Trauma expertise desperately needed

15 April 2022

Iryna Frankova is the chair of the ECNP Traumatic Stress Network. Temporarily on leave from Bogomets National Medical University in Kyiv she is currently living in the Netherlands. Here she speaks to ECNP press officer Tom Parkhill about the situation in Ukraine.

TP: Thanks for taking the time to talk to me. Where are you now?
IF: I’m in Utrecht, but I work in Amsterdam. My daughter and I came here around a month ago, and I’m staying with a friend until we find somewhere to stay long term. My husband is still in Ukraine; like millions of husbands who have had to stay because of mobilisation, he doesn’t know when he will be needed. I left Ukraine in mid-March, about a month ago, and I started working in Amsterdam just a week ago.

What does your husband do?
He works in agriculture, in logistics. He’s in charge of importing seeds from Germany. These crops are mostly sold back to Europe. Maybe you have seen that there are shortages of some products, certainly we see that here in the Netherlands. It’s getting difficult to get things like sunflower oil or flour. Ukraine exports supply around 80% of Europe’s sunflower oil. We were based in Kyiv. I worked in the Medical University in Kyiv.

What brought you to Amsterdam?
I’m an assistant professor in the Department of Clinical Psychology at Vrije University in Amsterdam. A close colleague of mine, Marit Sijbrandij, is a professor in the department. We have close professional links, we are part of an international group of experts working with trauma. I met Professor Sijbrandij around four years ago at an advanced research workshop in Odesa, organised by the chairs of ECNP Traumatic Stress Network Joseph Zohar from Israel and Eric Vermetten from the Netherlands. This workshop was part of the NATO Science for Peace programme.

And of course you have a position within the ECNP.
Yes, for the last year I’ve been chair of the ECNP Traumatic Stress Network.

What’s the situation in Ukraine?
The major challenge is that the services and systems which existed in Ukraine are either broken or just don’t exist anymore. In the current chaos it would take a huge effort to rebuild these systems – I’m talking about both mental health services and social support services. It’s especially difficult when we consider areas close to the border with Russia or occupied territories. We have no access to these areas, we can’t even deliver medication safely to mental health hospitals where there are no “Green Corridors,” for example. So there are different challenges in different locations. It all depends on geography; if you are closer to the Russian border, you suffer more from these broken health care systems. In western areas it’s different. They are overwhelmed by the number of people. Millions of people, perhaps six or seven million people are internally displaced within Ukraine. We lack professional mental health care workers; we lack psychologists and psychiatrists.

I guess in the occupied areas you don’t have much indication of what’s happening?
It’s painful when you know of people who need mental health help, but you can’t even organise the basics for them, even basic safety.

What can be done? What can organisations like the ECNP do?
The ECNP is a professional organisation, with great expertise. The scale of the problem is huge, so our mental health community is asking for additional training on how to provide aid to those who are under acute stress, rather than after exposure to traumatic experiences. We lack mental health professionals to deal with the numbers of those in need and the breakdown of the infrastructure. Yes, we need training, but this needs to be delivered in the Ukrainian language. There’s a real language barrier. Within the ECNP Traumatic Stress Network we are trying to organise relevant activities, such as ‘Hot topics‘ virtual meetings, where we invite international experts. At the moment we are working not only with leading researchers, but also with clinicians; for example, on clinical cases from Ukraine with international experts providing opinions. But we still have to find how we can deliver this expertise in the local language. And of course we need to understand how we can take existing interventions and services and deliver them to refugees in Ukraine and different European countries. We need to understand how we can adjust these services to the reality of war. So right now we are working to try to adapt existing best practices to the war.

This is what Tomasz Gondek said to me when I spoke to him in Poland last week. He has of course a very different situation. He’s based in Wrocław. He has an existing infrastructure, but he still says it’s impossible to treat these numbers of refugees in any depth. He said you need fast treatment but good guidance, and so training is important, even in Poland.
It’s interesting you say “even”. Maybe that’s the wrong word. Let me tell you a little of the background. Ukraine has effectively been at war for eight years, and to some extent we have been preparing for the worst. Here in Ukraine we’ve already had some good training in traumatic stress. Seven or eight years ago, when the war first flared up, I was already looking for opportunities to train in traumatic stress – I could see the need. I found this opportunity via an ECNP Research Internship for young scientists, and I went to Israel to Professor Zohar’s laboratory. And I wasn’t alone: within Ukraine a lot of people were looking to train in traumatic stress. But Poland didn’t do this. Neither did any other European country, so generally Europe is less well trained in dealing with trauma than Ukraine. So yes, European countries do need training as well.

Note: The UNHCR (the United Nations Refugee Agency) estimates that a quarter of the population of Ukraine has had to leave their home because of the war. It estimates that 4.6million people have left Ukraine, with 7.1 million internally displaced (13 April). See here

Information on the ECNP Traumatic Stress Network activities can be found on this page.