“I've lived in Mariupol ever since I was a child,” said Alina Rosheva, 20 years old. “We had a beautiful house. I had a group of friends. I looked forward to the future with confidence. This all came to an end in February 2022. All of our relatives came to join us in our basement. There were 13 of us, young and old, trying to survive however we could. The explosions were so loud that the doors to the basement were blown in. The decision to leave was obvious. If we had stayed, we wouldn't be alive.”
After 20 days sheltering in the basement, Alina undertook a long and dangerous journey with her relatives, passing through a dozen checkpoints controlled by the Russian army before crossing the front line to reach territory controlled by the Ukrainian army. Heading west through Zaporizhzhia, she finally reached the city of Vinnytsia, which has become her temporary home.
More than 4.6 million Ukrainians are currently displaced within the country, 160,000 of them in Vinnytsia. Since April 2022, Doctors Without Borders/Médecins Sans Frontières (MSF) mobile clinics have provided medical and mental health care, including psychological first aid in shelters for displaced people in and around the city. To raise awareness of the psychological support available, MSF health promoters run group sessions aimed at both adults and children.
The psychological support has made a tangible difference to many people’s lives, especially for children. "When we first started, people told us that their children just sat there, not communicating with anyone," said MSF health promoter Mariana Rachok. "We were happy to see that, over time and sessions, the children began to play together."
Mental care for war-related trauma
MSF teams in Vinnytsia soon realized there was a need for specialized mental health care for people living with post-traumatic stress disorder (PTSD) as a result of the conflict. In September 2023, MSF opened a trauma center in Vinnytsia for people with war-related PTSD.
“Most of the patients are displaced people who have seen and survived unbelievably horrific events," said MSF doctor Lilia Savchenko. "They experience hopelessness, nightmares, recurrent flashbacks, anxiety, and detachment from other people. These are all normal reactions to abnormal events. But if these conditions persist for more than three to six months, then this is an indication that the person has PTSD. From then on, it is likely to get worse every day."
MSF psychologists currently see around 30 patients for weekly consultations. Patients undergo an initial assessment, in the form of a consultation with the doctor and one of the psychologists, who make a diagnosis based on tests and clinical observation, and devise a treatment program.
"The treatment program depends on the mental state in which the person comes to us, but involves an average of 10 to 15 consultations," said Dr. Savchenko. At consultations, MSF psychologists use evidence-based practice divided into three phases—stabilization, trauma processing, and reintegration into social life—and tailored to patients’ needs.
The stigma of mental health care
It’s common for people with PTSD to be reluctant to seek help. This is often exacerbated by the stigma that exists around mental health care. "There is a lack of understanding of how psychotherapy works and this can discourage people from seeking help,” said Andrii Panasiuk, MSF psychologist and mental health supervisor. “This is where raising awareness plays a key role.”
To raise awareness of PTSD and inform people about its symptoms, MSF teams conduct sessions with general practitioners and with veterans' associations. We also work with local organizations to run creative workshops and art activities on the signs of PTSD for people displaced from regions like Mariupol or Kherson. During these activities, health promoters sit and talk with each participant individually in order to build trust, identify people who could benefit from psychological support, and empower them to seek care.
“I often draw parallels between physical and mental injuries,” said Mariana Rachok. “If you don’t disinfect or treat a wound, but simply cover it up and try to ignore it, the wound just gets worse. It’s not in the psychologist's power to bring back your home or your loved one, but it is in their power to help you find ways to live with trauma, learn to understand your emotions, cope, and find ways to help yourself.”
Starting to live again
Lidia Bazualyeva, 74, was displaced from her home in Kherson and received mental health support from MSF for PTSD. “All these creative activities helped me psychologically, as did the consultation with the psychologist. Slowly I came out of this very difficult post-traumatic state. Now this is my only family and I have never missed an event facilitated by the health promoters,” she said with a smile. “When I communicate and share information, I slowly start to live.”
Alina Rosheva recently completed MSF's PTSD program. "I went to a lot of therapy sessions,” she said. “It was difficult. Recovery does not happen overnight—it's a long and complicated process. But three months after I started treatment, I stopped having panic attacks; they went away. At last, I had learned to control them and to deal with them.”
Today, Alina is in charge of organizing cultural activities for I'Mariupol, a support organization for people displaced from Mariupol. She has built up a new group of friends in Vinnytsia and faces the future with confidence again.
About our work in Ukraine
MSF first worked in Ukraine in 1999, providing treatment for HIV/AIDS, tuberculosis, and hepatitis C. Between 2014 and 2019, MSF teams worked in the conflict-affected Luhansk and Donetsk regions, running mobile clinics, providing peer support to local health care workers, and training them to provide mental health care. In the two years since the war in Ukraine escalated dramatically, MSF has expanded activities to include: organizing evacuations and referrals of patients; and providing medical and mental health care, including surgical, emergency, intensive care, physiotherapy, and psychological treatment for PTSD.
In September 2023, MSF teams started providing specialized psychotherapeutic services for people with war-related PTSD in a new, custom-designed mental health center in Vinnytsia. Since then, MSF has conducted close to 1,400 consultations and run 4,400 awareness sessions at the clinic or at partner organizations’ facilities. To date, 81 patients have been discharged from the program after completing therapy.
