Refugees are in a state of shock. Many do not speak for days.
Caglar Tahiroglu, HI Emergency Mental Health and Psychosocial Support Manager in Ukraine explains the needs in mental health and psychological support.
Refugees cross the Ukraine border to flee the war. | © T.Nicholson / HI
“The collective center directors tell me that when people arrive from the conflict zones, they arrive in a state of shock. For two or three days, they don't speak. They sleep and they don't even want to explore their surroundings. Then in the 3rd or 4th day, all of a sudden they are ready to talk about what happened and start to form relationships.
There are different reactions. One is disbelief or dissociation- not believing what’s happening. One person told me that it’s like a dream. He feels like he is in a movie, and he won’t believe it is real until he sees his home in Kyiv to confirm if it’s intact or not. This is a common stress-trauma response, dissociation to believe that this cannot be real, or that it will go away. We’re also seeing constructive responses, with a lot of community mobilization, volunteering and organizing. It is actually is one of the biggest consoles we can give in a phase of stress. They’re helping each other and they’re doing it spontaneously.”
There is so much solidarity
“One woman in her 70s saw that the attack was coming and she started organizing right away. She was informing people to stay away from windows, to go to shelters. There were spontaneous help groups popping up to help orient people. They tell me that it’s difficult, but that staying together makes it better. People are at the centers every day bringing food and support, and a listening ear. There is so much solidarity. This resilience mechanism permits them to get away from the stressful and potentially traumatic situations. It has been really nice to see.
But, it is only the first month of the conflict. It doesn’t mean that additional support isn’t needed. At some point, this resilience would start to wear out. Our response aims to support these community efforts. They are still in survival mode and adrenaline is keeping people going. Several months from now, we are going to see the real psychological impact of the displacement, of the conflict and of all the violence they have experienced. There is the immediate response, but there will also be long-term psychological and social impacts. The World Health Organization predicts that all kinds of mild, moderate and severe mental health disorders double approximately in a conflict zone. 20% of people affected by disasters and conflicts require psychosocial support.”
How is HI responding to these needs?
“HI will work with collective centers, reception centers, some health structures and with community resources. In Chernivtsi alone, we have identified at least 10 structures in need of support, and we will be in other regions as well. We are designing our response alongside local organizations. We provide basic needs products, access to water and sanitation supplies, and physical rehabilitation services, all of which will have a direct effect on mental health and care practices.
First, we will reinforce human resources by hiring additional staff and finding funding opportunities. Then, we are setting up mental health and psychosocial trainings to support the organizations here. After seeing the important psychosocial needs of the displaced people and staff, there is significant need for trainings in stress management. We will train the general staff of collective centers because they are first responders. The welcoming period (right now) is very critical because we can start to determine if people are showing early signs of psychological distress. It is very important that everybody working in centers is trained in psychological first aid as a minimum for their reception. Then, we can consider additional trainings and supervision groups.
We will have a mobile mental health and psychosocial support team who will intervene in the structures one or two days a week to support existing staff, volunteers and beneficiaries. This would be to inform people about the effects of stress and potentially traumatic events, and how they can deal with it. We will also do follow-up individual counseling in some cases and eventual referrals if anyone requires further attention. We will set up psychosocial activities for adults, elderly people and children to improve their well-being and inclusive social support. We will also donate psychosocial kits for adults and children, which include toys, art supplies, games, and books.
There are lots of people recovering from heavy injuries, war-related trauma, burn victims, etc. So in the immediate and long-term, mental health and psychosocial support will be needed for these patients. We are looking at ways to provide support the patients and also the staff.
All of the volunteers and structures are doing a great job, but they are really overwhelmed and we are starting to see signs of burnout. HI’s intervention is really about supporting the networks already in place. Supporting the community response, the volunteer networks and grassroots organizations, are all very important. There is a mental health hotline set up by the university here, and it is run entirely by volunteers. They are doing an amazing job, but they have asked us for support and we are determining how we can best do that.
I am really impressed by the resilience and the community response that they have. It’s really hopeful that they’re organizing like this in the middle of everything, and as HI we want to come and support this community in what they’re doing by adding ourselves to that resilience effort.”