Ludmilla Boiko can’t sleep. Every night, before going to bed, she takes pills that eventually shift her into unconsciousness. “No normal person can go through this and come out without traces,” she said.
Boiko knows better than most the psychological effects Russia’s invasion has had on people in Ukraine. As the director of a long-standing Ukrainian centre of psychology in Borodyanka, a town north of the capital Kyiv which was pummelled by Russian bombs and then occupied, Boiko is at the forefront of one of Ukraine’s biggest civilian challenges – helping a traumatised population cope with the horrors of a war that shows no sign of ending.
Boiko and her team at the Centre for Social and Psychological Rehabilitation have set about treating their community while trying to deal with their own trauma. Boiko’s sister and nephew died in a basement in the town when a Russian bomb hit their apartment block.
Months after Russian forces were pushed out of the Kyiv region, people are struggling to cope with what they endured.
Those who lived through the Russian occupation are some of the worst affected, on what leading Ukrainian psychologists see as a spectrum of trauma experienced by the whole country, including those who have left.
Borodyanka’s centre of psychology was set up in 1994 to deal with the aftermath of Chernobyl. Later, it treated Ukrainian veterans from the war in eastern Ukraine.
After Russian troops rolled in from the Belarusian border, 200 miles north, the centre was destroyed by a Russian bomb in the first few days of the war. A volunteer was inside at the time.
The psychologists say every resident who stayed in the town is suffering from stress, including post-traumatic stress disorder (PTSD).
“You can visually tell the difference between a person on the street who wasn’t here and a person who stayed [during the occupation],” said Boiko.
“The person who’s just coming back still has strength, whereas a person who stayed is completely wiped. They have no energy, no emotions, no strength. It’s like a walking corpse. We are not coping with the scale of the problems.”
There were 15,000 people in Borodyanka before the war and 25,000 in the surrounding villages. Now that number is around half, said Boiko. Whole apartment buildings were obliterated by Russian bombs, making it difficult to determine the total number who died. Some of the residents may have left the town.
“I don’t sleep. I have to take medication,” said Boiko. “You leave your house and you understand that you still need to wake up – that this is all a nightmare and it is not real.
“There were people who were still alive under the rubble of two apartment buildings, just down this road. They were there for 20 days. They were calling out for food and water but every person who tried to go near them, to help them, was shot at. There were children there. They all died when they could have been saved – 40 people.”
The psychology centre offers a walk-in facility, online consultations, group therapy and a mobile unit, which acts like an ambulance service that intervenes in critical situations of a psychological nature. The “psychological brigade”, as they call it, is a team of residents consisting of two psychologists, a social worker and a lawyer. They are also running a week-long summer camp for children.
“The main thing we want to do now is to ensure that children feel their childhoods again,” said Boiko.
The struggle of treating PTSD is increased while the war continues. The effects of PTSD worsen if a person continues to live in an environment of heightened stress – such as a war, said Vitalii Panok, who is head of Ukraine’s Methodological Institute for Applied Psychology and Social Work, which develops approaches for psychologists in the country.
“These guys are just golden, they are stars,” said Panok of the work undertaken by Boiko and her team in Borodyanka. Panok has known Boiko since the early 1990s, when he was responsible for developing Ukraine’s national psychology programme.
Panok now acts as their supervisor – in effect he is the psychologists’ psychologist – and is there to help them deal with their trauma as well as the trauma they absorb through treating others.
On the one hand, said Panok, having psychologists who have experienced the same trauma is a plus, because the victim does not have to spend hours explaining what happened to them. But also, it is difficult for some psychologists not to react, either internally or externally, with their own emotions after experiencing the same trauma.
Panok, explaining why the role of a supervisor is so important, said the Borodyanka psychologists understand emotional burnout. “After a day of listening to people, they are ‘gone’ by the time they get home in the evening.”
The psychologists do not give advice. Instead, they offer tactics that people can use to help solve the problems they are experiencing on their own and to stave off feelings of panic as much as possible, said Tatiana Sushko, one of the Borodyanka team.
An important tactic for treatment, said Sushko, is learning what to do if the trauma is repeated – that is, if you experience another Russian attack – and, importantly, when to do to it.
“You need to be organised and know how to act,” said Sushko. “For every situation, there needs to be a rule that you know, and that you follow. That way you do not panic, you know what you will do. So, you hear the sirens, you know you need to go here or there.
“But when you know there is a real threat, you need to get your suitcase, the children’s things, your cat and dog and leave. And you have to make sure you always have spare petrol for your car, as you know there are shortages.”
She described how she and her husband left their basement one day to make a hot drink in their kitchen and were forced to throw themselves on to different floors of their house when a bomb flew overhead. She said there was one particularly intense day of bombing where she wondered if anyone in the town had survived.
Sushko said they were all still scared and certain sounds were triggers for those who stayed. “There is no safe place in Ukraine right now – we are all in a state of anxiety.”
Panok estimates there are up to 7 million trauma victims in Ukraine. Most of them, he said, were people who had to flee their homes and he estimates around 50% of them have PTSD. “You have to imagine the stress that people experience when they are forced to flee, when they literally have to look around for their documents and then just leave everything they have and not know where they are going to end up,” said Panok.
“Then you have the people who experienced bombing or heard it, saw their neighbours being shot by the occupiers, were shot at while trying to evacuate, were tortured. To some degree, most of the country is traumatised.”
Panok is working with the German government to train Ukrainian psychologists to deliver what they call first-aid psychological help, basic tactics people can learn to help themselves cope. But what he really wants to see is a nationwide support programme, which he thinks is achievable because of how the Ukrainian psychology system is set up.
While in Europe and the US people are referred to certain services run by psychologists – for instance for behavioural problems or alcoholism – in Ukraine, said Panok, such help is integrated into society through the education system and works on a preventative, rather than reactive, basis.
Starting in the early 1990s, psychologists were installed in all educational institutions. Their job is to follow the development of children and young adults and try to predict and prevent problems.
“If you take children and their family members, parents, grandparents, aunts, you already have access to about 90% of the population,” said Panok. What Ukraine needs, he said, is help training Ukrainian psychologists en masse on how to deal with stress, trauma and general first aid psychological assistance.
“The Ukrainian authorities are so busy at the moment I don’t think they realise what a tool they already have,” he said, referring to the 23,000 psychologists inside the education system. “If left unchecked, PTSD can affect the victim intermittently for the rest of their life. Common consequences include alcoholism, drug addiction, deviant behaviour, as well as physical manifestations, including heart attacks.”