With shaking hands as she covered her mouth, a woman gazed up at a gaping hole in the side of a skyscraper, the contents of the apartments spilling out of her side.
Standing next to her was Ivanka Davydenko, 29, dressed in a blue uniform with “Psychologist” inscribed in yellow on both sides, her arm placed gently on the woman’s back.
She handed him a paper cup filled with water and asked how she could help him. The woman’s son lived on the 18th floor of the building, she said, and he was not answering his phone. Most of this floor was gone.
“We help people because they are in shock and don’t always understand what they need at the moment,” Ms Davydenko said. “We offer mundane things: water, coffee, a blanket.”
Ms Davydenko is a member of a small team within the Ukrainian state emergency services, which provides psychological first aid in crises in the capital, Kyiv. It came minutes after a Russian attack in the early morning of June 24, in which Ukrainian air defenses destroyed incoming missiles, causing fragments to penetrate apartments.
Russia’s attacks on Ukraine have forced its emergency teams to deal not only with fire, smoke and blood, but also with the psychological effects felt by those at war. Public health experts warn that millions of Ukrainians are likely to develop mental health issues as a result of the invasion, and that number will only rise as days of bombardment, violence and grief continue.
So Ukraine’s emergency teams not only include firefighters, paramedics and police, but also psychologists, including Ms Davydenko, to help people dealing with the immediate effects of shock or other acute needs. in mental health care.
There are similar efforts in other cities, but with Russian missiles constantly raining horror on the capital, the Kyiv team is perhaps the busiest.
“Before, we responded to serious, large-scale emergencies, such as a gas explosion and where many people needed to be evacuated,” said Liubov Kirnos, head of the Kyiv unit. “When the war started, we were on duty all the time, we didn’t leave town.”
Like other first aiders, psychologists are on call. When an attack occurs, a coordination center sends a team running to the site.
There, psychologists often find people crying, frozen in shock, or breaking down.
“When we meet a person for the first time, we ask them, ‘What do you need right now? How are you feeling right now?'” Ms Kirnos said. Some people just ask psychologists to stay loved ones for a while.”They may be expecting their loved ones to be out of the rubble,” she said.
This was the case on June 24 with the mother supported by Ms. Davydenko. The psychologist accompanied her as she consulted a list of people taken to hospital or missing.
But as they walked away, a firefighter said in a low voice that there was nothing left on the 18th floor, where his son had lived.
The residents were sleeping when the strike ravaged their building before dawn. The bodies of at least two victims had been thrown out of the building along with twisted metal, insulation and furniture fragments, scattering in the parking lot below.
Dozens of people were in shock, Ms Davydenko said, some of whom had seen dead bodies and others who had been injured but did not fully realize they were bleeding.
Ms. Davydenko and another site colleague were helping about 45 people for about 12 hours.
Iryna Kuts, 62, went to Ms Davydenko with her daughter, still shaking with shock, asking for water and a moment to talk.
Ms Kuts described being shaken from sleep in her 19th floor flat and then her room filled with smoke.
“We were just hugging, thinking we were going to suffocate,” she said. They eventually made their way down the stairs, aided by police officers, but were staring at the ruins of their building in a stupor.
“We provide psychological first aid to people with anxiety, stress, crying, aggression,” Ms Davydenko explained. “Then we work with people who stay on the benches, in the yard, because it’s like a second emotional wave hits.”
A young woman in a white tank top who was wandering the parking lot sobbing was driven away. The woman’s father, a resident, had survived the strike but refused to come out.
“Don’t worry, everything will be fine,” Ms Davydenko told him, holding his arm, adding that the firefighters would help his father out. “But you can’t come in – no one can.”
She waited for the father to finally emerge, and the young woman threw her arms around his neck, crying.
Not everyone would have such a happy reunion. Later that day, Ms Davydenko accompanied the mother and her husband, who were looking for their son, to examine the badly mutilated remains of a body.
They were still awaiting official DNA confirmation, but the remains most likely belonged to her son, the psychologist explained.
The next day, city officials confirmed that five people had been killed in the strike.
Public health experts like Dr. Jarno Habicht, head of the World Health Organization’s office in Ukraine, have warned of the long-term and widespread effects of war on mental health. In an interview, he said that around 10 million people would most likely develop some form of mental illness as a result of the Russian invasion.
The WHO estimate, based on an analysis of how other conflicts have affected mental health, is likely to rise as the war drags on, he added. Stress-induced disorders, including anxiety and depression, are among the top concerns of experts.
The key to solving mental health problems in Ukraine, Dr Habicht said, “is not to wait until the war is over”.
A handful of programs have sought to help Ukrainians, including one led by Olena Zelenska, the first lady, which aims to provide people across the country with affordable, high-quality mental health services.
The Ukrainian Ministry of Health, WHO and more than a dozen other partners have also launched a training program for primary care physicians on how to treat patients with depression, anxiety, post-traumatic stress, suicidal behavior and substance abuse.
But programs like the Crisis Team of Psychologists try to provide early intervention in times of crisis.
“If you don’t deal with stress right away, it can turn into long-term stress, which can turn into PTSD,” Kirnos said. “It’s meant to help people understand that ‘you were in danger, but now you’re safe’. If we don’t do that right away, people could get stuck in that state.
Yet the burden can also be heavy for those providing psychological care. Days after the missile attack on kyiv, Ms Davydenko said team members were working with their own therapists to process what they saw.
“Of course,” she said, “I’m a human being too.”
Oleksandr Chubko, Oleksandra Mykolyshyn And Natalia Yermak contributed report.