Internal Displacement and Mental Health in Ukraine
In February, PaCCS Communications Officer Kate McNeil sat down with Dr Irina Kuznetsova of the University of Birmingham to discuss her work on mental health and internally displaced persons in Ukraine. Dr Kuznetsova’s work on internally displaced persons in Ukraine began with a project which was funded in part through a PaCCS grant on interdisciplinary conflict research.
Kate McNeil: Thank you for taking the time to chat with me today. Would you mind getting started by telling me a little bit about your PaCCS project?
Dr Kuznetsova: With the support of the research councils and a PaCCS grant, my team’s work has explored the social effects of population displacement for those displaced by the ongoing conflict in Ukraine. With as many as 1.5 million people thought to be internally displaced as result of the conflict in Eastern Ukraine and the annexation of Crimea, Ukraine is thought to have the largest number of internally displaced persons (IDPs) in Europe. When the conflict started, I studied what happened with the over a million of refugees from Ukraine in Russia. I recently published an article which explores policies from 2014 till 2019. As most of the displaced moved to the government-controlled areas of Ukraine, I was interested in learning about the experiences and lives of those who have experienced displacement in this context.
My work with these IDPs focused on the urgent problems they face in everyday life. Through extensive fieldwork, we were able to examine challenges faced by Ukrainian IDPs ranging from jobs and property rights, to pensions, housing and healthcare. I think that knowing more about these experiences is vital because, in my mind, meaningful reconciliation and reconstruction cannot occur unless there is a clear understanding amongst local actors, including those in the policymaking community, of the problems faced by those displaced by the conflict.
What did this fieldwork entail?
I am grateful for Professor Oksana Mikheieva from the Ukrainian Catholic University, Dr Svitlana Babenko from Taras Schevchenko National University and Dr Mariia Kolokolova from Karazin Kharkiv National University because my research would not be possible without their expertise and collaboration. We interviewed displaced persons, as well as well as speaking with people from a range of organisations working in the region, from those who work or volunteer for local NGOs, to staff working with international organisations that operate in Ukraine. Throughout our fieldwork, we aimed to examine peoples’ practices, and to take an intersectional approach to understanding how people experience displacement. As the study unfolded, we became particularly interested in how elderly people and people with disabilities experience displacement, so we did some work on that as well.
How did you end up doing this follow-up work which specifically zooms in on the state of mental health amongst IDPs?
As we put together our findings from the main research project, we realized that a lot of the people we interviewed had spoken about the psychological trauma they experienced as a consequence of being witnessing violence, including witnessing violence against loved ones, and they stress they experienced because of the displacement itself and the difficult living conditions they were experiencing. And, while we knew that there had been research done on mental health of IDPs in this region more broadly, there was a gap in the literature when it came to understanding cultural and social aspects of coping tactics in relation to mental health in Ukraine. It wasn’t clear how, or whether, the mental health of IDPs in Ukraine might differ from the mental health of the general population.
We were then lucky enough to receive additional funding and institutional support from the Wellcome Trust’s Institutional Strategic Support Fund to be able to conduct two surveys designed to help us fill that gap in our understanding. The surveys – one survey was designed for IDPs and the other was designed for the general population – explored the levels of anxiety and depression in the population, as well as asking questions about accessible mental health support. To compliment the surveys, we also conducted interviews which explored local ways of coping and mapped out what forms of mental healthcare were available and how much people were using them.
What did you learn?
We learned that there is a higher rate of depression and anxiety amongst IDPs in the population. Our key finding was that 20% of IDPs and 12% of the general population have moderately severe or severe anxiety, and that 25% of IDPs have moderately severe or severe depression, compared to 14% of the general population.
We also learned that there are significant barriers to accessing mental health services, both for IDPs and the population at large. Mental health issues are very stigmatized in Ukraine, and the Soviet-era image of those who suffer from mental illness is still part of the cultural consciousness, including the memory of Soviet-era mental institutions. So, there’s no robust culture of mental health support, and there are particularly significant barriers to support for elderly IDPs.
You recently released a briefing note which discussed some of your findings and recommendations for policymakers concerning mental health in Ukraine. Would you like to tell me a bit more about how policymakers can help?
First of all, we need to improve the accessibility of mental health services, especially for internally displaced persons. We also need to change the culture surrounding mental health – it shouldn’t be seen as something that is provided solely by a specific set of medical practitioners. Rather, mental health should be embedded in various facets of communities – through amenities, work, and activities. We also need to do more to encourage people to talk about mental health, and to connect mental health to the practices which people enjoy doing, from walking and gardening to going to church. Those making health policy also need to ensure that age and gender are taken into account in the development of specific approaches to supporting mental health, and they must lead the way in shifting the cultural attitude surrounding mental health issues. And it is crucial to reduce stigma surrounding mental health.
From a systems perspective, more also needs to be done to regulate mental health care. There is a need to strengthen a licensing system for those practicing psychology and psychiatry, and to strengthen the links between different actors in this space – including family doctors and those working in relevant NGOs. My research group has also conducted research on family doctors’ opinions about and experiences of mental health, and we know that general practitioners need more support and more information about these issues – particularly with respect to the unique challenges posed by those experiencing poor mental health who have also experienced displacement and war.
How have you been working to ensure that your findings reach those who might have the power to implement change?
Over the course of work in Ukraine, we’ve sought to disseminate our research findings in Ukraine and throughout the rest of Europe – including in Brussels and here in the UK. We’ve also spoken to members of the international community, such as UNHRC and IOM. There’s been a particular focus in our approach on sparking conversation about the mental health needs of Ukrainian IDPs, and the needs of elderly people who face many barriers, including poor living conditions and difficulty receiving their pensions.
As part of communicating our findings, we’ve published a number of policy briefings, available on our project’s website. This has included recommendations concerning how to best support IDPs that have been directed at actors including Ukrainian government ministries, international donors, and Ukrainian municipalities. We’ve also disseminated findings by hosting roundtables with groups such as international organisations and mental health experts, while ensuring that our findings are available in both Ukrainian and in English.
It’s very difficult to talk about the impact of my work on a big scale, however, because what matters here isn’t the work done by one single researcher or any one organisation. What will matter in the management of this crisis is how humanitarian groups, consisting of many organisations and experts working in coordination, are able to lobby for change and provide information collected by researchers to institutions.
Where will you take this project from here?
I’m now leading a research project which looks at mental health in the context of other displaced populations who have experienced conflict. We’re doing fieldwork in Rwanda and Nigeria, looking at the health of refugees and IDPs in developing contexts. We’re already realizing that the situation there is very different than the one in Ukraine, both in terms of the availability of services, and in terms of how living conditions affect the situation.
Dr Kuznetsova was the recipient of a GCRF / PaCCS Interdisciplinary Innovation Award on Conflict and International Development funded by AHRC and the ESRC. She has previously written for PaCCS about her work on art and geopolitics in a fractured Eastern Ukraine. This post is part of our Spotlight on Conflict Research Series, which will be running on Tuesdays throughout the month of March.
Photo Credit:This piece of art was created by Dana Rvana, and was shared under a creative commons licence by UN Women Europe and Central Asia. It was shared as part of a project called “Left Behind No More: Illustrations from Ukraine”, which highlighted the struggles, including employment, mental health, and housing challenges, faced by women who are internally displaced in Ukraine. You can view the source of the art here: https://flic.kr/p/QRrbBv, and can learn more about that UN project here: unwo.men/GlGw50kIFuH.