Russia-Ukraine international armed conflict: Not all scars are visible

Mental health is key to our overall health. Islam Alaraj, who heads up the ICRC's mental health and psychosocial work in Ukraine, explains the importance of mental health support in the country.
Article 20 June 2022 Ukraine United Kingdom

We all get scared when we’re alone in the dark. In the last four months, people in Ukraine have come to know life in the dark. The cold darkness of an underground shelter. The eerie city streets under blackout.

While everyone in Ukraine has become accustomed to moving between light and dark, the internal psychological darkness brought on by armed conflict is harder to shift. 

Every day brings new physical scars. The destruction and injuries are plain to see. Much less obvious, but perhaps more destructive, are the invisible wounds of armed conflict.

A psychological wound can cut deeper, last longer and harm people far beyond the direct victim. In places affected by conflict, mental health needs increase as violence creates new trauma and deepens pre-existing conditions.

Almost everyone affected by an emergency will experience stress reactions. For most, the symptoms will decrease over time.

But if you live in a conflict zone you’re three times more likely to suffer with a mental health condition. However, you’re much less likely to get the help you need as conflict depletes and destroys community resources.

Getting help early 

In years gone by, humanitarian responses have placed the emphasis on ‘traditional’ forms of aid – food, water, shelter, health care, livelihood assistance. Of course, these are all vital, but they’re not always people’s main priority.

As an example, one of my colleagues, who was registering people for cash assistance, was told by an elderly Ukrainian lady:

“Do you think I need money? You are mistaken. I want to sleep.”

Trauma related symptoms take a number of forms: withdrawal and isolation, hyper alertness, depression, confusion, anxiety, anger, fatigue, disturbed sleep, flashbacks, to name but a few.

Every day our MHPSS (mental health and psychosocial support) hotline, operated by four ICRC psychologists, receives calls from people displaying such symptoms.

In the first couple of weeks, this hotline was our only means of providing psychological support as insecurity restricted our access. We don’t need to solve people’s problems at the outset. We just need to listen and understand, that is all anyone wants.

The majority of callers are women asking for advice about how to help their children who are struggling with sleep or displaying behavioural problems. Children are particularly vulnerable.

Not only are they more sensitive to traumatic experiences, but they will also be affected by parents who are struggling to cope. When parents open up about their children, they often present their own emotional difficulties.

Some cases are more severe. One man had buried his wife’s body in the garden because no one was able to collect the corpse or arrange for a proper burial. He was completely crushed and clearly struggling to function.

It is vital that people get help early to aid the recovery process, as trauma symptoms can get worse and lead to wider health problems, such as high blood pressure, psychosomatic symptoms and PTSD.

Simply put, mental health is central to overall health. Addressing the issues today will help to avert a crisis tomorrow.  

Rebuilding inner and outer strength

In early April, we started our MHPSS programme in several areas heavily hit by the conflict.

It includes: direct psychological support; psychosocial training for local community volunteers, raising awareness about mental health; and psychoeducation sessions to promote positive mental health and resilience.

We are also providing direct support to families after they have identified the mortal remains of loved ones.

Having a psychologist available for people to speak to is vital as the identification process is extremely painful and something that no one should go through alone. 

It is difficult to comprehend the traumatic events that people have experienced. For those who live through them, such experiences can shatter your perception of life.

But with the help of a psychologist, an individual can re-build their inner world to create a holistic picture that will add these events to our life experience, so they do not dominate forever.

Our external strength comes from the community. Friends, family and community connections where you can draw strength from. But when your whole community has gone through the same trauma, what then?

The road to recovery will be harder and it will need community initiatives, such as creating support groups, raising awareness of trauma symptoms so people can look out for each other and training volunteers to provide basic mental health support.

In other conflict zones, we have supported efforts to rebuild damaged structures that have a significance to the community in order to rekindle a sense of belonging. 

It will take time for people experiencing trauma symptoms to rebuild their strength – weeks, if not months. Together with our colleagues at the Ukrainian Red Cross, we will support people on this journey.

However, we know that the services we are able to provide today are a drop in the ocean. There are clearly mental health needs that we are unable to meet and gaps in health services that we cannot plug.

People across Ukraine – or any conflict zone for that matter – must have access to mental health and psychosocial support services.

In times of armed conflict, mental health support can save lives. That’s why it must be integrated into humanitarian efforts in the midst of conflict, as well as in the aftermath when communities are attempting to move past the traumas of armed conflict.

We know people in warzones are remarkably resilient. But sometimes we all need a little help to escape the darkness.

Islam Alaraj is the mental health and psychosocial support programme manager for the International Committee of the Red Cross (ICRC) in Ukraine