The Economist - UK (2022-04-30)

The Economist April 30th 2022 Europe 29

clare success by May 9th,whenRussiacel­
ebrates  Victory  Day, marking theSoviet
Union’s defeat of NaziGermany.
It may want to go further.RustamMin­
nekayev,  deputy  commander ofRussia’s
central  military  district,recentlysaidthe
aim is to take controlofallofsouthernUk­
raine.  If  so,  Russia  stillintendstoseizea
western land corridortolinkCrimeatothe
enclave  of  Transnistria,a Russian­backed
separatist region of Moldova,onUkraine’s
western  border.  Thisseemsa muchtaller
order,  requiring  Russiato takeMykolaiv
and  Odessa,  where Ukrainian defences
have been strengthened.
That  said,  mysterious bombings in
Transnistria,  held  bysome1,500Russian
soldiers, have causedjitters.Localauthori­
ties  said  two  antennaebroadcastingRus­
sian  radio  were  blownuponApril26th,a
day after an attack ontheregion’sstatese­
curity ministry. The pro­euMoldovangov­
ernment suspects thesearefalse­flaginci­
dents staged by Russiatodestabiliseit.In
southern  Russia,  meanwhile,Ukrainehas
made  little  effort  todisguise itsrole in
“payback”  attacks  againstfuel­andweap­
ons­storage facilities—amoveendorsedby
a British junior defenceminister.
For  all  the  talk  ofwinning,theWest’s
aims are unclear. Ms Trussspeaksof“going
further and faster to pushRussiaoutofthe
whole of Ukraine”. MrBlinkenismorecau­
tious.  He  has  spoken oftheneed for a
ceasefire,  and  has  saidthat“theend­state
should be determinedbytheUkrainiansas
a sovereign, independentcountry.”
The unSecretary­General,AntónioGu­
terres, visiting Kyiv aftergoingtoMoscow
on  April  25th,  tweeted:“The soonerthis
war  ends,  the  better—forthesakeofUk­
raine,  Russia,  and  theworld.”Hisspokes­
man said Russia had agreedinprincipleto
let the unhelp evacuateciviliansfromMa­
riupol.  But  his  effortshaveangered Uk­
raine, which says he shouldhavegonefirst
to  Kyiv  to  see  evidenceofRussia’satroc­
ities. For its part, Russiaistryingtodivide
the European allies througha combination
of threats, such as warningof thedangerof
a nuclear exchange, andapplyingeconom­
ic  pressure  by  cuttingoffgassuppliesto
Poland and Bulgaria onApril27th.
Many experts nowseeparallelswiththe
“winter  war”  of  1939­40, when Finland
fought off the Soviet Unionformonthsbut
was ultimately forcedtocedeterritoryand
for  decades  afterwardshadtomaintaina
precarious  neutrality.“Iusedtothinkthe
winter war was the bestthatUkrainecould
achieve. I now think it’sthebestRussiacan
achieve,”  says  Dan  Friedof theAtlantic
Council, a think­tankinWashington.“An­
other scenario is possible:thedefeatofIm­
perial  Russia  by  theJapanesein1905.”If
there is a partition, heargues,it isunlikely
to  be  a  stable  peace  but,moreprobably,a
dangerous armed truce.n

UkrainianrefugeesinPoland

The wreckage

within

Y

ulia malinovskalooks fromawin­

dowina Warsawofficebuildingwhere

400 Ukrainianwomenandchildrenarebe­

ingputup.Asa planecrossestheskyshe

huddlesoverhereight­month­olddaugh­

ter.Hereyes,fixedonthedistance,turnto

tears. “Every planescares menow,” she

sobs.Sheissafe,afterescapingfroma dis­

trictofKyivthatwashitbyRussianplanes,

buthermindisstillinturmoil.“Themo­

mentyouacceptyourowndeath,some­

thinginyouchanges.”

Morethan5mpeoplehavefledtheRus­

sianinvasion,andmanyhavecarriedwith

themtraumaandloss.Thathasbeencom­

poundedbytheeconomicstressofliving

abroad,andbyfamilyseparation—Ukrai­

nianmenaged18­60muststayandhelp

defendtheircountry.TheWorldHealthOr­

ganisation(who) estimatedinMarchthat

atleasthalfa millionrefugeesweresuffer­

ingfrommental­healthissues.That has

overwhelmedthealreadyinadequatemen­

tal­healthinfrastructureoftheir eastern

Europeanhosts.

AgnieszkaSiwinska,whoheadsa clinic

inWarsaw,saysthatshehasseenaninflux

of 150 new patients, roughly a 25%in­

crease.Sheenlistedpsychologystudents

whospeakUkrainianorRussianto help

putthenewcomersatease.Shehasalso

distributeddozensof“sensorybackpacks”

withtoysforshell­shockedchildren.The

next challenge is to find specialists for

long­termtreatment.Psychologicaltrau­

ma  specialists  are  so  rare  in  Poland  that

one flew in from Britain to help out.

The  problems  are  a  result  of  a  long­

standing neglect of mental health in east­

ern  Europe.  Poland,  the  main  destination

for refugees and home to more than half of

them,  had  a  third  the  number  of  psychia­

trists per person as Germany at the time of

a comparison in 2016. The country spends

only  3.4%  of  its  health  budget  on  mental

health,  the  lowest  level  in  the  euapart

from  Bulgaria.  It  takes  on  average  three

months  to  get  a  psychiatric  appointment

in next­door Slovakia. 

To  plug  the  gaps,  the  euhas  suggested

that countries recognise the qualifications

of  Ukrainian  professionals  to  allow  them

to  work  with  local  services.  It  has  also

pledged  €9m  ($9.5m)  in  funding  for  ngos

that provide psychological relief. Gabriella

Brent of Amna, a humanitarian group, says

that  much  of  “psychological  first  aid”

comes down to harm reduction, and can be

provided  by  trained  volunteers.  Under­

standing  the  patients’  language  and  con­

text can render them more effective as ini­

tial responders than foreign professionals. 

If  the  acute  phase  of  the  conflict  sub­

sides and people start to return home, the

need for psychiatric support in Ukraine is

likely  to  grow  substantially.  As  other  con­

flicts have shown, a drawn­out war of attri­

tion could pile on mental casualties. Syria

Relief,  a  charity,  estimated  last  year  that

three­quarters of Syrian refugees in Turkey

and  Lebanon  may  have  had  serious  men­

tal­health symptoms. Ukraine already had

the  world’s  highest  prevalence  of  depres­

sion, at 6.3% of the population, according

to a 2017 whostudy. 

Since that report, Ukraine has made im­

provements. Just as it has trained its mili­

tary  muscles  by  fighting  Russian­backed

separatists in its east since 2014, it has de­

veloped its mental­health response, by ca­

tering to the needs of combatants and vet­

erans. Marta Pyvovarenko is one of 40 psy­

chologists  and  psychiatrists  in  the  who’s

Mental Health Gap Action Programme who

since  2019  have  trained  more  than  3,000

doctors  in  Ukraine  to  offer  emergency

mental­health aid in conditions of war. 

Attitudes  are  changing.  A  tradition  of

tight­lipped  stoicism  is  easing,  as  people

learn to talk more openly about their pro­

blems.  Suspicion  of  psychiatry,  under­

standable given the old Soviet habit of de­

claring dissidents mentally ill and locking

them up, is easing too. Charities campaign

to  reduce  suicide,  which  is  worryingly

common.  The  government  wants  to  shift

from  an  archaic  system  of  providing  care

in  closed  facilities  towards  looking  after

people  at  home  and  trying  to  reintegrate

them  into  society.  All  this  will  help  Uk­

raine  cope  with  the  mental  scars  ofwar,

says  Ms  Pyvovarenko.  As  support  increas­

es, she says, “the stigma is decreasing.”n

WARSAW

Traumatised refugees need care that

their hosts are ill-equipped to provide

Safe only physically