Published by the Guardian, republished here in shortened form to comply with republishing rules.

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Luke Harding in Kyiv

Mon 15 Jan 2024

Serhii Dovbysh was defending his home in Chernihiv when something inside him snapped. The Russians were a few kilometres away. Enemy planes bombed the city. Shells landed among its gold-domed cathedrals. And young soldiers under his command were dying in battle. Dovbysh, a major in Ukraine’s armed forces and a deputy commander, felt responsible.

“Everything broke in my head and soul. And my body. You are alive but you don’t feel alive,” he said. He estimated that about 10% of the men in his battalion were killed during fighting, and another third wounded. “You eat with people. For months you share a room with them. It’s like a big family. When they die you feel a wound in your heart.”

Russia’s full-scale invasion exacerbated his pre-existing mental health issues, he said, in a stressful period when there was scarcely time to eat or sleep. “I wanted to be brave and strong, to protect my country and town. But it was hard to cope. You knew the Russians might attack at any moment.”

Now discharged from the army, Dovbysh, who was suffering from depression, works with war veterans who are struggling to deal with physical and psychological trauma. Some suffer from anxiety. Others have lost limbs and are adjusting to a new life with prosthetics. “For these guys it’s a long process. They need to find a reason to carry on living. A few want to kill themselves,” he said, adding that he knew of cases of suicide from other units.

Dovbysh said the government was doing its best but the challenge of dealing with so many veterans was vast.

He said he managed his own mental health by taking up competitive sport and last year he took part in the Invictus Games. Other service personnel attend a three-week camp at a rehabilitation centre in Kyiv offering therapy with psychologists and doctors, as well as kickboxing, swimming, table tennis, gym sessions and massages.

Military therapist Mykhailo Parfonov said the veterans had a wide range of problems including physical damage caused by mines and concussion, post-traumatic stress disorder, depression, nightmares and panic attacks. The goal was to rehabilitate soldiers so they could return to the frontline, he said. About 80% of those went through the course were fit for service.

He said that soldiers who came back from Russian captivity were in a bad state. “They are reserved. They have been beaten and starved. It’s not just physical wounds. The Russians humiliate them,” he explained, adding that veterans were often reluctant to seek psychological help. “They worry about being judged,” he said.

Ukraine’s first lady, Olena Zelenska, last year launched a campaign to persuade Ukrainians to look after their mental wellbeing and the online information portal Ti Yak – how are you? “The battle with pain, past traumatic experience, is an invisible front where we also have to win,” she said, adding that more than 90% have at least one symptom of an anxiety disorder but only a few sought help.

Paul Niland, an Irish writer and businessman living in Kyiv, who in 2019 founded the suicide prevention and mental health support hotline Lifeline Ukraine said that since the invasion its caseload has quadrupled. Ukraine’s rate of suicide is decreasing but remains high and above EU levels – in 2020, 30.6 deaths per 100,000 people, against a global average of 10.4

The hotline initially offered help to veterans and their families and now serves everybody. Niland said many of those who got in touch by phone or SMS were acutely worried about loved ones being killed. They also struggled with “constant exposure” to images of destruction from cities such as Mariupol, or more recently Avdiivka, flattened by Russian bombs. Some callers had traumatic personal experience of living under Russian occupation, where rape of women and girls by invading troops was widespread.

“You see young women with blank expressions. When we talk to them they say that they don’t want to live any more because of what they have been subjected to,” he said. There was a stigma attached to mental health problems dating from Soviet times, he added, plus a shortage of trained psychologists. Numbers were significantly lower than in countries like Germany or the US.