As Russian advances in Ukraine grow ever more ferocious in these days, amid hundreds of dead and wounded, the psychological pressure and morale of the Ukrainian population is experiencing one of its most difficult and gruelling moments in the past eight years.

Moving away from the centre of Kyiv, it becomes difficult to find one's bearings beyond the countless buildings that line the way. Their functionalist style fits into a uniform architectural language that unfolds block after block, broken only by roads and mounds of snow. Continuing this journey back in time, the apartment buildings give way to a silent, grey forest that conceals within it the Lisova poliana veterans hospital.

The story of Ukraine's first mental rehabilitation centre for veterans began in late 2019, thanks to the vision of neurologist Kseniia Voznytsina and a team of psychologists, doctors and lawyers who believed in the potential of this vast grey complex, with its communal spaces, recreational facilities and pleasant natural surroundings on all sides.

The psychological consequences of war on soldiers

In this organically isolated and sheltered environment, veterans live through their stay by taking part in individual and group therapy sessions and receiving legal assistance to ensure they receive what they are owed by the government in terms of financial support and official recognition of their condition.

According to the centre's staff, there have been many cases in which military doctors failed to recognise the emotional burden weighing on the lives of soldiers who, after spending several days shaking, struggling with and fighting off bouts of nausea, and barely sleeping, were sent back to the front with no acknowledgement of the seriousness of their condition. Through the main entrance, one enters a large common room with games tables, billiard tables and chess boards.

This enormous space is interrupted only by staircases and corridors that, as in an Escher painting, create cyclical movements within the building, where the brisk pace of white-coated staff alternates with the slow, uncertain gait of the patients. Dr Kseniia Voznitsyna is a determined and sunny woman; she tidies her hair as she picks up a copy of her book Le ferite invisibili from her desk.

"Unfortunately, in our society, the issue of mental health remains something that is not spoken about openly. And the veteran community is no exception in this regard. Our goal is to develop a clear mechanism for providing psychological support to all military personnel and volunteers who have returned from the war, and to introduce and create common standards and methods."

Her work tells the story of a conflict that for eight years has tried to conceal its hardest wounds to heal — those of the mind. Thousands of veterans are unable to readjust to civilian life; many sink into alcoholism, others take their own lives without ever having known that help exists for their condition. Voznitsyna runs the facility through a strict policy banning alcohol and smoking, alongside a packed schedule of appointments. She has worked with soldiers returning from the front lines since 2014, and it was not difficult for her to anticipate the problems caused by overexposure to gunfire, heavy artillery and the fear of never making it home.

"In 2014–2016, we had many traumas related to brain injuries, but there were no programmes or methodologies to tell us how to work to mitigate these symptoms and how to treat these people," she says, with a sorrow that seems to want to conceal the Ukrainian government's responsibility in mishandling this issue. "The main problems concern traumas such as PTSD (post-traumatic stress disorder), TBI (traumatic brain injury), but also anxiety, panic attacks and sleep-related problems."

The emotional wounds

It is important to recall, moreover, that this is not the first time Ukraine has grappled with post-traumatic stress disorder — a condition that literally broke an entire generation of Ukrainian veterans who had fought in the Soviet-Afghan war between 1979 and 1989. The stigma of potentially "falling apart" after the war and becoming a criminal, a killer or a homeless person is a memory still very much alive in a country that lives in denial of the need for neurological and psychological support. From initial research carried out at the Lisova poliana veterans hospital on nearly 1,500 veterans at the centre, over 56 per cent had sustained a traumatic brain injury. In many cases we are talking about volunteers who formed the first battalions in 2018, when around 80,000 explosions were recorded across the Luhansk and Donetsk regions. This helps us understand that, even though symptoms may overlap in many cases, concussion following traumatic brain injury remains the most prevalent issue.

PTSD, on the other hand, manifests in more insidious ways. The intrusive symptoms associated with the traumatic event can take the form of recurrent, involuntary and intrusive memories, or recurring nightmares in which the content and the emotions of the dream are somehow connected to the traumatic event. In most cases, behaviours are enacted that aim to avoid any stimulus associated with the traumatic event, such as places, conversations and objects. In some cases there is a genuine form of post-traumatic amnesia, compounded by feelings of guilt, shame, anger, fear and depression. Some veterans also suffer from concentration difficulties and hypervigilant behaviour, problems with impulse control, irritability and angry outbursts.

What Ukrainian soldiers feel

Among the activities offered by the hospital are art therapy workshops, sport, physiotherapy and the use of pet therapy as a facilitator of the process of coming to terms with one's condition. Kostantin hangs back while the other residents gather in a circle around a game of billiards that seems to carry the weight of a world championship. Today he is 26 years old; he went to fight in 2014 when he was 19. Kostantin is originally from the Donetsk region and enlisted in one of the many volunteer groups that at the time were fighting alongside the regular forces, which were unable to bear the burden of the war effort alone.

I had no training at all — we had to learn fast or die

"I had no training, we had to learn fast or die." In 2018 he was struck on the head by a metal fragment, sustaining a wound that left him with physical and psychological consequences. Like most of the patients at the centre, he too is reluctant to talk, carrying with him, alongside the pain, a kind of personal defeat tied to the sense of disorientation he lives with.

His roommate is at least thirty years his senior; he sneaks a cigarette on the balcony while joking about the surroundings: "It's all white and covered in snow, we could be anywhere, couldn't we?" It was 2019 when the shockwave from an explosion left him temporarily deaf; he was very frightened, but after a few sleepless days he was back on the battlefield, like everyone else. The statistics count him among the many veterans in whom symptoms surface years after the trauma, bringing on a sudden breakdown that can prove terrifying in the absence of any awareness of what is happening. "An active, successful and healthy veteran is the key to our country's national security," stressed Yuliia Laputina, Ukraine's Minister of Veterans' Affairs.

The situation was further exacerbated by the pandemic, during which many soldiers found themselves forced to confront their own inner world, face to face with a hidden pain that was difficult to accept. With the hope that the conflict will end as soon as possible, we can only imagine the psychological toll that Ukraine will have to bear in the years ahead — invisible wounds of a war that many find impossible to justify.