Apr 6, 2022 7:00 AM

For Kids Fleeing Ukraine, Wartime Trauma May Leave Lasting Wounds

Volunteers are rushing to provide online counseling, art therapy, and stress relief for the more than 2 million Ukrainian children who have become refugees.

bloody heart looking at hand block rockets

On February 24, Maria Mazyra-Martos woke up to the sound of shelling as Russia launched its attack on Ukraine. She wasted no time. With a few packed clothes, medicine, and two cats in tow, the 41-year-old squeezed into a small car with her husband and three children and left Kyiv. But shortly after their arrival in Western Ukraine, air raid sirens sounded. They spent the first of many sleepless nights in the basement of a friend’s house, huddled with other displaced families.

The next day, the stress got worse. Her 13-year-old daughter, Maja, could hardly breathe; her legs were shaking and her heart racing. “There was a lot of noise and I began to feel that I can't overcome these feelings, that something will happen and I don't know what it would be,” Maja recalls. “When I tried to concentrate on breathing, I closed my eyes and saw explosions of bombs, so I couldn’t concentrate on breathing.”

It was a panic attack that lasted for more than an hour. “I really didn't know what to do because it was the first time that I had experienced something like this,” says her mother. Stretches and exercises, hugs, and a phone call with the girl’s godmother, a psychologist, provided some relief in the moment. “What helped me was that my psychologist said that this is normal,” says Maja.

Children’s lives are at the mercy of adults—who themselves struggle in times of war. Some 2 million children have fled Ukraine, most with their mothers and grandparents because men between the ages of 18 and 60 are not allowed to leave and could be drafted into the army. These children have had to leave behind not only fathers, but also friends, pets, and toys. They have had to move to basements and bomb shelters. They arrive exhausted after difficult journeys but are unable to sleep or eat. Some have emotional outbursts or talk of shame and survivors' guilt. Others are overly excited at one moment and then immediately withdraw because of stress and anxiety.

These are signs of trauma beginning to manifest itself. To help, volunteers and charities are rushing to offer online therapy or art and play activities to provide a bit of normality. They distribute toys at border crossings, and in Poland and Moldova troupes of professional clowns have been cheering up new arrivals.

It’s not an ideal situation for delivering therapy, says Azad Safarov, a journalist and cofounder of Voices of Children. The charity coordinates psychological care and drawing sessions in Ukrainian refugee centers and orphanages, helping displaced children use art and games as a way of dealing with the reality of war. Their art therapy programs were launched in 2015 in response to the conflict between the Ukrainian military and separatists in the Donetsk and Luhansk regions.

Normally, these programs last 10 weeks and are led by a psychologist. But in the first weeks of the current refugee crisis, Safarov says, it was difficult to provide continuous or individual therapy, as the children were often just passing through. Now that they are settling into centers in Central and Western Ukraine, art and counseling sessions take place weekly. “It doesn't mean that we will cure all the kids just by this, but it is a crucial step for stabilizing them, for making them calm down, for taking anxieties and stress from them,” says Safarov.

Where children used to draw parents, houses, and trees on white paper, they now draw bombs, tanks, and weapons. Safarov says that children draw what’s on their minds, even if they may not talk to their parents about it. For example, he says, while not all displaced children have experienced shelling, they may paint pictures about it based on what they have overheard from adults. “Kids stay near their parents and listen to what they talk about, all the time,” he says.

Another sign of trauma is if children are excessively preoccupied with death or mortality, says psychologist Maryna Nosyk, who volunteers at a crisis center in Lviv and offers online counseling to children in Ukraine. “If a child had a traumatizing experience, such as bombing or seeing someone being murdered, they can return to this topic with disturbing regularity,” she says. They may talk about death in morbid detail or develop an obsession with their own safety and the safety of those close to them.

Courtesy of Voices of Children

Nosyk previously worked with internally displaced families who fled the southeast after the Russia-backed separatists took control in 2014. Many of these families have had to give up their homes for the second time in the face of Russia’s full-scale invasion.

In her counseling sessions, Nosyk has not noticed an excessive focus on death or mortality, but she expects that to change as more children from war zones arrive in Lviv. “I would say that I see more behavioral problems, like aggression and emotional lability, and that group of symptoms is associated with depression,” she says.

Elizaveta Vlasyuk, a psychologist from Kyiv, witnessed similar behavior during a 60-hour journey to Prague. “I met so many children aged 3 to 12, dealt with them, and tried to calm them down,” she says. Vlasyuk now offers free online counseling to fellow refugees through the Czech Psychology Network for Global Changes and occasionally intervenes in person, as in an incident where a 4-year-old boy lashed out at an elderly woman who had welcomed him and his mother into her home.

Refugees who are repeatedly exposed to traumatic events in the context of war and displacement are likely to develop depression or stress and anxiety disorders. Unemployment, loneliness, and uncertainty about the asylum process in host countries can also explain why refugees who stay for long periods have poorer mental health than local populations. The World Health Organization’s representative in Poland, Paloma Cuchi, said on March 22 that about half a million of the arriving refugees need support for mental health disorders, and an estimated 30,000 of them have severe problems.

Children are especially vulnerable to the effects of trauma because their brains are still so malleable. Older children are more likely to understand what war means, but they may feel just as unable to relieve their distress. In 2016, clinical researchers surveyed 131 Syrian children in their first months in the US—after having spent two years in refugee camps. Half of them showed high anxiety, and almost 80 percent had separation anxiety; they were so scared that they could not leave their parents’ side. None of the girls met the criteria for post-traumatic stress disorder (PTSD), but 9.1 percent of the boys showed signs of the condition, in which people relive traumatic events through flashbacks and nightmares.

Courtesy of Voices of Children

Children often interpret dangers and experiences based on their mother's reaction to them, so it’s not surprising that these boys' mothers also screened positive for PTSD. Although the study sample was small, the findings were consistent with other surveys of refugee children resettled in Western countries.

Not all Ukrainian children who have experienced trauma will be predisposed to PTSD, says child psychologist Nosyk. Those who left home with both parents at the very beginning of the war and who can quickly get back into their social routine may not suffer long-lasting problems. “The situation would be very different for someone who survived the bombing and saw how people or one of her parents died,” she says. This kind of trauma requires intensive therapy—and relatives who are resilient, calm, and attentive to their needs.

Although Maria Mazyra-Martos’ family initially fled to Western Ukraine, as the fighting around the country’s main cities intensified, she had no choice but to cross into Poland with her two youngest children, leaving her husband and adult son behind. Her children don’t want to burden the Polish social service system, and they think others need psychological help more than they do, so they are using physical exercises to feel calm.

In her hometown of Kyiv, Mazyra-Martos runs a dance school for children and teaches body practices. Since her daughter's panic attack, the whole family has been practicing a Japanese movement technique called Noguchi Taiso for 40 minutes every day to release tension—and shake off fears. “It helps them a lot,” says Mazyra-Martos.

Although there are hundreds of kilometers between Krakow and Kyiv, her family is reminded of the war every day—by the sounds of planes and emergency vehicles and by news on social media or from friends and family who stayed behind. “My children have grown a lot during this month of war,” she says. “Even though I can't manage the whole situation, I feel responsible for my children having to go through this. So I try to do my best to make it less difficult somehow.”