By Maite Allerborn Ibanez, Jakub Ciolkosz, Norah Lång, Anastasiia Palchyk
Ukrainian refugees go through a double traumatization when coping with the war and adapting to a new life. Struggling with mental health issues, they face limited access to public health care in Sweden – and experience inequalities in the support they are provided.
– I felt vulnerable and disrespected, says Olena.
In the Gothenburg neighborhood of Fiskebäck, Kira, 9, is absorbed by computer games in a communal accommodation for Ukrainian refugees. At first glance a happy child, but when her mother Olesia demonstrates how Kira would repeatedly catch her breath and shrug her shoulders, her health struggles manifest – both physical and mental.
– I was crying and crying, says Olesia recalling their first visit to a neurologist in Sweden.
in their refugee accomodation. Photo: Norah Lång
She felt like Kira was neglected when the doctor could not find any problems with her wellbeing, even though back in Ukraine she was diagnosed with anxiety, prescribed antidepressants, and later diagnosed with an invasive streptoccocal infection.
After Swedish friends had made several phone calls, Kira could see another doctor who noted signs of ADHD. In October, she went to her first psychiatrist appointment – but can expect a waiting time of at least eight months before she can begin her assessment.
– We were told that Kira needs to live without stress. But Kira goes to school, we are moving soon, and we are unsure about the future. Kira has no way to be calm.
Temporary solutions
Valeriia, 23, fled from Kharkiv in March 2022. Experiencing anxiety and sadness, in Sweden she was prescribed sleeping pills without being referred to a psychotherapist.
– Now I have even worse mental health because the shock is gone and I need to think about the future, says Valeriia who considers finding a Ukrainian psychotherapist instead.
Only when Olena, 52, started hallucinating out of sleep deprivation, she decided to see a neurologist. They prescribed antidepressants, but Olena says it tranquilized her so much that she could not work, nor take care of her son.
– The doctor said that there was nothing more he could do to help me and called the Red Cross.
Olena is attending their program for people with PTSD and while the psychotherapy helps, she needs a Ukrainian interpreter.
– I burst into tears when they provided me with a Russian translator, Olena says referring to the language of her oppressor.
The limits of “personnummer”
Interviews with 10 Ukrainian refugees in Västra Götaland reveal that access to public mental health care differs.
As in the case of Oleksiy*, 46, who struggled with sleep problems and was prescribed medication that only worked temporarily. Or in the case of Dmytro, 34, a Ukrainian soldier who was injured in the war and had to be transported to Sweden for surgery. He claims that he was never offered any psychological help despite feeling depressed. On the contrary, Marharyta, 27, was satisfied with the help she received for panic attacks and OCD.
Baidar Al-Ammari works as a Health Communicator at the Transcultural Centre – an initiative by the Region of Stockholm. He says the lack of a personnummer** makes medical staff struggle with knowing what kind of mental health care they can offer. This is stressed by Maria Sundvall, psychiatrist and researcher at the Karolinska Institutet, who acknowledges that it is up to individual medical personnel to assess mental health issues – which may create inequalities in treatment. Even research is affected by this, as the lack of a personnummer sorts out non-registered Ukrainian refugees from studies on mental health.
What is next?
Before being registered in Sweden, Ukrainian refugees are only offered “treatment that cannot be postponed”.
Sara Tedsjö from the Knowledge Center for Equal Health Care in the Region of Västra Götaland says that the vague understanding of this hinders treatment.
– Medical staff may provide Ukrainian refugees with too little care, even though they have the right to an initial health assessment arriving in Sweden.
We have reached out to Karin Looström Muth, Healthcare Director in Västra Götaland, and Janette Olsson (S), Chair of the Strategic Healthcare Committee. Neither of them has chosen to comment on this issue.
Away from the war, our interviewees still have a battle to fight – rebuilding their future.
– I cannot see me and my family in Ukraine, nor in Sweden. I do not know anything about the future, says Olesia.
* Name altered
** Personal identity number for registration in Sweden