psychological distress was a “flaw of character.” A desire to appear strong and resilient in the face of war has contributed to this stigma, says Yuliia Okhmat, International Medical Corps’ deputy MHPSS coordinator in Ukraine. This “narrative of strength” makes Ukrainians worry that seeking mental health support is a sign of weakness.

Though reforms to the mental health system had been planned for years, the COVID-19 pandemic and the full-scale invasion accelerated the urgency, and the country is making unprecedented progress. The government is currently drafting Ukraine’s first-ever law on the mental health care system, which will define its legal, organizational, economic, and social foundations—and is meant to ensure the accessibility and quality of services for the population. Another milestone has been the “How Are You?” campaign, pioneered by First Lady Olena Zelenska to call attention to and reduce mental health stigma.

The government is working closely with international humanitarian organizations on these expedited efforts to meet the country’s growing mental health needs. Since 2021, Ukraine has been part of the World Health Organization (WHO) Special Initiative for Mental Health, which has helped build the country’s capacity and advocate for the prioritization of mental health in the country’s response. The WHO and International Medical Corps, a global first responder that has worked in Ukraine since 1999, are co-chairing the country’s MHPSS technical working group. We are providing technical expertise to build the country’s mental health and psychosocial support capacity, giving input on the new law, and supporting the First Lady’s stigma-busting campaign. We’re also training clinicians across the country to integrate mental health services into everyday healthcare services provided locally.

Meeting the Immediate Needs

Though addressing the flaws in the overall system is crucial, providing relief to Ukrainians suffering from mental health complaints is an immediate priority. International Medical Corps is working with the Ministry of Health and other local and international partners to provide a range of services across the country, including psychological first aid, mental health case management, psychosocial support and awareness-raising sessions, counseling, and more.

In addition to directly providing these services, our central approach, which we’ve tried and tested in conflict zones around the world since the 1980s, is to build local capacity by training Ukrainians. We are training health professionals to identify, manage, and refer cases using the WHO Mental Health Gap Action Program intervention guides. We’re also training other frontline workers, including first responders, in psychological first aid and stress management, helping them to recognize and address mental health issues in those they’re trying to help—and themselves.

Integrating mental health and psychosocial support into other services is crucial if Ukrainians are to effectively confront and overcome the challenges of the institutionalization and centralization of the healthcare system, and the persistent stigma surrounding mental health. MHPSS programming and training must supplement primary healthcare services, physical rehabilitation, gender-based violence prevention and response, water and hygiene activities, and more. An integrated approach is effective on a basic level because everyone affected by the conflict faces multifaceted challenges, explains Okhmat. They may need essentials like food, safe water, shelter and medical care, as well as mental health services.

Even if the conflict were to end tomorrow, Ukraine’s complex mental health needs would continue to develop and change for many years, as veterans and displaced people return home, and the country embarks on its recovery.

“An integrated approach also means that people who wouldn’t otherwise feel comfortable seeking out mental health support can benefit from the services,” Okhmat says. “For example, women visiting mother-baby spaces run by our infant and young-child feeding experts, or women’s and girls’ safe spaces run by our teams addressing gender-based violence—even someone attending something as basic as distribution events for hygiene and dignity kits can take advantage of the mental health services we provide—even if they didn’t show up looking for mental health care.”

For older people, this integration of MHPSS with other services is especially important. Older Ukrainians are more likely to distrust mental health professionals due to memories of the repressive and institutionalized approach under the Soviet regime. To overcome this, an effective technique is to train family doctors—whom they already know and trust—to identify, manage, and make referrals for mental health conditions.

Another challenge is that many older Ukrainians live in rural communities near the frontlines, where they face difficulties accessing care and support, and because younger residents and healthcare professionals have fled to cities in western Ukraine. Therefore, services must come to them. That’s why we send mobile medical teams of health workers and MHPSS experts to villages in rural areas like Mykolaivska and Khersonska oblasts to provide integrated care for their physical and mental health.

Strengthening the Mental Health System

Meeting current mental health needs is essential, yet strengthening the healthcare system's long-term capacity must remain a key priority—both for the national government and for local and international NGOs. The transition to community-based care is a major task that requires immense investment in people, training and resources, as well as complex legal and policy frameworks—all during a time when resources are especially hard to come by.

Amid the difficulties of transforming the national mental health system during a full-scale war, collaboration between international humanitarian agencies and local actors is key to bringing about effective and sustainable change. Global NGOs bring resources and expertise, including perspectives gleaned from working in other conflicts around the world. For example, as co-chair of the technical working group for MHPSS in Ukraine and a key partner of the Ministry for Health and the Ukrainian government, International Medical Corps is providing input on legislation regarding the mental health system that will act as a foundation for the country’s future.

Even if the conflict were to end tomorrow, Ukraine’s complex mental health needs would continue to develop and change for many years, as veterans and displaced people return home, and the country embarks on its recovery. The good news? Coordinated efforts between Ukraine’s government and international and local actors are already having a positive impact. These efforts, including direct MHPSS services as well as training, awareness-raising and communications campaigns, are already reaching hundreds of thousands of people. Moreover, immense progress has been made in breaking down the barriers of social stigma, although Okhmat says that there is still a long way to go.

Ultimately, mental health is not a standalone issue in Ukraine. It is intrinsically linked to the country’s current challenges and future recovery. If Ukrainians are to one day rebuild their lives and country, effective MHPSS services must be a key part of that. The aim, then, isn’t just for the government and international community to establish a strong and resilient mental health care system in Ukraine; it’s also to develop a flexible system that can adapt to evolving needs in the years to come.

Matthew Stearns is Ukraine country director for International Medical Corps and Claire Whitney is senior advisor for mental health and psychosocial support for International Medical Corps.

Cover photo: An instructor teaches a relaxation technique during a training session in Kyiv. Participants included psychologists from Ukraine’s State Emergency Services. Courtesy International Medical Corps, used with permission.