Her hand trembled as she covered her mouth, a woman looked toward a large hole in the side of one of the tall towers, and the contents of the apartments exploded from her side.
Standing next to her was Ivanka Davydenko, 29, in a blue uniform with “Psychologist” written in yellow on either side, her arm placed gently across the woman’s back.
I gave her a paper cup of water and asked how she could help. She explained that the woman’s son lived on the 18th floor of the building, and was not answering his phone. Most of this floor is gone.
“We help people because they are in shock and don’t always understand what they need at the moment,” said Ms. Davydenko. “We provide normal things: water, coffee, a blanket.”
Ms. Davydenko is a member of a small team within Ukraine’s State Emergency Services, providing psychological first aid in moments of crisis in the capital, Kyiv. It arrived minutes after a Russian attack, early on the morning of June 24, as Ukrainian air defenses destroyed the incoming missiles, causing shrapnel to crash into the apartments.
Russia’s attacks on Ukraine have forced its emergency crews to grapple not only with fire, smoke, and blood, but also with the psychological spillover effects felt by people suffering from the war. Public health experts warn that millions of Ukrainians may develop a mental health condition because of the invasion, and that the number will only increase as the days of bombing, violence and grief continue.
So emergency crews in Ukraine include not only firefighters, paramedics and police officers, but also psychologists, including Ms. Davydenko, to help people dealing with the immediate effects of trauma or other acute mental health care needs.
There are similar efforts in other cities, but with Russian missiles continuing to rain terror on the capital, the Kiev team is perhaps the busiest.
“Before, we responded to serious and large-scale emergencies, such as a gas explosion and where many people needed to be evacuated,” said Lyubov Kernos, director of the Kiev unit. “When the war began, we were on duty all the time, never leaving the city.”
Like other emergency workers, psychologists are on guard. When an attack occurs, the Coordination Center sends a team that races to the site.
There, psychologists often find people crying, frozen in shock, or breaking down.
“When we meet someone for the first time, we ask, ‘What do you need right now?'” Mrs. Kernos said, “How are you now?” Some people simply ask psychologists to stay close for a while. “Maybe they were expecting their loved ones to be pulled out from under the rubble,” she said.
Such was the case on June 24 with the mother whom Mrs. Davydenko was supporting. The psychiatrist walked with her as she consulted a list of people who had been hospitalized or missing.
But as they were walking away, a firefighter said in a low voice that there was nothing left on the 18th floor, where her son lived.
The residents were asleep when the pre-dawn strike destroyed their buildings. The bodies of at least two victims were thrown from the building along with twisted metal, insulation, and fragments of furniture, and littered the parking lot below.
Dozens of people stood in shock, Ms. Davydenko said, including some who saw dead bodies and others who were injured but did not fully understand that they were bleeding.
Ms. Davydenko and another colleague on site will help about 45 people over the course of about 12 hours.
Still shaking with shock, Irina Coats, 62, went to Mrs. Davydenko with her daughter, asking for some water and a moment to talk.
Mrs. Coates described how it shook her out of her sleep in her nineteenth-floor flat, and then filled her room with smoke.
“We were just hugging,” she said, “and we thought we were going to suffocate.” They eventually made their way down the stairs, aided by police officers, but were distraughtly examining the ruins of their apartment building.
“We provide psychological first aid to people suffering from anxiety, stress, tearfulness and aggression,” explained Ms. Davydenko. “And then we work with the people who stay on the benches, on the patio, because it’s like the second emotional wave that hits.”
A young woman in a white T-shirt was caught wandering around the parking lot crying. The woman’s father, a resident, had survived the strike but refused to come out.
“Don’t worry, everything will be fine,” Mrs. Davydenko told her, holding her arm, adding that firefighters would help her father out. “But you can’t get in – nobody can.”
She waited until the father finally appeared, and the young woman, crying, threw her arms around his neck.
Not everyone will have such a happy reunion. Later in the day, Mrs. Davydenko accompanied the mother and her husband, who were looking for their son, to examine the badly mutilated remains of the corpse.
The psychiatrist explained that they were still waiting for official DNA confirmation, but the remains were most likely her son’s.
The next day, city officials confirmed that five people were killed in the raid.
Public health experts such as Dr Jarno Habicht, head of the World Health Organization’s office in Ukraine, have warned of the war’s long-term and widespread effects on mental health. In an interview, he said that an estimated 10 million people are likely to develop some form of mental health condition due to the Russian invasion.
He added that the WHO’s estimates, which are based on an analysis of how other conflicts affect mental health, will likely increase the longer the war drags on. Disorders caused by stress, including anxiety and depression, are among the experts’ main concerns.
The key to addressing mental health concerns in Ukraine, Dr Habicht said, is “not waiting for the war to end”.
A range of programs has sought to help Ukrainians, including one led by Olena Zelenska, the first lady, which aims to provide high-quality, affordable mental health services to people across the country.
Ukraine’s Ministry of Health, the World Health Organization and more than a dozen other partners have also initiated a program to train primary care physicians in how to treat patients with depression, anxiety, post-traumatic stress disorder, suicidal behavior and substance abuse.
But programs like Emergency Team of Psychologists try to provide early intervention in moments of crisis.
“If you don’t deal with stress right away, it can turn into long-term stress, which can turn into post-traumatic stress disorder,” said Ms. Kernos. “It’s meant to help bring back to people the idea of, ‘You were in danger, but now you’re safe.’ If we don’t do that right away, people might get stuck in this situation.”
However, the burden can also be heavy for those providing psychiatric care. Days after the missile attack on Kiev, Ms. Davydenko said team members were working with their therapists to process what they saw.
Of course, I am also a human being, she said.
Oleksandr ChupkoAnd Oleksandra Mikulyshin And Natalia Yermak Contribute to the preparation of reports.