War Leaves Unhealable Wounds. Treating PTSD in Eastern Europe
15 March, 2020
Former military nurse Rukhsara Dzhumaeva, a participant of the Karabakh war Meydan TV

A series of military conflicts in Eastern Europe has left millions of people with post-traumatic stress disorder.

Picture the following situation: a seriously traumatized person, as if not noticing their condition, is trying to behave as usual. This person walks the streets, uses public transport, talks to people and goes shopping – all this despite the wound continuing to bleed. This person is in a really bad state, and if no help is provided, this person will just die. But instead of rushing to see the doctor, the person is trying to somehow get used to their circumstances, drown out the pain or adapt to it.

Millions of people are living with such traumas. Only in this case, a wounded person is someone who has been through war, and the bleeding wound is the post-traumatic stress disorder, abbreviated as PTSD. This condition occurs in people who had faced something terrible, dangerous, terrifying; some extremely negative experiences that threatened their lives – like war.

READ MORE: How Displaced Children In Ukraine Overcome Psychological Trauma

Residents of Eastern European countries have been subjected to a series of military conflicts  (and some are still ongoing). Millions of people were left with PTSD. However, many do not even realize what exactly is happening to them. On top of that, they have no idea that professional assistance could help them get rid of this condition.

Belarusian “Afghantsy” living and dying with PTSD

30,000 Belarusians took part in the Afghan war from 1979 to 1989, but only the physical injuries were treated in the aftermath. “Afgantsy” (as they are commonly referred to in the post-Soviet space) try to avoid talking about the war, although they often do not regret the experience. Euroradio spoke to some of them.

Belarusian veterans recall that many of them felt the same way, but there was little point in trying to convey their pain to others as “hardly anyone understood them”.

In the aftermath of the Afghan war, veterans suffered from a disorder that wasn’t even classified in the USSR and as a result, there were no doctors who could offer treatment.

Many of those who required help are no longer alive, whereas those who did manage to pull through themselves didn’t require it altogether. 

Anatoly Kozhukh. Photo credit: Euroradio

Afghan war veteran Anatoly Kozhukh recollects frequent nightmares featuring the bearded faces of dushmans (Afghan mujahids, Afghan word for “insurgents” - ed.). Kozhukh also speaks of the prejudiced attitude in everyday life – even store attendants would often question what such young people went to Afghanistan for. The whole idea seemed very exotic to the rest of the population.

Another veteran Nikolai Garbuza remembers how the state turned away from those who went to Afghanistan:

We performed our duties there, defended our homeland. But they turned away from us after the war as if they didn’t send us there in the first place. It hurts.

Despite this, he has some fond memories of the surroundings and if it weren’t for hostilities, he would not even mind returning to see the city of Jalalabad and the mountains.

Alexandr Gemsky, who also took part in the war, attributes the state’s indifference to the disastrous state of the economy at the time. In his opinion, there were more important things to take care of in the early ‘90s than the Afgantsy’s mental health. 

READ MORE: Preventing Suicide Among Veterans in Ukraine

The memories of torn-off limbs and blown open stomachs are still fresh in his mind, however. In any case, he believes it is too late to help now as “80% of his comrades got divorced right away as if they had nothing in common [with their other halves]”. This indicates that there was, undoubtedly, "something wrong with their minds." 

Helpless: PTSD among veterans of the Transnistrian conflict

The 1992 Transnistrian war took the lives of around 1,000 people. 4,500 were injured, but there were no attempts to count those who suffered psychological injuries in Moldova. They received no psychological aid, and many of them are still affected by PTSD. The more time passes the harder it becomes to treat. Many veterans admit to finding it harder to overcome psychological trauma. Our partner Ziarul de Garda investigated this issue.

For Anatoli Croitoru, it was the loss of comrades and friends to war that was most painful. He still says that he feels the effects of those losses. 

Whilst others, like Victor Patrascu, say they were psychologically prepared to fight for and defend their homeland.

Psychiatrist Vadim Aftene explains the pain of these people:

“The symptoms range from anxiety and sadness to mental illnesses and an inability to focus on anything else. Sadness, lament, isolation keep repeating. Compulsive ideas and sudden flashbacks of past experiences appear. Emotional emptiness, sleep disorders, nightmares. These symptoms exhaust the human mentally and somatically.”

Some Moldovans simply accept that they are “not Europeans”, so they didn’t even expect to see personal psychologists. Thus former servicemen treat PTSD with alcohol or marijuana. 

According to military expert and war veteran Andrei Covrig “rehabilitation is done independently. For Moldovans, a psychologist is a glass of wine from your cellar.”

“It is all done to relax and forget the past. For a brief period, it helps you to doze off, but in the long term, it makes things worse. Compulsive ideas, fears repeat around the clock. This person cannot lead a normal, quality life,” Aftene explains.

Covrig admits that despite the temporary improvement “it’s impossible to forget what has happened. And if you had a trauma or injury, you never forget it, you take it with you. If you saw your friend being injured or killed, it can’t be forgotten.”

Without qualified help, PTSD can and does have dire consequences.

 Karabakh war veterans in Azerbaijan

For these people, the war has not ended. Is it possible to defeat post-traumatic syndrome in Azerbaijan?

“It is not customary to turn to psychotherapists. Even talking to your relatives about it is shameful. But we have to talk about this illness,” confessed veteran Karabakh conflict veteran Gasym to JAM News. 

When he returned home in 1986, nobody could grasp what’s happened to him. He was treated for neurosis, but was eventually diagnosed with PTSD by a doctor he came across by chance. Most Azerbaijani veterans, unlike Gasym, live with these symptoms – war nostalgia, depression, headaches, insomnia, suicidal thoughts, and aggression – ignorant of their diagnosis.  

Tens of thousands of people died during the Karabakh conflict between Armenia and Azerbaijan in the early ‘90s. Those who did return brought home dreadful injuries. But it was even harder for those who suffered from PTSD. There is not even an approximate figure. The state never provided veterans with psychological aid. 

PTSD symptoms include anxiety, insomnia, nightmares, compulsive flashbacks of war, aggression, and irritation.

Two factors come into play according to psychologist Azad Isazade: the unpreparedness of the body, and the intensity of the trauma. The latter can break even the strongest of characters. 

Elshad Rakhmanov spent four years at war and was injured. He lives with his mother in a one-room flat and works at a construction site. 

Elshad Rakhmanov. Photo credit: JAMnews

“War dictates its own rules. You don’t distinguish people: they’re all enemies. Whenever I tell people what I had to go through, they look at me as if I’m mad, as if I’m some monster.”   

You’d be having lunch with a comrade, you walk off 15 meters and return to see him killed. You literally just shared bread with him, it’s still in your mouth. You just discussed how you’d meet up in post-war life, but he is no more. I left my soul there. So many years later I’m still there with those guys.

Rakhmanov never visited a psychologist but did undergo a medical examination. He was diagnosed with a contusion.

“I was prescribed something for my nerves. If I don’t take them for three days straight, I get wild,” Rakhmanov describes his condition.

He knows at least five fellow servicemen who have the same problems as him. Once every three to five months, they meet up to drink tea and recall those days.

I didn’t go to war to get something from the state in return. I just want my fatherland to love me as much as I love it.

His pension is $120 per month, so he can’t afford treatment himself. 

Isazade mentions that there is a state war veteran rehabilitation center. There should allegedly be psychologists and psychotherapists there too.

“Individual work is a must in order to filter through the hardest cases and treat them individually. Groups can attend light relaxation sessions, so that the person can drift away. So that he doesn’t enter society with that condition. The next stage is socio-psychological rehabilitation: we shouldn’t just provide them with jobs, but make them feel privileged as veterans,” the psychologist explains.

Karabakh war veterans in Armenia

On the other side of the barricade is an Armenian veteran of the same conflict – Aik Torosian. He was lucky to have been diagnosed correctly and was offered psychological help in time, although he did fight 20 years later. Our partner JAM News spoke to him and other veterans.

Daniel Grigorian is still afraid of loud noises and bright light even 25 years after the hostilities. Whenever he watches movies, he often mentally transfers to the frontline, to the early ‘90s. He was 17 when the war broke out. 

We had no idea what a war was. We were teenagers, so we just thought it was a common occurrence. It was difficult to get used to it. Our fallen comrades remained in Shaumian (on the Azerbaijani side - ed.). We wanted to return to fetch their bodies. This thought tortures me to this day. 

Daniel’s platoon returned home after the truce in 1994. He had to learn to live in peacetime from scratch.     

PTSD follows extremely negative emotional experiences. The affected develop a feeling of exposure that prevents them from returning to ordinary life.   

Psychologist Karine Tatrian says “it’s best to turn to a professional because PTSD only gets worse with time.”

It is common among people who survived a life-threatening event such as an act of terror, torture or violence.

Torosian took part in the 2016 Nagorno-Karabakh clashes. For four straight days, full-on hostilities resumed for the first time since the 1994 truce. Torosian received an injury that was incompatible with military service and returned to civilian life. 

This situation is barely discussed in my family. But I still can’t forget it. It’ll remain with us forever. I no longer get as irritated by sounds. But it still has an effect on me. Especially now – I can’t stand it.

Torosian received psychological assistance in the rehabilitation center. Despite all his difficulties, he began his studies at university. Now he wants to become a care worker to help those who need assistance.   

"War changes people." How a military nurse, a migrant from a war zone and a veteran of the Karabakh war survive psychological trauma

It’s not just former soldiers who suffer from PTSD. The disorder does not spare those who never picked up a weapon too. Meydan TV looked into the fate of such people.

Рухсара Джумаева

Rukhsara Dzhumaeva. Photo credit: Meydan TV

“We were unable to adapt, neither women nor men, and therefore it is difficult for us to communicate with children, with neighbors, and in society. We never spoke with psychologists. They didn’t explain anything to us,” says military nurse Rukhsara Dzhumaeva, who went through the Karabakh war with a medical bag instead of a gun in her hands.

War is blood, losses, death, life in captivity. Nobody: neither men nor women, were able to adapt after returning from war.

Salim Salimov, a refugee from the Laschinsky district, describes war as the most terrible thing.

“It took everything from us… apart from life, but I’d rather it had taken my life too. God forbid anyone goes through what we’ve been through. I wouldn’t wish this upon anyone. It’s like nothing else.”  

It’s been 25 years since the truce between Azerbaijan and Armenia. Any war is destructive to those who don’t even hold arms. They often suffer more than the direct participants in warfare.  

Journalist and Karabakh war veteran Rey Kerimoglu recalls how difficult it was after the war:

“So many people died before our eyes and so many people were left crippled. It is a big trauma for us.”

Dzhumaeva recalls that“during one of the battles we had 96 people injured, dozens died and our tanker Balolgan went missing. We never learned of his fate. That’s the toughest thing for me.”

Psychologists think that the horrors of war can break anyone. The symptoms are similar among everyone. 

Dr. Olya Zaporozhets, who is an associate professor in the School of Psychology & Counseling at Regent University in the United States, notes that “people start to behave in an untypical way. If they used to be the life of the party, they become unrecognizable. They let themselves slide, take up drinking, can’t find employment. It’s these people that require therapy.”    

But psychological traumas are seldom discussed, let alone treated in Azerbaijan.

Kerimoglu remembers that there was not a single functional state program to help the veterans and many of the servicemen keep living with traumas. 

Рей Керимоглу, журналист, ветеран Карабахской войны

Journalist and Karabakh war veteran Rey Kerimoglu. Photo credit: Meydan TV

“We were unable to adapt which is why we find communication with children, neighbors, and society difficult. We never spoke with psychologists. We never had any explanations about anything,” nurse Dzhumaeva says, remembering the aftermath of the war.

Insomnia, nightmare, rages, and lost raison d’etre are the typical complaints of Azeri who went through warfare. A human cannot overcome the psychological breakdown alone, psychologists say. 

Zaporozhets goes on to argue that “the human will never be the same because war transforms people. But the symptoms and their intensity can be addressed.”

Not a single psychologist who specializes in PTSD was found in the whole of Azerbaijan. There are also no statistics in regard to the number of those who suffer from it. But according to international data, up to 10% of people have symptoms of the disorder. 

Psychological wounds of civilians in eastern Ukraine

People who do not take part in the fighting, but live in the frontline territories, are in a constant state of stress. After the war, a human will never be the same as before, but the symptoms can be treated. 

Inna Dolia, a psychologist from humanitarian mission Proliska, who works with people at the frontline says, “people aren’t easily convinced that they require psychological aid.” 

According to International Alert’s 2017 survey, around 32% of IDPs suffer from PTSD. Almost 22% of IDPs have depression, and 17% have anxiety. 

READ MORE: Donbas Reality Check: Frontline Medicine

People with mental disorders rarely turn to doctors due to prejudice, despite all work being done confidentially. Often there is no access to psychosocial assistance at the frontline. 

Image result for інна доля донбас

Inna Dolia and Yevhenia Sukhotska. Photo credit: hromadske

Dolia recalls that “people come in with nightmares, compulsive memories, traumatic experiences, insomnia, phobias, or basic mourning - everyone has their own history of trauma.”

"People with mental disorders rarely turn to doctors due to stigma, prejudice, and the superstitious beliefs that a psychologist is someone who gets into your brain with a spoon."

The psychologist finds it difficult to comprehend how people cope: 

“When the person is in a danger zone, they mobilize. But this can’t be a long-term state, not for over five years. It’s very tough, but people have to [adapt].”

Pensioner Yevhenia Sukhotska, who lives near the frontline, has outlived both her son and granddaughter. They were in their thirties. The latter could not bear the burden of hostilities on top of her health problems.

Dolia has to find ways to comfort the woman, “it’s painful and tough at first, but it gets better.”

The psychologist mentions that not everyone at the demarcation line requires psychological help. It is only those who can’t bear it alone. But people also have to be ready to accept help.

Post-traumatic stress disorder is not exclusively triggered by war trauma. A repressive state regime – illegal detention, torture, extrajudicial executions, arson, public humiliation – this can also cause or exacerbate PTSD. Especially among people who went through violent conflicts.

PTSD affects people from different countries who have survived the war with or without arms, those who volunteered for war, and those whose homes were subjected to it. Others continue to be hurt by their state. All these people require help.

/Based on materials from the Russian Language News Exchange