Olena Zelenska: War is harming global mental health — even for people living in safety

I have some photos on my phone. Young girls and boys - school graduates - are dancing a waltz down the middle of a wide city street at night. It's a lovely image — until you realise that these are young people who have just graduated from school in the Ukrainian city of Kharkiv. And that they are rehearsing the dances for their graduation party at five in the morning, seizing a rare moment of calm in-between the Russian shelling.

When the Russian bombers next take off, these students will be alerted via a special app on their phones, designed to give them a chance to reach shelters before the bombs start falling. Every Ukrainian has this app on their mobile now.

Here, the ever-present threat to life exists alongside the need to work, to graduate from school and to live. The awareness that you are a Russian target is a heavy burden to carry. And it is taking its toll on our people with surveys showing that almost 80% of Ukrainians are under constant stress and anxiety. Our society is suffering a great collective psychological trauma.

It is well known that there is a direct correlation between mental wellbeing and physical health. In times of war, this negative impact is felt particularly quickly and violently. In Ukraine, the number of patients with diabetes has increased by more than 20%, those with heart attacks by more than 16% and those with strokes by more than 10%. We expect a large number of neglected cancer cases, because of occupation, migration and, once again, stress, which paralyzes us and prevents us from taking action.

There is a growing body of evidence that suggests conflict-related mental health problems do not apply just to Ukrainians or other peoples impacted by conflict.

The Summit of First Ladies and Gentlemen aims to tackle the problems that affect all of our countries, so that we can use our influence to overcome them and help our people together. Psychological wellbeing is an issue of such importance that, at last year’s Summit, held in Kyiv, my colleagues and I chose to focus our work on the topic of mental health.

At the request of the Summit, Alligator Digital conducted a survey of more than 11,000 people and found that mental health is one of the top 5 global challenges. The survey also showed that conflict-related anxiety and fear are playing a growing role in this mental health crisis.

Moreover, people are as concerned about mental health as they are about poverty, the COVID-19 pandemic, climate change and rising prices. Those questioned also believe that mental health will remain among the top challenges for the next five, 10 and even 20 years.

A key takeaway from the survey is that even people in countries unaffected by military conflicts, ongoing or recent, still feel anxiety related to war and conflict.

In fact, 57% of individuals directly unaffected by world conflicts have experienced emotions that hinder their ability to cope with day-to-day activities. Sadly, it is our youngest people who see the most impact, with 13 to 15-year-olds most likely to feel affected by conflicts.

Conflict’s impact on mental health is like radiation. No borders or distances can protect against the "contamination of war" and the anxiety, uncertainty and phobias it sparks. If bombs fall anywhere in the world, no-one feels safe. In this sense, the world has proved to be more global on the issue of mental health than even economic crises - inflation does not spread as quickly as stress seeps across borders.

The question, then, is what can we do about it?

In Ukraine, our answer is the All-Ukrainian mental health program. We have called it: “How are you?” because that is the question we ask each other most often after Russian bombings. We want to hear the answer: “I'm alive”. But in the context of mental health, it is critical that we can go even further and be able to say: “I am holding on, I am in control, my nerves are fine”.

To this end, 100,000 of our family doctors have already been trained by the WHO, gaining skills in primary psychological assistance. Now they can help people who come to them with anxiety, insomnia and fears - the most common complaints of today's patients in Ukraine. It goes beyond medical practitioners though - everyone who works directly with people, be it bank employee or transport workers, undergoes the same training. So if a person unexpectedly starts crying at a reception desk or in a train carriage, there are people nearby who can find the right words to help them.

The programme also promotes and teaches self-help. Gone are the times, living under the Soviets, when we were expected to suppress our feelings, to “just grit our teeth” or “pull ourselves together”. Today, we prove to people that talking about, analyzing and treating one's mental state and feelings is not a weakness. It is a responsible and mature act of self care.Ukrainian resilience is often admired, but if we think about the definition of the word resilience - the ability to withstand and recover from external stress - we see that it is also synonymous with mental health. A resilient society is also therefore a mentally healthy society.

When it comes to tackling the global fear and anxiety surrounding conflict, these lessons from Ukraine — focusing on mental health training and expertise, and combating mental health stigma — can be employed wherever people are suffering. Ukraine’s All-Ukrainian mental health program is a global example of addressing war-related mental health problems, be they caused directly or indirectly.

But there is another way to ease this global mental health crisis - to prevent wars ever beginning. We must stop aggressors and aggression from the very outset. This means not allowing brute force to "infect" the world with the idea that it can serve as a final argument.

The impunity of evil, as well as setting a bad example to other potential attackers, creates insecurity and frustration in societies. It creates a lack of confidence in one's own principles, in governments and in states.

This mental "radiation" of conflict-related anxiety requires an immense amount of effort to tackle and time to diffuse. The most effective way to address it is to reduce its primary source - wars and conflict.

A just end to the war and a punishment of the aggressor is therefore necessary not only for Ukraine, it is vital for the mental and value-based wellbeing of the entire world, for every single person on our planet.