Ukrainian soldiers have been fighting at the front for months. Now they're being sent for mental health help

Years before Russia launched its full scale assault against Ukraine, Lt. Col. Oleksandr Vasylkovsky saw first hand that soldiers in the country's east were struggling to cope with the mental health consequences of fighting and living through war. 

Some were abusing alcohol and drugs, and a number took their own lives. More than 14 months after the entire country has been plunged into war, Vasylkovsky says suicide is a big problem in Ukraine's military, but he was unable to talk about the statistics because they are classified. 

"Man is not made of iron or concrete," he said. "A person has a limit and when they break it they can have psychological breakdowns."

In June with the help of donations and foreign aid, Vasylkovsky launched a health program where soldiers can receive a week of physiotherapy and psychological counselling, along with alternative treatments designed to be restorative, such as laser therapy. 

Vasylkovsky, who is with the National Guard of Ukraine, spoke to a freelance crew working for CBC news and granted access to the centre, as long as its exact location wasn't identified for security reasons. 

A week off, then back to fighting

Each week as many as 100 soldiers arrive at the site in the Kharkiv region, which used to house a Soviet sanatorium that was designed for people experiencing chronic health issues or who were in need of rest and relaxation.  

When the news crew visited the site, 40 per cent of the soldiers there had arrived from the Bakhmut region. For several months a hellish battle has been unfolding there, leading to enormous losses on both the Russian and Ukrainian sides. 

"The human psyche is broken," Vasylkovsy said, noting that the soldiers fighting now are not only dealing with the horror of battle, but also, in many cases, the stress of being separated from family members who have migrated west or outside of Ukraine.

Vasylkovsky says 95 per cent of the soldiers are sent back to the front lines after their week off. 

Dmytro Manchenko, 26, says his family tries to call him every day, often in tears. He finds it difficult to ease their fears, given that he worries every time he heads out on a mission in eastern Ukraine. 

Since September, Manchenko has been driving a tank near Avdiivka, in Donetsk, an area that's come under heavy Russian bombardment in recent weeks. 

"Everyone is afraid in their own way," he said. "One explosion and you are dead. It may not happen, but what if it happens?"

During one mission, Manchenko said his tank broke down when they were just over one kilometre from Russian positions. They came under shelling and were forced to run for their lives. 

Another time, his tank was hit with machine gun fire. 

Manchenko says he isn't sure why his commander made the decision to send him to the health centre, but admits that unlike the rest of his unit, he's much quieter and tends to keep his emotions to himself. 

Salt rooms, swimming and therapy sessions

When it comes to those affected by protracted conflicts and war, the World Health Organization (WHO) believes that one in five people end up suffering from mental health issues like depression or post-traumatic stress disorder.  

When that estimate is applied to Ukraine, WHO expects that nearly 10 million people will suffer from mental health issues. 

Vasylkovsky believes there needs to be a new system of rehabilitation for Ukraine's entire population, as families, medical staff and essential workers are all experiencing the horror of war. 

Between 2014 and 2016, Vasylkovsky worked with military psychologists to support troops fighting in the Donbas. But afterward he had his own struggles with mental health which led him to quit the military, before he rejoined in 2019. 

He's now focused on trying to set up additional health centres, including one in the Sumy region, northwest of Kharkiv. 

At the health centre, some soldiers are joined by their partners and children. They can take part in some sessions like salt room therapy, or swim in the centre's warm pool. 

In addition to joint counselling sessions the soldiers attend, they can also spend one on one time with a psychologist. 

Though most soldiers are soon back on the front lines after their rest, Vasylkovsky says if they need more time with a psychologist, they can stay another week or two.

If it's clear they have developed severe health issues, they can be sent to a hospital. 

Back to the front 

Yuri Ivlev spent several weeks at the hospital last May after his artillery unit was hit by shelling. Two of his fingers had to be amputated and all of the tendons were destroyed in a third. 

As the 59-year-old stands outside among the trees listening to the birds, he holds a cigarette between the remaining fingers on his right hand.

He says what he saw and heard in the hospital was more traumatic than anything he's experienced so far in battle. He described listening to screams of people in unbearable pain, and the groans of dying patients. 

Despite his injury, he's keen to go back and join his unit. He says continually being drawn back to war is like a disease. 

His fellow soldiers, many of whom are in their 20s, refer to Ivlev as "Grandpa" because of his long, white beard, and often turn to him for advice.

He insists he isn't struggling with any mental health issues now, but says he found it tough to speak to the female psychologists on staff at the centre because there are "many problems that you cannot tell a woman."

While Ivlev says he's managing, he believes it will be difficult to adjust to normal life when there is eventually peace. 

He says it will take time and support to forget. 

"Forget those explosions. Forget death and not smell of blood or burning … to not look at the sky fearing to see a drone flying. "