As delivered by Ambassador Michael R. Carpenter
Vienna, November 8, 2023
Thank you to our panel of experts for sharing their insights with us today.
In a few days, it will once again be the 11th hour of the 11th day of the 11th month, when many of the countries that fought in World War One will pause to reflect on what is called Armistice Day, Remembrance Day, or Veterans Day. The unrelenting violence of that war caused many to suffer from what was then known as “shell shock.” Those who suffered from “shell shock” were often unfairly and tragically dismissed as weak; however, today it is well known that they were suffering from a genuine medical condition called post-traumatic stress disorder or PTSD.
As a result of Russia’s brutal assault against Ukraine, we again are bearing witness to a ground war featuring trench warfare and relentless artillery barrages that can overwhelm the limits of human resilience. While the physical wounds inflicted by Russia’s shells, bullets, landmines, and airstrikes can be treated with surgery and prosthetics, the invisible damage to mental health is more difficult to identify and treat, and it can persist indefinitely. Treatment is made even more complex as trauma affects men, women, boys, and girls in different ways, especially considering the sexual violence experienced by victims and survivors of all genders in this conflict. The effects of trauma are also cumulative, can compound over time if left untreated, and potentially can be passed from generation to generation.
In this war, Russia’s barbarity knows no limits, and its attacks have repeatedly hit civilians. Such attacks aim to demoralize, weaken, and permanently damage the social, psychological, and cultural structure of Ukraine’s society – to break the will of the Ukrainian people and subjugate them. Traumatizing the Ukrainian population is one of Russia’s objectives, not an unintended side-effect. From its arsenal of tactics, we have seen evidence of appalling patterns of abuses and atrocities, including war crimes and crimes against humanity, by members of Russia’s forces and other Russian officials, such as attacks against civilian infrastructure, rape, murder, torture, and the forcible transfer or deportation of Ukraine’s children.
Many soldiers receive some training to anticipate the violence of war, but civilians often do not, and children are the least prepared and the most vulnerable. An entire generation of Ukraine’s children has witnessed suffering and violence on an unimaginable scale, and many have experienced separation from loved ones, grief, and flight. While the immediate resilience of Ukraine’s people, including its children, remains remarkable, the mental health effects of exposure to such violence and inhumanity will be long-lasting. And the longer Russia continues its war of choice, the greater the threat to the overall mental health of the people of Ukraine. A significant and expected rise in post-war mental health conditions has the potential to hamper Ukraine’s recovery and reconstruction efforts severely.
Anticipating this, the United States is funding mental health and psychosocial support for both Ukraine’s veterans and civilians, including those who may be survivors of conflict-related sexual violence. Our assistance strengthens Ukraine’s healthcare system. It puts mental health tools into people’s hands with adapted web applications and hotlines. We are bringing Ukraine’s psychologists to the United States for exchange programs, during which they can visit our state-of-the-art Veterans Affairs polytrauma facilities. Furthermore, we are working to provide refugees from Ukraine and survivors of conflict-related sexual violence and other forms of gender-based violence with access to mental health and psychosocial support, no matter where they are. We also support the OSCE’s work to help provide psychosocial support through the Support Program for Ukraine. In the written version of my statement, I will provide specific examples of these efforts.
Chairs,
More than 100 years have passed since World War One ended, and treatments and therapies for PTSD have improved significantly since then as we learned from our panelists today. Nevertheless, we know that the only sure way to prevent conflict-induced mental trauma is to end the trauma of conflict itself. While we strive to provide the assistance and the technical know-how to help Ukraine treat its wounded, we cannot lose sight of the ultimate objective: a just and lasting peace that ends Russia’s aggression now and prevents it from ever happening again.
###
U.S. MENTAL HEALTH ASSISTANCE TO UKRAINE
Expanding access to mental health and psychosocial support services, both as part of the emergency response and through support to develop Ukrainian capacity and systems, is a key focus of current and planned U.S. health assistance to Ukraine. Examples of U.S. government-supported mental health lines of effort in Ukraine include:
U.S. Department of State:
● Support for mental health includes sponsoring a hotline through the Ukrainian Veterans Foundation (UVF) for veterans and their family members, the modernization of the Mental Adaptation and Rehabilitation Tools and Analysis (MARTA) platform of Ukraine’s Ministry of Veterans Affairs, and initiatives such as phone apps and “Resilience During War” trainings.
● Working with local Gender based Violence service providers in Ukraine to develop referral pathways and improve psychosocial support services available to survivors of conflict-related sexual violence and other forms of gender-based violence.
● Providing mental health and psychosocial support (MHPSS) for refugees from Ukraine in the neighboring countries, enhancing host countries’ capacity to provide MHPSS services in emergencies, training responders to provide psychological first aid and mental health services, and facilitating access to focused MHPSS and specialized services.
U.S. Agency for International Development (USAID):
● Expanding community-based mental health treatment services in eight oblasts, leveraging approaches that will help develop the foundation of a new comprehensive and more accessible system of care in Ukraine, while helping to strengthen human resource capacity.
● Providing mental health care via internet, phone, and social media to reach all parts of Ukraine, including those under Russian occupation, as well as refugees outside Ukraine.
● Supporting 15 humanitarian partners operating countrywide for the provision of humanitarian psychosocial support services and clinical mental health services for vulnerable, conflict-affected populations (including survivors of Gender Based Violence, children, those with disabilities/older people, as well as those injured by explosives/mines).
● Direct technical and financial support to the new national Mental Health Initiative spearheaded by the First Lady of Ukraine, including through support to the World Health Organization (WHO), to expand current services while strengthening Ukraine’s mental health system. USAID partners are providing communications support to the First Lady’s team and helping to develop the national mental health model and support the national coordination mechanism established by the First Lady. In addition, USAID will support analysis of international best practices as well as developments in the mental health sector in Ukraine over the past 5-7 years, analysis of trends in demand for mental health services, stakeholder mapping, and detailed analysis of the target audiences in order to deliver concrete recommendations for the development of the new National Mental Health Plan.
● Development of community-based mental health services for children which have historically been largely unavailable in Ukraine.
● Providing residents of consolidated territorial communities, particularly internally displaced persons (IDPs), women, children, veterans, and other vulnerable populations, with psychosocial support and mental health services to restore a war-affected person’s mental health and position as a functioning and contributing member of the family and community.
U.S. Center for Disease Control:
● Monitoring health conditions of Ukraine’s population, including refugees and IDPs, with a focus on COVID-19, HIV, tuberculosis, measles, polio, mental health, non-communicable diseases, nutrition, and maternal and child health.
● Collaborating with implementing partners to adapt and implement a previously developed emergency telehealth mental health platform to be supported by a cross-border referral network of mental health providers across countries hosting refugees from Ukraine.
U.S. Department of Defense (DoD):
● Prior to the February 2022 full-scale invasion by Russia, DoD provided the Ukrainian Armed Forces (UAF) with medical equipment, training, and advisory support, such as field hospitals, ambulances, Combat First Aid training, development of a Combat Medic program, advisory for the establishment of military rehabilitation centers and implementation of behavioral health clinical practice guidelines, advisory of the establishment of a Medical Command, and a Ministry of Defense Advisor for medical issues.
● Following the full-scale invasion, DoD has provided UAF with medical supplies for point of injury care, to include first aid kits, as well as a recent planned donation of 100 armored ambulances equipped and ready for patient transport.