For Ukrainian people living in frontline and formerly occupied areas, the trauma of war is never far.
“Before the war, my blood pressure had been very high, and now, even more so,” says teacher and grandmother Svitlana L., referring to the armed forces who occupied the region where she lives in 2022. “My hands and legs shake when I think about this war, about the [occupiers] we had here.”
Protracted conflict — like the war in Ukraine — threatens people’s mental health. The World Health Organization expects that nearly 10 million people in the country may have a mental health condition.
Conflict can also hinder health care systems’ ability to offer services, leaving people without the support they need. That’s why FHI 360 is providing mental health and psychosocial support services to conflict-affected communities in southern and eastern Ukraine through FHI 360’s Ukraine humanitarian programming, which is supported by USAID’s Bureau for Humanitarian Assistance.
Meeting people where they are
FHI 360 supports psychologists who are embedded within 11 mobile medical units. These teams travel to over 150 different villages in six regions of Ukraine and offer both mental and physical health care.
We have also placed 10 psychologists within government primary health care centers, enabling us to support the Ukrainian Ministry of Health and ensure programmatic sustainability.
Oleksii Lytvynov, a psychologist with one mobile team, describes how his team will set up in a new location and introduce themselves to the community. When he tells people that he is a psychologist, many say, “We are fine” or “We are not sick.” Stigma surrounding mental health care is common, though the psychologists share that it is decreasing.
Once Oleksii describes common symptoms that people experience when struggling with their mental health, such as insomnia or panic attacks, many will say, “It happens to me, too.” Oleksii will offer a group session; after that, some people return for individual appointments.
Since the full-scale invasion began in 2022, the team has noticed an uptick in stress-related conditions among people in conflict-affected areas. Many who seek care at mobile medical units are older women who didn’t necessarily have the option to flee when others did.
“These patients, they are completely cut off,” says Dr. Natalia Kolisnyk, a medical doctor in a mobile team that supports rural villages in the Kherson region. They are “cut off from Kherson [city], where they used to go for treatment and examination; cut off from pharmacies. Their houses are destroyed; they have very little money, barely enough to get by. Sometimes they can’t afford the basic necessities, household essentials — let alone medication.”
Larysa Vysotska is a patient who regularly sees a psychologist at the mobile medical unit. “Whenever there is something that worries me, that bothers me, or [if] there is something that I need, I always come over,” she says. “They always help me sort things out.”
Building tools to cope with uncertainty and emotional burnout
Oksana Lapinska is a psychologist working in a mobile medical unit. She tries to help her patients live amid uncertainty. “We cannot predict when the war will end, when these explosions will stop, these planes and so on,” she says. “But now, despite it all, we are still alive. We can do something.”
Oksana believes that “it is crucial to show people that it is not only fear, pain and suffering around us … I try to teach people to see things they can lean on even in hard, stressful situations: their personal experiences, and things around them.”
Many of her patients are experiencing burnout. Psychologists in the mobile medical units use modalities such as cognitive behavioral therapy, art therapy, talk therapy and mindfulness techniques to help people cope.
Oksana teaches patients ways to process their emotions through the help of drawings, metaphorical cards, and breathing and grounding techniques, encouraging them to connect with their senses and the environment around them.
Amid war, tapping into play
In sessions, psychologists try to find what suits each person. “It is an individual approach; [if] someone says, ‘It doesn’t work for me,’ [then] we try to find something that will,” says Oleksii.
He likes to blow bubbles with his patients because they put people in a good mood, force them to breathe slowly and remind them of childhood (one woman shared that she hadn’t blown bubbles in 70 years).
Oleksandr Belan, another psychologist with the mobile medical unit, asks patients to describe their issue or emotional state through the help of “knickknacks,” he says. “Then, I start asking questions. For example, ‘Here, you have laid out a pattern … what did you mean while creating this pattern?’” This opens the door for deeper conversation.
Oleksii assures his patients that it’s normal to feel anxious or depressed. “We all go through periods of heavy thoughts and anxieties,” he says. “We dive into these thoughts; we sink in them like an ocean. And it is crucial to be able to find some support in this ocean — a raft to lean on, some stability.”
At the end of sessions, Oleksii asks patients to select string, then he makes them a bracelet. Later, if they feel anxious, patients can use the bracelet as a reminder of what they practiced with him.
As the war drags on, traumatic events continue to happen, and people will continue to need mental health services. FHI 360 is committed to supporting people’s health and well-being, both in times of peace and those of conflict.
“Our village is tiny,” says Svitlana L., but “they [mobile medical unit staff] come and do not forget us.”
All photos and videos are credited to Ivan Fomichenko for FHI 360.