The Ukraine refugee crisis: the view from Poland

4 April 2022

On 3 April the United Nations High Commissioner for Refugees (UNHCR) reported that around 4.2 million refugees have left Ukraine. 2.4 million of these refugees have arrived in Poland.
Also last week the WHO reported that, in Poland, half a million refugees need mental health support, and 30,000 have severe mental health conditions. The situation inside Ukraine itself is more difficult to assess; the International Organisation for Migration estimated on 21 March that 6.5 million people are displaced within Ukraine.

Tomasz Gondek works as a psychiatrist in Wrocław, in the south-west of Poland. Although Wrocław is over 500km from the border with Ukraine, it has received a significant number of Ukrainian Refugees. Here he speaks to Tom Parkhill.

Tomasz, what’s your background?
I’m a general psychiatrist, I work in my own practice, and I carry out some research. Mostly though I’m focused on my clinical practice.

Tell me about the situation. What are you seeing yourself and what people are telling you?
It’s a very difficult situation. Many people have had to leave their homes in Ukraine, but we, and they, can see what is happening live. They can watch videos and see images of the fighting, and of the extent of the destruction in Ukraine. They can see that their homes are being destroyed, effectively in real time. It’s a very difficult situation to cope with, fleeing from war and yet living it through the news.

From my own perspective, I work with refugees. We’re psychiatrists, and we believe it’s our duty to treat refugees. We provide additional time for consultations, we work at the weekends, we work free of charge of course. We are finding a lot of PTSD and adjustment disorders, and plenty of anxiety disorders. And of course there are also people who have been already treated for various mental disorders in their home cities in Ukraine. Of course we have to continue the treatment, but that gives us some difficulties because we don’t have all the medications which were available in Ukraine. This means that we have to change some medications, which is not ideal, and there are hardly any recommendations on how to do this.

Most refugees are women: men of conscription age remain in Ukraine. And there are many children, so our child psychiatrists are struggling to help these children. We also need to consider the families of refugees. In recent years many Ukrainian families have settled in Poland; refugees with families already in Poland seem to cope better. From our point of view having a settled family makes the consultation easier, simply because the family member can translate what the refugee is saying. Many refugees do speak Polish or English, so we consult in these two languages. But we also see problems with these families, people who have been in Poland for a few years but who have left family and friends behind in Ukraine. They also suffer from adjustment disorders and anxiety. We’re seeing an increasing number of Ukrainian families in Poland who are seeking help for this.

So even though you are based in the south-west, and quite far from the border, you are seeing lots of refugees.
Yes, we’re seeing difficulties in the major Polish cities. Most refugees end up in the major cities, such as Warsaw, Krakòw, and Wrocław. I’ve checked the numbers for Wrocław, the city I live in. The authorities say that around 250,000 refugees have arrived from Ukraine in the last month. There are around 640,000 people normally in Wrocław, so that means that we’ve had an influx equivalent to just under 40% of the normal population. Of course, some have now been relocated to smaller towns; some have moved abroad, but the majority of people have remained here, so it’s a huge challenge for the whole system in Poland.

So how are they being accommodated?
Since the beginning of the crisis, society in Poland seems to have mobilised, and people are mostly hosting refugees in their own homes, as if they were hosting their own families. It’s incredible: the amount of support people have shown to Ukrainians has been really great. We have the capacity to accommodate many people, but this would not be enough if it weren’t for ordinary people offering beds in their own homes. Probably the majority of refugees are staying with Polish families.

And of course, the numbers and the overwhelming of structures probably means that mental health problems are very difficult to diagnose?
Yes, the main problem is the shortage of mental health personnel. Even before the outbreak of the war there was a shortage of clinical staff in mental health, but right now we really lack appropriate numbers of psychiatrists and specialist nurses. Just now we have tens of thousands of people just in Wrocław who need psychiatric care. It’s a huge workload, and of course at the same time we need to continue with caring for our local patients.

I presume there are shortages of beds, medication, etc?
Yes. Fortunately just now in Poland there is a shift from institutionalised care to more open, community-based care. So there is a provision for patient care, but of course some people are in severe need, and need to be admitted to hospital. It’s a problem.

And medications?
Fortunately the Polish state is providing the same access to care as it provides for Polish citizens. So they have the same access to medication, and they can have costs reimbursed. The problem as I mentioned is often in the availability for the medications. Some are just not available in Poland, which means that we have to change the treatment according to what is available.

What’s needed?
The number of mental health personnel needs to rise, but this cannot happen overnight. Staff need to be trained, which can easily take a couple of years. There are some controversies over how this might be done, especially how we maintain quality when trying to increase the quantity. There’s a lot of discussion on this. This has also been an issue during the Covid-19 pandemic. Our research assessing the well-being and knowledge of psychiatrists during the pandemic found that the most important factors were additional courses and education opportunities. This gave the clinicians more confidence in how to proceed, for example, with mental health comorbidities, but also we found that specific recommendations on how to proceed – such as guidelines, for example – these really helped. Here in Poland we don’t have much experience in treating war trauma, so we need to learn how to manage these problems. Any additional course, even online course, will be really helpful. We need to learn, and quickly.