The War After the War: Why Ukraine's Mental Health Crisis Is Just Beginning

As Ukraine is halfway through its fourth year of war, the world has watched in awe as communities have shown extraordinary resilience under unimaginable pressure. But there's a hidden truth that other countries recovering from the wars learned the hard way: the real mental health crisis doesn't peak during the war—it emerges in the quiet years that follow, when the adrenaline fades and the full weight of trauma settles into minds and hearts.

The early warning signs are already visible. A recent World Health Organization survey revealed that 68% of Ukrainians report a decline in their health since the war began, with mental health concerns topping the list. Nearly half the population now struggles with anxiety, depression, or neurological problems. These aren't just statistics; they're a glimpse into Ukraine's future if we don't act decisively now.

The Invisible Epidemic Taking Shape

Across Ukraine, front-line clinicians are witnessing something both predictable and heartbreaking: the steady rise of post-traumatic stress disorder amongst all demographics. Recent research suggests that 24-26% of civilians exposed to traumatic events have already been diagnosed with PTSD—and this is whilst the war continues, before the full psychological reckoning begins.

The World Health Organization's projections are sobering. They estimate that one in four Ukrainians is at risk of developing mental illness. Between 1-2 million people will likely need specialist care for moderate mental disorders, whilst 2-3 million more will require support for milder conditions. Most staggering of all: 18 million people—nearly half of Ukraine's pre-war population—may need some form of community support to manage psychological distress.

These numbers aren't abstract. They represent millions of individual stories: the soldier who can't sleep without checking every window and door; the mother who jumps at every siren, even when the all-clear has sounded; the child who draws pictures of explosions instead of flowers; the elderly person who has lost everything twice in one lifetime.

Bosnia's Crystal Ball: A Preview of What's Coming

Bosnia's experience serves as both warning and guide for what Ukraine faces. Thirty years after the Bosnian war ended, the psychological wounds remain painfully fresh for hundreds of thousands of people.

In Bosnia, researchers found that 28.3% of women in heavily bombarded areas developed PTSD, compared to just 4.4% in areas that weren't directly attacked. Eight years after the war, 20% of residents and 33% of refugees still struggled with PTSD symptoms. Today, an estimated 592,778 Bosnian adults—roughly a quarter of all war survivors—continue to live with PTSD.

But the statistics that should most concern Ukrainian families are these: Bosnian veterans with PTSD were nearly four times more likely to see developmental and behavioural problems in their children, and seventeen times more likely to report emotional problems. The trauma didn't stop with the generation that lived through the war—it moved into nurseries and classrooms, shaping a generation of children who were born after the fighting ended.

The economic toll was equally devastating. People with PTSD generated healthcare costs 63% higher than those without the condition. Families drained their savings caring for traumatised loved ones. The tragedy was compounded by the inadequacy of available treatment: even in specialised PTSD centres, only 14% of patients recovered after a full year of therapy.

Perhaps most heartbreaking of all, more than 900 Bosnian war veterans are believed to have died by suicide in the decade following demobilisation—heroes who survived the war but couldn't survive the peace that followed.

Ukraine's Race Against Time

The good news is that Ukraine isn't starting from scratch. Learning from Bosnia's experience, Ukrainian authorities and international partners have begun building mental health infrastructure before the crisis peaks.

Since 2017, Ukraine has been working to transform its mental health system, moving away from the old Soviet model that allocated 89% of funding to inpatient hospitals. New initiatives like the national "How are you?" programme are working to reduce stigma and encourage help-seeking. The WHO has helped develop comprehensive plans for mental health and psychosocial support, and rehabilitation teams are being trained to address not just physical injuries but psychological and social needs as well.

But there's a cruel race happening: can Ukraine build adequate mental health infrastructure faster than trauma accumulates in its population?

The challenges are immense. The war has created severe shortages of trauma specialists and rehabilitation experts. With over 100,000 amputations recorded by mid-2024 alone, the need for specialised care far outstrips available resources. Hospitalisation rates for war-related trauma and mental illness remain dangerously high, straining systems already pushed to their limits.

The Lessons Bosnia Teaches

Bosnia's three-decade journey through trauma and recovery offers Ukraine a roadmap—both of what to do and what to avoid.

Act early or pay forever. Bosnia's biggest mistake was delaying comprehensive mental health intervention until trauma had become chronic and entrenched. Ukraine has a narrow window to provide support whilst people are still psychologically flexible and before destructive patterns become fixed.

Community healing beats clinical treatment. Bosnian survivors consistently emphasised that recovery required more than medication or therapy sessions. They needed community-based counselling, mutual support groups, stable employment, and the restoration of social connections. Healing happens in communities, not just in hospitals.

Address the whole life, not just the symptoms. Post-war stressors—poverty, unemployment, social isolation—were stronger predictors of ongoing mental health problems than the original trauma itself. Ukraine's mental health strategy must include economic support, housing assistance, and job programmes.

Think generationally. The children of traumatised parents often carry the heaviest burden of unhealed trauma. Programmes must include parenting support, school-based mental health services, and safe spaces for children to process their experiences.

Build systems, not just services. Bosnia's over-reliance on hospital-based psychiatry kept mental health care separate from communities and daily life. Ukraine's shift towards integrating mental health into primary care and community services is promising, but it needs sustained investment and commitment.

Plan for the long term. Many international donors funded short-term interventions in Bosnia and then moved on, leaving local systems unprepared. Ukraine needs commitments measured in decades, not years.

The Critical Choices Ahead

Ukraine faces choices now that will echo for generations. The country can learn from Bosnia's painful experience and build comprehensive, community-based mental health infrastructure before the crisis peaks. Or it can repeat Bosnia's pattern of reactive, inadequate responses that left hundreds of thousands struggling in isolation for decades.

The window for prevention is closing rapidly. Every month that passes without adequate mental health support means more people developing chronic PTSD, more families trapped in cycles of trauma, and more children inheriting wounds they didn't create.

Economic policy is mental health policy. Cash transfers, housing assistance, and job programmes aren't separate from mental health care—they're essential components of trauma prevention and recovery.

Education is intervention. Training teachers, community leaders, and employers to recognise and respond to trauma isn't optional—it's the foundation of a trauma-informed society.

Technology can bridge gaps. Mobile and online mental health services can reach people in remote areas or those unable to access traditional care, but they must be culturally appropriate and linguistically accessible.

Local leadership matters. The most effective programmes will be led by Ukrainians who understand their communities' specific needs, not imposed by well-meaning outsiders.

Signs of Hope

Despite the enormous challenges, there are reasons for optimism. Ukraine has advantages that Bosnia didn't: greater international awareness of mental health, better understanding of trauma treatment, improved technology for delivering care, and perhaps most importantly, a more unified society emerging from shared resistance to aggression.

Ukrainian communities have already demonstrated extraordinary mutual support during the war. Neighbourhoods have become extended families, strangers have opened their homes to displaced people, and ordinary citizens have organised to support their defenders. This social cohesion is a powerful foundation for collective healing—if it's properly nurtured and sustained.

Our Commitment to Prevention

At Viburnum Bridge Foundation, we understand that we're working not just with today's crisis, but with the future mental health of an entire nation. We're not waiting for the war to end to begin building the infrastructure for healing.

Our programmes are designed to interrupt the cycle of trauma before it becomes entrenched. We provide early intervention for veterans showing signs of PTSD. We support families learning to navigate the challenges of loving someone with trauma. We train community leaders to recognise and respond to mental health needs. We advocate for policies that address the social and economic factors that can transform temporary distress into lifelong suffering.

We know that every person we help today is potentially dozens of people we won't need to help tomorrow—the family members who won't develop secondary trauma, the children who won't inherit their parents' untreated wounds, the communities that will remain strong and resilient.

A Call to Action

The mental health crisis emerging in Ukraine isn't inevitable—it's preventable. But prevention requires action now, whilst there's still time to intervene before trauma becomes chronic.

We need sustainable funding for mental health infrastructure, not just emergency interventions. We need training programmes for mental health professionals, teachers, and community leaders. We need economic policies that support recovery, not just survival. We need to build systems that can serve millions of people for decades to come.

Most importantly, we need to understand that supporting mental health isn't separate from supporting Ukraine's victory and recovery—it's central to both. A nation's strength isn't just measured in military victories or economic growth, but in the wellbeing of its people and their capacity to build a thriving future together.

At Viburnum Bridge Foundation, we're committed to ensuring that Ukraine's story doesn't repeat Bosnia's tragedy. We're working to build a future where Ukraine's heroes don't just survive their service, but thrive in the peace they fought to secure. Because the ultimate victory isn't just winning the war—it's winning the peace that follows.