It is common in the course of an extended war for a substantial proportion of the population to become sick or unwell, and not just soldiers but civilians as well; and not just physical illness but likewise psychiatric injury. Many of the indicating factors showing a deterioration in a person’s health amidst exposure to war are overlooked at the early stages with the result that they become ever less healthy.
The principal dangers afflicting people resident in war zones are psychiatric; this is often overlooked. The daily grind of life in a war zone is gruelling upon the psyche. It tends to involve waking early, in time for lifting of the curfew and dawn; planning basic necessities, such as food and drink for one’s family or other people in one’s team; ensuring the safety and welfare of all people involved; planning the coming working day (every day involves some work for able bodied people within a war zone, particularly close to the front line); and also trying to find some time to relax and catch elements of a normal existence. This regime typically continues seven days a week, all the time during which, day and night, one may hear air raid sirens, calls to shelter, or receive messages about different types of incoming ordnance, aeroplanes, UAV’s or other prospective military encounters.
After some time, the mental strain of this constant stressful activity visibly takes its toll upon the participants in war, whether civilian or military. People become distressed by separation from their loved ones, thoughts or memories of the dead or the injured, constant worry about their welfare and the welfare of others, and thoughts about where the next meal is coming from or what the next danger might be.
In Ukraine, one of the principal psychological dangers of participating at the sharp end of war is alcoholism. Strong alcohol is and always has been extremely cheap in Ukraine; at the time of writing a bottle of vodka may cost less than three Euros. Some people seem to drink it all the time, as a form of self-medication for stress and anxiety. It is not uncommon to encounter men in particular, at early periods during the day, reeking of vodka. This may include soldiers on active duty. Everyone has the temptation to take a drink, to numb the pain of the constant stress of living in a war zone. As well as this being bad for the body, it poses an additional potential risk to public safety, as the streets may be roaming at night with drunk people; violent incidents may erupt in bars (yes, bars continue to operate plentifully, even on the front line of a war zone; they may be more popular than ever); there may be drink-driving accidents; drunkenness may induce situations close to riot amongst crowds of people waiting for food or refugees waiting to be processed.
Also alcohol is not a very effective form of self-treatment for psychiatric distress; no doctor would recommend it. Unfortunately Ukraine never had a particularly good healthcare system; it was always renowned as being one of the worst in Europe, in particular its public hospitals that are the only centre for treatment outside Ukraine’s larger cities. Psychiatric healthcare was next to non-existent. Ukraine harboured, and to an extent continues to harbour, a Soviet-era aversion to psychiatry that is associated with the disappearance of political prisoners and is generally considered to be an instrument of communist state oppression. This stigma associated with psychiatry never really disappeared in either Ukraine or in Russia, with the result that people are loathe to admit they may have psychiatric issues; loathe to seek treatment from a psychiatrist; and loathe to accept any psychiatric medication that may be essential to their recovery without resort to alcoholism.
The most common psychiatric conditions arising out of continued wartime stress are anxiety, trauma, post-traumatic stress disorder, and often psychosis. All these conditions merit pharmaceutical treatment under the supervision of a trained medical practitioner, but unfortunately in wartime Ukraine such practitioners are rare and far too few in number given the demand that ought to exist, even if one could persuade people in need of their services to seek advice and medication. Such psychiatrists as there were prior to the war have often fled the country, being relatively affluent members of the country’s middle classes. Indeed there has been an exodus of Ukrainian doctors in general, including before the war even started, as they sought better salaries in western countries for their skills. Hence these psychiatric conditions are going untreated in any rational way, and this will harbour long-term consequences for the mental health of the Ukrainian population.
We have seen this before. In the 1990’s, in the wars in Bosnia and Herzegovina and in Serbia (including the war in Kosovo and the NATO bombing of Serbia in 1999), countless people of the former Yugoslavia suffered traumas, anxiety disorders and other psychiatric issues that were never treated adequately or in many cases at all and in some cases linger onto the present day, almost 30 years later. Yugoslavia had a similar taboo against psychiatry, that is only slowly being overcome in the Western Balkans region and then only in the principal cities. It is deeply shameful in many Western Balkan countries to admit to one’s family or friends that one has sought psychiatric assistance, and this continuing taboo negatively impacts the collective mental health of the nation. As in Ukraine, in the former Yugoslavia doctors in general and psychiatrists in particular fled military theatre, in many cases never to return, leaving traumatised populations in their wake without access to treatment.
It is essential in the context of any war to focus upon mental health issues, because they have a disproportionate impact upon a disjointed population. So battlefield psychiatry becomes an essential available public service for both civilians and military personnel alike. Stigmas must be overcome, through public information campaigns and otherwise, so that the inevitable traumas and anxieties incurred through life in military theatre are addressed at the earliest possible moment and before they become worse and compound problems of alcoholism. International assistance to Ukraine ought to have a component to it that focuses upon the supply of psychiatric services, and their advertisement, into war-torn Ukraine, particularly on the front line.
Other psychiatric problems arise. War zones often attract very unusual people, some of whom may exhibit psychiatric disorders. A number of military roles in their very nature require killing people, and this may attract psychopaths or other people with severe personality disorders who may find themselves concentrated in front line positions. Those oblivious to danger may exhibit autism spectrum disorders or schizophrenic disorders. War both attracts unwell people and makes them unwell. This is an aspect, particularly of extended civil conflicts, that is often overlooked. It is a horror with which the international community needs to engage if it is to provide comprehensive and adequate support to the Ukrainian people.
Any views expressed herein are purely the private opinions of the author and should not be attributed to the Paladins Organisation or otherwise.