Since February 24, more than three million refugees have fled Ukraine in what the United Nations is calling the fastest-growing humanitarian crisis in Europe since World War II. And each day of war poses another threat to their long-term mental health, says resilience expert Dr. Nicole Nugent, an associate professor of psychiatry and human behavior and emergency medicine who leads psychological services at the Hasbro Pediatric Refugee Clinic.
Nugent frames the emotional roadmap of refugees through a theoretical model depicting six phases of disaster: pre-disaster, impact, heroic, honeymoon, disillusionment, and reconstruction. Today, Ukrainians are in the “impact” and “heroic” stages of the crisis, Nugent says, when emotions are climbing toward their peak.
“We're in a period right now where everybody is rallying together,” she says. “Everybody feels like they're part of this community, cheering them on. You can see the heroic presentations all over the media, and it's great. Part of how you foster resiliency is to build up this sense of community — this ‘honeymoon’ period.”
What happens next in the crisis, says Nugent, could set the groundwork for chronic mental health complications such as post-traumatic stress disorder or depression — particularly as refugees move through the “disillusionment” period of intensifying emotional lows pocked by trigger events. Trauma doesn’t happen in a vacuum, Nugent adds. People with a history of trauma are more likely to have a problematic course through displacement versus a resilient one. Citing the conservation of resources (COR) theory of war and disaster research, Nugent says a person's resilience is also tested by each loss and its significance in their life: home, family, community, education, career. Those losses can accumulate over time.
“Some help now from the international community can go a long way for the current and future mental health of Ukrainians,” Nugent, who is the associate director of the Stress, Trauma, and Resilience COBRE and serves as vice president of the International Society for Traumatic Stress Studies, says. “My hope is that this crisis in Ukraine will end very soon and people can go right to that 'reconstruction' stage. There could be another period of time for rallying together and rebuilding.”
If it doesn’t, and families must relocate long-term, the resettlement process can be similarly traumatic, Nugent says. She recalls a young patient at the Hasbro Pediatric Refugee Clinic who wasn’t eating and wasn’t playing with a new soccer ball his parents gave him. All he could think about, he told Nugent, were the kids back home who didn’t have a ball of their own.
“The relief of resettlement is sometimes accompanied by survivor guilt, worries about loved ones left behind, and, for some, struggles with anxiety and depression,” she says. “In some communities, for some individuals, this level of distress has even resulted in death by suicide.”
Nugent mentions a handful of initiatives in Rhode Island, many led by Brown University collaborators, that help refugees navigate the challenges of resettlement and the traumas of their past.
“The medical home model at the Hasbro Pediatric Refugee Clinic, directed by Brown pediatrics professor Dr. Carol Lewis with myself directing the psychological services, works to break down barriers for families through an integrated care approach,” she says.
Lewis and Nugent also serve as advisors for Brown Refugee Youth Tutoring and Enrichment (BRYTE), a student-run organization that matches Brown students with recently resettled refugee youth in Providence. The resettlement agency Dorcas International Institute of Rhode Island; the post-resettlement nonprofit Refugee Dream Center; and the Women's Refugee Care resource center are just a few of the statewide organizations that help newly resettled refugees and welcome support from volunteers, Nugent says.
It's unclear if and when Ukrainian refugees would resettle in the United States but, in a letter to President Joe Biden dated February 28, Rhode Island Governor Dan McKee wrote: “Ukrainian refugees should know that they can find solace and safety in our state.” On March 11, Biden said he would welcome Ukrainian refugees “with open arms.” Nugent says she would do the same, if the assault continues and they must seek resettlement abroad.
“But gosh,” she says, “I hope that they don't need to.”
To help Ukrainians now, Nugent points to Friends of Ukraine RI, an all-volunteer group led by School of Public Health faculty members Natasha Rybak and Timothy Flanigan that's raising funds for medical supplies for Ukrainians on the front lines. Individuals can also support trusted aid organizations UNICEF, Doctors Without Borders, the UN Refugee Agency, or Ukraine’s Voices of Children, which offers psychological and psychosocial support to children affected by war.
“There are things that we can all be doing now to show our support of Ukraine and, in the future, there are ways to get involved to support our refugee families in Rhode Island,” Nugent says. “We can make things better together.”
For more information on war and resilience research, visit istss.org.