'The trauma of loss...': Experts contemplate impact of Russia-Ukraine war on mental health

As the world continues to witness the immense devastation and destruction in Ukraine, unleashed by Russian President Vladimir Putin's forces for almost a month now, the sufferings of Ukrainians remain unfathomable.    

Experts around the globe are estimating losses incurred by Kyiv in terms of economy, money and personnel, but no one can estimate how many dreams and aspirations have been killed in the few weeks that have wrecked Ukraine's cities; Children losing childhood, teenagers being scarred by the trauma of war, and people losing everything they built through their lives.  

While the physical damage to property and infrastructure will be recovered in the coming days, the scars of war ingrained in the hearts and minds of people who have witnessed the fall of their country and the deaths of their loved ones remains a difficult wound to heal.  

Russia-Ukraine war: Mental health a major concern as hardships unfold

Deliberating over the hardships of the Ukrainian civilians trapped in the conflict, Lt Colonel JS Sodhi (retd), who has served 21 years in the Indian Army interprets that "the effect of a war stays on the survivors for an eternity." 

 “People who have nothing to do with the war, have been caught between the cross firing of the two warring countries and they are bound to undergo tremendous psychological challenges due to the debilitating situation. 

The pressure of seeing the weapons firing, bombardments leave a huge impact on a person. Despite being trained in the army to act wisely in a warlike scenario, even army men go through immense psychological pressure,” he told Republic.

Spine-chilling visuals of incessant attacks and shelling in Ukraine's civilian areas, flattened buildings, residential complexes turned into debris, and city skies painted grey as plumes of smoke and dust blanket the once colourful streets of Ukraine speak of the reality that war is. 

Desperate, people flee the war zone in a bid to save their lives; some survive, others remain unfortunate.  

(People walk on the ruins of what was once a flourishing shopping centre in Ukraine; Image: AP) 

 “Everyone works their whole life to build a home of their dreams, and seeing it shatter into rubbles in a moment breaks their heart into pieces,” Lt Colonel Sodhi said empathising with the people who lost everything they had earned in their lifetime in a split second.

“Impact of the war is very severe, it will probably take a generation or two for inhabitants of Ukraine to emerge out of these tragic feelings. With the help of loans, the country will be established again, Woh ghar banjayenge, but woh emotions dobara kabhi nahi aayenge (The houses will be built, but the emotions will not return), because those emotions are very pious for that person,” Lt Col Sodhi expressed. 

'The trauma of losing people, nostalgia about the past...'

“Those scars and void could never be filled," the Indian Army veteran said. 

"It’s not just one odd incident that one could forget, for 27 days now with continuous violence and tragedy around them, probably those who have survived the war could never be able to forget what they have witnessed on the war zone.”

On being asked if the Ukrainian refugees will ever be able to resettle after the war ends, the Lt Colonel responds, “People will come after the Russian forces withdraw troops. They will start fresh lives, but it will be very difficult for them to re-establish. The trauma of losing their people, nostalgia about the past will trigger the feelings of loss among them.”

Contemplating the dire consequences of war on children and youth of Ukraine, Lt Colonel Sodhi asserted, “The impact of the war will be most on children as people of older age groups are more resilient; however, (for) a teenager, a 14-year-old boy or a 20-year-old girl, it will be very very difficult for them to process it.”

Recalling an incident from his life the Army veteran narrated, "When the Gujarat earthquake came on 26 Jan 2001, I was in the first Air Force plane that took off from Bhatinda for the rescue operation...After a few days, it was decided to open the schools at the earliest for all those children (who were affected by the tremor) there since they have seen this trauma first hand and need a change of environment around them."

(A Ukrainian citizen measures her window destroyed in Russian shelling as she gazes on the ruins the war has caused; Image: AP)

"It was understood that once the schools will open, they will go back, meet friends and with time, that pain and that trauma will wither away...We observed that children used to be happier in schools, but as soon as they went back to their families, they would again slip back to those memories,” the Army veteran told Republic while emphasising that children will be worst affected.

'There is forced migration and a sense of irrevocable loss attached to war'

To understand the possible post-war effects on the mental health of Ukrainian citizens, Republic got in touch with psychology professionals and experts.

Antano Solar John, CEO & Co-Founder, Antano & Harini, Legacy Accelerators, who received recognition from the Government of India for his work on personal evolution of individuals, said, "War, the practices and beliefs that it inspires, seep into the very culture and sub-culture of war-affected communities. There is forced migration and a sense of irrevocable loss attached to war."

Notably, with millions rendered refugees, the Russia-Ukraine war has caused the largest refugee crisis in Europe since World War 2. Explaining the trauma that comes when one is rendered homeless, John said, "This trauma, if not treated with empathy and superior mental health practices, may be passed on from one generation to another. We also know that there is science into what gets different people to respond differently in the same crisis, with varying intensities of emotions. While some people are deeply affected and may need mental, emotional, psychological rehabilitation, others may be concerned, but at the same time not crippled by it."

(Firefighters search for people under debris in a shopping centre bombed by Russia in Kyiv; Image: AP)

Lessons learnt from World War II

Recalling the devastation the second World War caused, Antano Solar John said, "Two of the worst war-affected countries have been Japan & Germany. After World War II, Germany witnessed a phenomenon of mass rape and other tragedies. Japan, on the other hand, was left in shambles after the bombings of Hiroshima and Nagasaki. And yet, these countries don’t face such societal challenges. In fact, as two of the leading economies in the world, they have found their way to peaceful co-existence, trusting the world around and having the trust and reverence of their global counterparts.” 

“The nations have rebuilt themselves and are, at present, torchbearers in technology, innovation, lifestyle, work ethic and more. Of course, there was a time when these nations were at the brink of economic and financial collapse...while we have seen people in war-infested areas finding it impossible to trust anyone else, we should also not allow it to become a self-fulfilling prophecy. What is important is the stories and metaphors of people and nations that have built themselves up, and have been able to trust others,” he added.

Psychosomatic ailments as an aftermath of war

Dr Jalpa Bhuta, Consultant Psychiatrist at Global Hospital, Mumbai explained the psychological impact that war can have on people. 

Talking about Russia's relentless military offensive in Ukraine, Dr Bhuta said, “Ukrainians are suffering through life-threatening traumas. The war survivors in Ukraine would be dealing with a lot of uncertainties, they don’t know whether they will be able to survive or will they be able to protect their families, will they be separated, what does the future behold for them? – All these are the questions that will be troubling them. A warlike crisis could give anybody severe anxiety; people can go into depression. The depression might later grow into PTSD (Post Traumatic Stress Disorder) in some.”

(Ukrainian refugees gather at a railway station in Przemysl, Poland, that has received more than 2 million Ukrainian refugees; Image: AP) 

Acknowledging that people react differently to situations depending on their temperament, the psychology expert said, "Suddenly being uprooted from a particular geographical area and being put into a place where everything is different makes one lose their identity."

"You were once recognising yourself as a person from a particular place and then suddenly you are sown into a place where you don’t know anything. No one knows you, the culture might be different, sometimes even the language is different. One has to adjust to all of that and people around might not be empathetic to them,” she said.

“Most commonly people suffer from depressive disorder, anxiety disorder, psychosomatic ailments like chronic body aches, arthritis, sleep disturbances, they might resort to alcohol and substance abuse,” Dr Neha Smita Lal, consultant psychiatrist at Jain Multi-speciality Hospital, Mumbai, echoing Dr Bhuta's words.

To put into numbers the devastation the Ukraine war is causing, the United Nations High Commissioner for Refugees estimates over 10 million people displaced with over six million of them displaced within the country. This includes a sizeable number of women and children. 

“The survivors will be learning things from scratch, they will be developing things from scratch. The whole community is in agony. The Ukrainian government and the World health organization has to take up initiatives to provide resources to survivors to come out of the trauma and build themselves again. They would need a lot of support and a lot of therapy to better themselves,” Dr Jalpa Bhuta noted.

'What children observe, they also imbibe'

Saying that there might be mass hysteria among refugees since the whole community is dealing with difficulties, Dr Jalpa Bhuta said, “Children might suffer from adjustment issues. Loud noises can trigger memories of the past and they might end up having panic attacks. They might start avoiding situations to escape reminding them of the past. They might even get into a shell.” 

Expanding on the same, Dr Neha propounded, "If a mother is affected, then her child will go through the same trauma, because, children learn from their parents and they are in most close contact with their mother. If the mother is disturbed, it passes on to the children. What children observe, they also imbibe.”

“In childhood, if a child witnesses shootings, killings and violence around him/her, it will harm the child’s mental and psychosocial health. They might develop aggressive behaviour and they might suffer from nightmares, sleep disturbances, poor academic performance, stunted growth as a consequence,” she added.

(A man covers the shattered window of his living room in Kyiv with a plastic sheet after it was damaged in bombing the previous day; Image: AP)

Double suffering for people who witnessed Russian Invasion in 2014 and COVID catastrophe

Sufferings of the Ukrainians in the Donbass region and Russia-annexed Crimea were doubled as they have witnessed a Russian invasion in 2014 as well. 

Dr Milan Balakrishnan, an experienced psychologist at Mumbai's Masina Hospital said, “Repetitive tragedies and traumatic events and putting people through the same atmosphere again can be very distressful on the mental health of the survivors and cause severe psychological trauma that could develop into PTSD. Most people might suffer from some emotional impairment, repeated tragedies will make them more vulnerable to chronic mental health issues.”

Dealing with the war just after an unprecedented COVID outbreak is also a double whammy on the mental health of survivors.

What can be done to avoid mental health catastrophe?

Despite all odds, human beings, have time and again proved their resilience and have dealt with the worst scenarios in the past. Post this war, many will brave the circumstances and will be able to rebuild themselves. Dr Jalpa, Dr Neha and Dr Milan shared a consensus on this as they elucidated that with the help of social support, support from the government, WHO and other organizations, Ukrainians will be able to revive themselves.

According to the experts, people dealing with distressing circumstances should seek support from their peers, religious groups and health authorities. With the help of the right kind of support, therapies and treatment, they will be able to cope, they asserted.