'Our husbands didn't go to war for Ukraine so we can sit around crying'

Maria Ivashchenko’s husband Pavlo volunteered to fight the very same day Russia invaded Ukraine in 2022.

Six months later, he was killed as Ukrainian forces went on a counter-offensive in the region of Kherson – making Maria one of the hundreds of thousands of Ukrainians who have lost loved ones in the war.

To cope with her grief, Maria has been attending therapy classes organised by a volunteer group called Alive. True Love Stories.

In the sessions, the widows and mothers of fallen fighters express their feelings, and seek solace and closure by painting. They then accompany their paintings with written stories of their love.

Maria says that painting helps externalise and process memories and moments that people can be afraid to re-live.

"There's total trust. No one will judge you, whether you laugh or cry,” she adds. “They understand you unconditionally. There's no need to explain anything.”

"There's a reason why it's called Alive. We came back to life. This project has pulled many of us out of the abyss."

The founder of Alive, Olena Sokalska, says more than 250 women have become involved in her project so far, and there is a waiting list of about 3,000.

Olena says that the paintings generally depict scenes that remind the women of the times they spent with their loved ones or of dreams they had. Some paint themselves or their husbands, Olena adds.

“Very often they paint angels, their families or children are depicted as angels," she says. "These paintings mark the end of the life they had and the beginning of a new life."

In addition to the trauma of bereavement, the dangers and insecurities of war have affected millions of Ukrainians.

Anna Stativka, a Ukrainian psychotherapist, explains that when wars start people lose safety and stability – basic human needs.

“When these two basic resources are gone very suddenly, this creates a lot of stress."

In situations where war is sustained, this can also turn chronic, with symptoms such as anxiety, depression, apathy, insomnia, lack of concentration and difficulties with memory.

"You can't stay in this hyper alert state for so long,” Ms Stativka says, adding that this has consequences on people’s mental and physical health.

“So this is generally what is happening to Ukrainian society," she says.

Research and statistics suggest that the share of Ukrainians who are experiencing mental health issues is huge, and it is growing.

According to the Ukrainian Health Ministry, the number of patients complaining of mental health problems this year has doubled since 2023, and market research data shows antidepressant sales have jumped by almost 50% since 2021.

A study published in the medical journal The Lancet suggests that 54% of Ukrainians (including refugees) have PTSD. Severe anxiety is prevalent among 21%, and high levels of stress among 18%.

Another study carried out in 2023 showed that 27% of Ukrainians felt depressed or very sad, up from 20% in 2021, the year before Russia's full-scale invasion.

The World Health Organisation (WHO) estimates that the majority of Ukraine's population may be experiencing distress caused by war.

"It may have different symptoms. Some feel sadness, some feel anxiety, some have difficulties with sleep, some feel fatigue. Some are getting more angry. Some people have unexplained somatic syndromes, be it just pain or feeling bad," the WHO representative in Ukraine, Jarno Habicht, told the BBC.

But, Mr Habicht says, Ukraine has made strides in dealing with the acute crisis and battling the Soviet-era stigma associated with mental health.

He says mental health was prioritised during the first months of the war. “Ukraine started to talk about mental health, and I think that's something unique which we have not seen in many places," Mr Habicht says.

Ukraine's first lady Olena Zelenska spearheads a mental health campaign called How are you? and she also held the Third Summit of First Ladies and Gentlemen focusing on mental health in times of war. It was co-hosted by the British broadcaster, author and mental health campaigner Stephen Fry.

In an interview with the BBC's Ukrainecast, Mr Fry described the mental health challenges facing Ukraine as an "urgent crisis", but said he was also impressed by what Ukraine is doing to address it.

"It's extraordinary to me that in Ukraine this is being talked about," Mr Fry said. "It is certainly a strength of Ukraine. The day Russians start to talk about the mental health of their soldiers and the crises amongst them will be the day that it's moved away from some of the totalitarian horror in which it seems to be mired at the moment."

According to psychotherapist Anna Stativka, one of the ways in which Ukrainian society has responded to the trauma of war is by coming together.

She says that people have generally become much more ready to help to each other and are much more polite, even in public places. “People talk to neighbours more. So many are volunteering, donating, trying to help each other. This is a very stabilising factor. We see much more trust towards each other, much more empathy," she says.

Maria Ivashchenko is now raising four children on her own. But she is smiling again, even if through tears sometimes. He message to those who are struggling with their loss is: "Don't be afraid to talk to people. Get out of your bubble. Don't be alone.”

"The most important thing is not to give up and not to think that you're alone in this world, or that nobody cares. Oh yes, they do," she says.

"Our husbands did not go to war so that we can sit around crying, but so that we keep moving on, so that we keep living."

The impact of this war will be felt by generations to come, but Ukrainians are working hard to deal with the trauma now.