Mental health expert Oleh Hukovskyi recently stood in a temporary classroom in eastern Ukraine speaking to a group of soldiers. They were attending a class on how to deal with the stress of war.
Hukovskyi is one of hundreds of professionals and volunteers across Ukraine treating soldiers for mental health problems. It is a growing issue for an army facing fatigue as soldiers fight a larger enemy.
Reuters news agency spoke to 13 people involved in supporting troops and four soldiers undergoing treatment. The treatment can last for a few days to several weeks in more serious cases. It also includes soldiers who have lost arms or legs and who are learning to live with their injuries.
Soldiers spoke of stress, anxiety, fear, guilt and being extremely tired. But they also spoke of friendship, a sense of obligation to hurry back to their units and a strong desire to repel the enemy.
Hukovskyi is one of the soldiers Reuters spoke to. He is a former psychiatrist. He joined the armed forces about six months after Russia launched an invasion in February 2022.
Now, he runs a mental health support group attached to the 67th Separate Mechanized Brigade. The brigade is in the area of Lyman, a town heavily damaged by the war.
"They have obligations and have to return to the front line," Hukovskyi said of the troops.
Some of the soldiers are being treated for light wounds and battle stress at a medical aid center.
Hukovskyi said Ukrainian soldiers were not given enough breaks from fighting.
"Forty-five days is a critical period when soldiers can stay and...have a chance to stay mentally healthy," he said. He added that in some situations they might remain in battle longer. When that happens, they experience more head injuries and more battle fatigue.
Citizen soldiers
Many of those fighting joined as volunteers. They had little, if any, preparation for sometimes fierce combat conditions.
The soldiers attending the class answer questions and suggestions. However, Hukovskyi knows there are limitations. Soon, the soldiers will have to return to fighting.
"Ukraine has an army of mobilized citizens who just yesterday were teachers, artists, poets, IT specialists, or workers," said Dana Vynohradova. He is deputy brigade commander for mental health support.
Nightmares and fear
"DJ" attended Hukovskyi's class last month. Before the war, he was a factory worker from central Ukraine. Like most other soldiers, he goes by his call sign, DJ.
"I have nightmares and they exhaust me. When I get some time to rest, I don't sleep at all," DJ told the group. Later, the 50-year-old explained that he was not prepared for the fierce combat.
DJ said his position near the front line was under continuous attack by Russian forces. Like others, he said he suffers from post-traumatic stress disorder (PTSD) and a concussion.
On a rainy November day in a nearby village, Dmytro, a 24-year-old soldier, talks with his unit's stress control group leader. He is a man named Serhii Rostikov. The Russians occupied the village in 2022. The two men walk and talk among damaged houses.
Rostikov said soldiers decide for themselves whether to seek mental health support. However, other specialists said unit commanders could make recommendations if they see signs for concern.
"After the artillery shelling, I developed a fear of going back to (combat) positions," said Dmytro. He is with the 21st Separate Mechanized Brigade.
He told Reuters that he reached out to his former group leader Rostikov for help. After working together, Rostikov sent Dmytro to rehabilitation. Dmytro said, "...I have no fear now and can easily go back to a combat position. I think we need psychologists, because soldiers suffer from a lot of stress."
Many soldiers who seek psychological support return to battle after short breaks. Some more serious cases are sent away from the front for more treatment.
DJ later said he had been kept away from combat for further treatment. Dmytro has rejoined his unit.
The Ukrainian military has tried to recruit more people for psychological support.
Ukraine's armed forces declined to answer questions about efforts to get support workers. It also did not release how many soldiers had been treated for psychological conditions since the start of the invasion. Such details are often treated as military secrets.
I'm Anna Matteo.
And I'm Mario Ritter.
Charlotte Bruneau reported this story for Reuters with additional reporting by Sofiia Gatilova and Stefaniia. Anna Matteo adapted it for VOA Learning English.
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stress –n. a state of mental tension
fatigue –n. a condition of being very tired
anxiety –n. fear or worry about something
obligation –n. the feeling of having a responsibility to do something
psychiatrist –n. a medical doctor who deals with mental health
critical –adj. very important
mobilize –v. (military) to organize and use people and resources for war
call sign –n. a set of letters or numbers that is used to identify a person on radio or for special purposes
nightmare –n. a frightening dream
concussion –n. an injury that results from a blow to the head
rehabilitation –n. treatment for an injury that is physical or mental that aims to return the patient back to normal life
psychologist –n. a health worker who deals with mental health but is not a doctor and cannot order the use of medication