Healing the wounds of war in Ukraine

New Europe

As the 200th day of Russia’s invasion of Ukraine passes, the immense human cost of this conflict has never been clearer. Millions of Ukrainians have fled their homes and thousands of civilians are believed to have been killed as fighting engulfs densely populated urban areas.

The Western economic front, including both sanctions and large military and economic aid packages led by the United States and the United Kingdom, has sought – along with the voluntary sector – to remedy some of the most acute needs of Ukraine and its people, but one area, in particular, remains neglected. The mental health of both children and adults as a result of this war.

Research by World Vision International highlights that the constant fear, hopelessness and loneliness, inherent in the most violent wars such as those in Syria, South Sudan, and now Ukraine, can lead to PTSD, depression, and anxiety in as many as one-fifth of the population. Children are naturally resilient, and with the right support, it is possible to overcome the effects of even the most distressing experiences. But without adequate care, we risk long-term scarring of these young lives, with large proportions of the affected population suffering from emotional, psychological, or mental disorders as they develop.

Compared to the $200 billion, the Kyiv School of Economics has estimated it will cost to repair Ukraine’s infrastructure, residential buildings, utility networks, and services, the cost of providing mental health resources to Ukrainian civilians is very modest, with as little as $50 for each of an estimated 1.5 million affected children. Ms Catherine Green, World Vision’s Ukraine Country Director, added that due to international generosity towards Ukraine “we are in a rare position in this emergency: there are funds for programming to protect children’s mental health, and that of their caregivers”.

As for adults, even before the war, Ukraine faced a high prevalence of mental illness, depression, alcohol use disorder, and suicide, affecting up to 30% of the population according to some sources, of which a majority were men. Western countries, especially those who support veterans who have fought in recent conflicts around the globe, are familiar with the mental health legacy of war. Unfortunately, as with children, adult mental health – and especially for soldiers dealing with separation from their families, the ongoing threat of death as well as physical stressors and sleep deprivation – is made to give way to the priorities of the battlefield. Much more concerning, a 2015 study and a 2021 study both showed that around 60% of servicemen are reticent to seek help for their mental health concerns. Many worry that they will be perceived as unfit for duty if they speak up.

While the most enduring and robust solutions to this growing mental health crisis lie with the attention of family, society and mental health professionals, and in cultivating a less stigmatised societal attitude towards mental illness, many of these solutions are less feasible during war, and can be difficult for soldiers and for displaced families to access. Yet sometimes there are smaller, simpler options that remain for both adults and children impacted in Ukraine to take a personal control over their own wellbeing. Professional militaries have for decades been promoting simple solutions to various battlefield medical conditions. For instance, the US army ran a trial of chewing gum to tackle the issue of up to 15% of deployed soldiers experiencing “dental emergencies”. They also considered that gum might relieve stress during deployment, as many studies have found, such as a 2010 clinical trial which found it is associated “with greater alertness and a more positive mood”. The benefit of small interventions is that they minimise financial and logistical costs and save time. Sport remains another important solution. Programmes such as the US “Comprehensive Soldier Fitness” (CSF) initiative seeks to build psychological resilience through sport, as well as through community-based buddy programmes and positive social support when soldiers take their leave from the frontlines. Sport has been proven to reduce levels of stress hormones cortisol and adrenaline, and releases endorphins which improve your mood. The effects are, according to an Australian study, even stronger in team sports.

Indeed, a further study from Public Health Wales and Bangor University found that of children who had experienced traumatic or adverse childhood experiences (ACEs), participation in sport reduced mental illness prevalence from 25% to 19%. The power and relevance of these findings for the situation in Ukraine is too great to ignore. Policies to encourage sports uptake in Ukraine (and amongst those families dispersed in host nations across Europe) would need not be costly, and could help save Ukraine from decades of societal hurt.

When the war ends – as it certainly will – it is imperative that the nation remains fit and able to rebuild itself. We need to make sure that Ukraine’s most valuable assets, its people, are viewed as a strategic and defensive priority alongside the rivers, bridges, forests and steppes. Western aid packages should stipulate that even modest amounts of money be spent on measures, however small, to support Ukrainians’ mental health.