Emergency psychologists see 100 patients a week as refugees break down at border crossings 

In a blue tent next to the road leading into Ukraine’s border crossing in Siret, Romania, emergency psychologist Melinda* is perched on the end of a bed, talking to a child in distress.

Soft toys and colourful blocks sit on a table at the foot of the bed. Refugees and volunteers stroll past the canvas structure as trucks carrying supplies rumble past. On the outside of the tent, a sign sways in the wind: “You are not alone”, it reads. 

More than 4.3 million Ukrainians have fled their country since Russia invaded six weeks ago, with an estimated 6.5 million internally displaced. Many have witnessed atrocities, lost family members or are struggling with the stress of leaving their homes, husbands, fathers and brothers behind. Most flee with only what they can carry. 

Psychologists run off their feet offering help

Melinda is here to offer mental health support for refugees crossing the border, seeing children from aged four to the elderly. She speaks English, Russian, Romanian and Spanish and has a translator when needed. She says the child she’s currently treating, who is also permanently paralysed, is in a particularly “nasty” situation requiring intervention.

The child’s father tells me she’s having a mental crisis. Melinda walks with the girl’s mother to collect supplies from the Red Cross. The couple’s car, which they drove from Ukraine, is jam-packed with clothes, water and valuables. Their pug barks at passers-by.

Melinda is run off her feet — in the month since she’s been working in Siret she’s seen close to 100 people a week, including volunteers “struggling with strong emotions”. Sessions range from an hour down to just 15 minutes: express therapy to check in on people before their bus departs for another destination.

“We have to adapt our emergency psychological intervention to this schedule,” Melinda tells Crikey.

“Safety is the biggest concern — sometimes they don’t trust the people they’re going to other countries with. They are scared, some are traumatised from the war.” She’s also aware of people at other border crossings who have required psychological assistance for sexual violence, but she hasn’t treated any cases herself. 

“We’re trying to reduce secondary anxiety,” she says. “Sometimes they’re anxious about their anxiety, and we’re trying to normalise those normal emotions that rise up in abnormal situations. It’s our job to keep them safe, calm and prepared for their trip.”

Breaking point

Acute mental health crises are common at border crossings. Many refugees manage to hold themselves together until they reach safety before breaking down. 

At a converted sports stadium in Dumbrăveni, also in Romania, one woman had to be escorted to the hospital by security during an episode of psychosis, threatening to hurt herself and others. 

Another woman starts sobbing and screaming the second she makes it into the safety of the blue tents in Siret, waiting for paperwork to be finalised so she can be transported to Spain. She lost her mother during the journey and is inconsolable. Volunteers work to locate her family, and after a few hours of coordinating with border crossing staff, they were able to get in contact with her mother.

“Some of them haven’t spoken or expressed their feelings until the moment they cross the border, so it’s important to offer a safe space,” Melinda says. For children, sometimes all that consists of is playing music, drawing and listening. 

The music makes for an eerie addition to the site — one child given a harmonica plays a sad, off-key tune sitting on a bed in the blue shadow of the tent. His mother passed away several years ago and he made the border crossing from Chernivtsi — a city that has so far avoided damage — with his father. His dad says the boy doesn’t know the country is at war. 

Teens are a key concern

At an NGO-run transit hub in Warsaw, comprising large, heated, white tents nestled in the snow on a sports field opposite the Warsaw East train station, paramedic and volunteer Sylwia Jablonska says the biggest concern isn’t children, but adolescents. 

“Children often don’t understand what’s happening — parents try to keep details from them,” she says. While some may be scared or have witnessed atrocities, Jablonska says adolescents are a major concern. They understand what is happening and are worried about their friends and families. Many Ukrainian adults, she says, had lived with the threat of war for all their lives, with some adapting better than others. 

The hub has dedicated psychologists, and ambulances available to transfer those who need it to psychiatric care. 

Rape, murder and warfare are not issues teens should have to worry about. But sitting in her dorm-style room at a shelter in Eastern Ukraine, Maria* urgently shows me text message exchanges between her class. 

She fled her town, which lies just 60 kilometres west of Kyiv, with her mother, brother and his wife at the beginning of the war, seeking haven in the shelter while her father stayed behind to fight. 

Her Year 7 teacher has gone missing and there are rumours in the class Telegram chat that she was being held captive and raped by Russians. She brings up the executions and war crimes in Bucha. 

“I’m really, really scared of this information. I don’t want to believe it, but I read about it,” she tells Crikey.

“My mother cries every day — every single day she lies on the bed and cries.” 

Maria said she has access to psychologists and is more worried about her mother, father and teacher than herself. 

*Surnames withheld for privacy