Russia’s bombs and bullets did not kill Liubov Hrudiy — the stress of war did.
Following a perilous journey from eastern Ukraine with her grandson, Hrudiy, 73, died minutes after arriving in the western city of Lviv last week.
Now her grandson, Vladyslav, 17, has to live with the nonphysical scars of that trauma.
He’s not alone. The more than 3.1 million Ukrainians who have fled their country since Russia invaded it on Feb. 24 will all carry invisible scars with them long after they reach safety.
And while many will carry the emotional and physical impact of their experiences for many years, experts on refugee trauma say there are ways to help.
“Nothing can be done to undo the horrible things that have happened, but a lot can be done to help on a human, individual and community basis to support the dignity of Ukrainian refugees,” said Dr. Allen Keller, founder of the Bellevue Program for Survivors of Torture and the director of the New York University Center for Health and Human Rights.
Hrudiy had been reluctant to leave her hometown of Sumy, about 40 miles from the Russian border, but the onslaught of attacks had become too dangerous.
“Every day the attacks are more, are bigger and bigger,” said her grandson, who goes by “Vlad.”
Vlad said that his mother, Larysa, a “really brave” pediatric doctor, felt compelled to stay in Sumy to take care of the children getting injured in the Russian attacks.
So, he and his grandmother set off on an arduous 24-hour bus ride with the family cat to seek safety in the western city of Lviv.
But the stress of the journey was too much for Hrudiy, her grandson said. She collapsed just as they reached Lviv on March 12.
Peter Holz, 35, a nurse with the American aid organization Samaritan’s Purse, threw Hrudiy over his shoulder because he saw she needed immediate medical attention, but there was no stretcher available.
“It’s not perfect but, when you’re in a crisis, you do what you have to do,” said Holz, who is from Asheville, North Carolina.
Despite the best efforts of medics who rushed in to help, Hrudiy died.
A distraught Vlad broke down in tears, saying, “I don’t know what my mother will say.”
Reached by text message, Larysa declined to give an interview, simply saying: “I’m emotionally exhausted. I can only say that the war took away my dearest person.”
To experts on refugee trauma, what Vlad went through is an extreme example of what many experience.
“In some ways, the experience of this young man mimics what I think everyone in Ukraine is going through, just a smashing of normalcy,” said Keller, who is based in New York City and has worked for decades as a primary care physician with refugees who have been victims of trauma and torture from all over the world.
Aspects of the refugee experience that compound the trauma of war even after they’ve reached safety are a “sense of helplessness and hopelessness, but also a sense of profound isolation,” according to Keller.
Zarlasht Halaimzai, CEO and co-founder of the Refugee Trauma Initiative, said that the stress of the experience can manifest itself physically — through body aches and lack of sleep. And it can have profound impacts on children, affecting their ability to learn, form healthy relationships and even walk.
For adults, in addition to losing their homes and belongings, they can also lose a sense of identity, and many experience prejudice and discrimination.
Halaimzai, 39, is based in London and knows from experience. Her family fled Afghanistan in 1992, following the collapse of the Soviet Union, when she was 11 years old, finally settling in the United Kingdom when she was 15.
She helped start the Refugee Trauma Initiative with the goal of providing refugees with the kind of mental health care that can prevent long-term suffering and depression.
Her organization is responding to the current refugee crisis by partnering with local organizations in Poland, Moldova and Romania to set up programs to address trauma.
They provide psychological first aid — “light touch, nonclinical intervention that allows people to feel that they are being heard, that their pain is valid,” she said. “That can go a long way at preventing long-term impacts of their trauma.”
To Keller, the antidote to the helplessness and hopelessness many refugees experience is a return to normalcy and restoring a sense of community.
He believes that the outpouring of love, support and compassion that have been seen on a global scale toward the Ukrainians right now is therapeutic in its own right.
The trick is to keep that up and follow the Ukrainian people’s example of resiliency even in the face of extreme violence and destruction.
“We don’t need to teach the Ukrainians about community, we need to learn from them. They have and are teaching us,” he said.
For Vlad, his journey back to normalcy is just beginning. His mother joined him in Lviv, where they buried Hrudiy and plan to stay for now. They hope to return to Sumy when the war ends.