April 3, 2024

BEARR representatives attended an event at King’s College London, 20 February 2024, on work funded by FCDO through the XCEPT programme (Cross-Border Evidence, Policy and Trends). Here they share some of the main points.

Moderated by Lt Gen Dr Martin Bricknell, ex-Surgeon-General of the UK Armed Forces and current Professor in Conflict, Health and Military Medicine at King’s College London.

Speakers:

Heidi Riley, University College, Dublin, undertaking academic research on psychosocial support programmes for men.

Masi Nayyem, a recent Ukrainian veteran and lawyer speaking from his own experience of recovery from combat trauma and the current experience and support needs of troops and veterans in Ukraine.

Ivona Kostyna, runs the Ukrainian NGO ‘Veteran Hub’.

Bricknell set out that the intensity of combatants’ experience in the Ukraine war, mainly but not entirely men, makes the experience of veterans of Iraq or Afghanistan pale into insignificance by comparison. There is a huge physical and emotional toll being taken, that will last well beyond the end of the conflict.

(And in a chilling conclusion to the talk, he said that lessons from Ukraine with regard to recovery from conflict trauma may be needed here in the UK.)

‘Conflict-related trauma’ is the phrase used when combat experience of threat overwhelms an individual’s coping resources.

Riley considers PTSD (Post-traumatic stress disorder) a western medicalised, individualised way of conceptualising trauma. In her view it doesn’t address collective trauma, and the intersection between traumatic experience and daily stressors. All the speakers referred to the additional challenges of poverty, insecurity, displacement, the difficulty of navigating bureaucracy and the masculine-specific social stress of not being able to provide for family, or protect family members from the danger of war.

Kostyna agreed that the definition of PTSD needs to be updated to take social context into account. She emphasised that the recovery process is strongly influenced by livelihood issues, the closeness of the surrounding community, and emotional proximity of loved ones / friends. Meaningful interactions and relationships are key. Collective and inter-generational trauma need to be taken into account, as does the effect on families.

The war continues and Ukraine isn’t post-combat. Combatants released from the front because of injury can’t and don’t think in terms of reintegration. They know that they will continue to be needed at the front, and, if their physical injuries allow, they expect to return. Most remain in the reserve force. They feel themselves to be neither combatants nor civilians.

Nayyem emphasised that men at the front form very deep bonds with each other. When injured and away from the front line, they experience huge guilt at leaving their comrades behind and particularly when others die. Many organise collections for the front to try to deal with this. He talked from personal experience of how difficult it is to come to terms with irreversible physical disability, becoming, in his view, a different person. It was clear that this has had as much effect on his mental health as his combat-related experience. Injured combatants expect to be forgotten: he reported that 72% don’t expect the state to continue to care for them.

The portrayal of male combatants’ resilience as ‘strength’ creates the idea that vulnerability is something opposite to masculinity: trauma is suppressed and maladaptive coping mechanisms develop, such as substance abuse, risk-taking, violent behaviours and social withdrawal. Domestic violence increases in post-combat societies. This is what underlies the need to rethink the notion of resilience.

There is no data collection or tracking of demobilised combatants, and service providers are not aware of their needs: physical injury is much more likely to be recognised than mental health issues. Psychological stress may not be recognised as linked to combat experience.

There are therapeutic services only in large towns and there are very few mental health providers. Almost all NGOs dealing with violence address women’s needs, and neglect men’s. There are some online services, but no clear eligibility criteria: help doesn’t necessarily go to the male traumatised combatants most in need. Most male traumatised combatants are reluctant to seek help; appearing to need help is stigmatised.

Interventions need to be ‘mainstreamed’ into health, education, and broader livelihood programmes, to encourage participation and complement efforts to cater to the more obvious needs of conflict veterans. Stronger understanding is needed within society – among primary healthcare practitioners, teachers, community leaders – of how trauma affects combatants, and that ‘it is ok not to be ok’.

It isn’t feasible to fund large-scale psycho-social support. Kostyna emphasised that community support is key, and that community-led models could be developed. A methodology could be developed for CSOs, but as yet protocols, understanding of ethics, etc are not in place. However, these could be developed in simple language and rolled out to CSOs. Preventative work could also be carried out, to prepare families for the return of combatants, and with combatants, to prevent stigma around accessing help, should it be needed.

Report by Armorer Wason, BEARR Special Adviser