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Healing the Hidden Wounds: Mental Health Challenges in Ukraine's War Zones

by Robbie Schneider

Photos were provided by Irina Deyneka
Photos were provided by Irina Deyneka

"In the beginning of the war, there was a chaos, a mixture of feelings,” recalls Irina Deyneka, a psychotherapist working in a refugee shelter in western Ukraine. “Now it’s a different type of work, it’s more about your use of self, who you are as a therapist. It is slower, it takes more patience and more effort. Leading people through trauma is a very hard work."

Mental health professionals like Irina work long hours in shelters and refugee centers, conducting individual and group therapy to support and restore mental health for a steady flow of people traumatized by being a victim or witnessing violence brought on by more than a year of war. Irina, a refugee herself, sees as many as eight patients a day, sometimes on top of group therapy. Some of whom she may only see once before they move on.


"Behind that visible frontline, there is another frontline, where the battle with the tremendous trauma takes place," said Eva Skinner-Regel, LICSW, M.Sc, M. Bioethics, Program Clinical Director with Health Tech Without Borders’ Helping Healers Heal program. “The war challenges people's perception of self, space, and time. People's self-identity undergoes changes, which happens on top of the psychological and frequently physical trauma.”


This trauma and fear of an unknown future in Ukraine is displayed in many ways across the generations. While Irina sees in younger children an internal ability to find a drive to keep going, that fire dampens as people age. Even in teenagers she sees a devastating loss of hope and fear of the future.


Irina recalls recently asking teenagers in a art therapy class to create a “map of wishes” by picking different cutouts and gluing them on a piece of paper. She noted a significant difference in how the teens approached the work based on whether they came from active war zones.


“Those who were not in an active zone could see themselves with a future. They were able to have 6-7 even more colorful cutouts” she said. “The teens in active war zones had absolutely nothing. They had to work to see one or two pictures on their map. They needed help to see their future, to see themselves in that future.”

Adults, particularly those of retirement age, are struggling with similar challenges but in a deeper and more profound way.


“The feelings of depression are deeper in the senior generations,” Irina said. “They have nowhere to go, they have no place to stay. As older people, there’s a feeling no one needs and cares about them, that they’re alone and have no future. It’s very different when there’s no hope.”


Bad news from home can set her clients back in their healing process.


“One of the biggest challenges of working in a ongoing war setting is so many people came from battle zones and areas that continue to be battle zones, and they continue to experience constant re-triggering and re-traumatization,” Irina said. “They hear what’s going on in the places they call home or get news that friends, or family were killed, or their home destroyed, everything they’ve identified with has been destroyed.” They are retraumatized when they hear what happened when they were away." So, all the therapeutic ground that was gained in previous trauma recovery work is lost, and Irina and her clients must start building emotional resilience and hope again.


Because healthcare workers working in Ukraine aren’t immune to the stressors of living in war, Skinner-Regel helped launch HTWB’s Helping Healers Heal program, mental health support and education program, in August 2022. The aim of the program is to provide mental health and healthcare clinicians working in zones of humanitarian disaster with mental health support and the opportunity to process emotions, experiences, and thoughts caused by a disaster. For the last year, Skinner-Regel and other mental health clinicians/volunteers have met weekly with Ukrainian mental health clinicians like Irina virtual. The goal of these meetings is to help lessen symptoms of burnout, create a space for the narrative of their own lives and work in war times, provide space and time for the clinicians to process their own thoughts and emotions related to primary (their own) and secondary (their clients) trauma of war, and strengthen resilience and professional sustainability.


During the meeting, Ukrainian mental health clinicians can do their own restorative work so that they have resources and emotional and mental fortitude to continue supporting and helping the people of Ukraine as the was continues.


Though the conversations can be difficult, Irina continues her work with Helping Healers Heal. She is now one of three champions in a pilot to engage the Ukrainian therapists who participate in the Helping Healers Heal program to provide the same level of support to their colleagues in Ukraine., making it a true peer-to-peer support.


"Being a good trauma therapist is definitely an art,” Irina said, brushing back tears. It is difficult work, and it is exhausting and slow work. It is hard not to close off because everything is so raw and tragic. But I don’t feel frozen, I can feel sunshine, I can bring the part of life and part of me and offer to someone else.”


To help support the Helping Healers Heal program, visit https://www.htwb.org/donate


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