“After seeing the psychologist, I feIt like a new person” – MSF mental healthcare in Vinnystia, Ukraine

Natalia Kyshnir, 56, survived the siege of Mariupol but was forced to make the terrible choice of staying to look after her mother or leaving for safety with her son. She escaped to Vinnytsia but was left traumatised by her experiences. After receiving psychological support from MSF teams, she says she is ready to face the world again.

“I was born in the city of Mariupol and lived there until the war escalated. It started on 24 February 2022. Five days later, it reached Mariupol. Arriving at work that day, we heard that the war was in our city. People stood in long queues to withdraw money and everyone went to the shops to buy food. I and my youngest son did the same. We stood for three or four hours at the money withdrawal centre, then went to the shop with all this money and queued outside for another three hours. After stocking up on food, we queued for another two hours to pay for it.

First the power went off and there was no light and no communications. Next the water went off and then the gas. That was it: no water, no gas, no light. We could hear the Russian troops all the way to the border.

Five days later, my neighbour and I decided it was time to take shelter in the basement. We were lucky because our cellar was free of rats, mice and damp.

Life in the basement was very hard. Every five minutes there were planes overhead, artillery fire, that sounded like hailstones. We had very short slots when we could go outside and cook. We ate the same thing twice a day. When we ran out of water and it was minus nine outside, we collected snow with shovels and melted it. We made tea from snow and we washed our hands and our faces with it.

One day, my son and I went to the river [to collect water]. More than 500 people stood in a long queue waiting to reach the well. Just then the bombing started. We started screaming and shouting. I don't know how many kilometres we ran, but when we got home I couldn't breathe for an hour. Maybe that's why I was so scared.

My 83-year-old mother lived with us in our flat. Because of problems with her legs, she couldn't manage the steep stairs down to the basement, so we arranged a space for her in the hallway of the flat, boarding up the windows with plywood to protect her from shrapnel.

There were a lot of people in our basement, but it was a friendly space: we shared medicine, we shared food. My youngest son turned 18 in the basement. We invited everyone for tea and biscuits. We celebrated and cried together. He told me: ‘I can't be an adult in a situation like this.’

My son has epilepsy. One night he was shivering. I asked him: ‘Are you cold?’ and he replied: ‘Mama, I'm scared.’ He had been prescribed two medicines. I had a supply of one of the drugs but not of the other. This increased our anxiety dramatically. He was supposed to have medication after a seizure, but we ran out of medication for that too. We didn't know how long this would go on.

There was a bombing and people were left lying there without arms or legs. People were screaming for help, but nobody could do anything because there was no hospital, there was no doctor. Everything was destroyed, all the ATMs were looted, the pharmacies were looted, the shops were looted, there was nothing left. My mother was sick. Three people were killed while cooking nearby. The woman was blown over by the shock wave. We couldn't bury her. We kept hoping that it would all be over soon. It turned out that nothing ended and eventually we ran out of food, so we had to do something.

We lived in that basement for a month. On 23 March, in the evening, we gathered in the basement and decided to leave Mariupol. I got my mother ready to leave too. We took nothing with us because it was very hard to carry anything more than a pair of socks and a big bottle of water. We walked and walked and walked. My mother could not carry on. At that point I had to choose between my son and my mother: to escape with him to find medicine, or to stay in Mariupol and look after her. I will always remember that moment. My mother told me to leave. She gave me some money to buy something to remember her by. We left and my mother went back home.

We walked 16km that day, with Russian troops every 2km checking everything: phones, laptops. When I looked back, black smoke covered everything. People were dying in Mariupol. They were dying of hunger. How many people died there under the rubble!

As we walked on, there she was: Anna, a nurse. I am so grateful to her for getting me and my son out. I will thank her for the rest of my life. Anna called a friend, who came by car and picked us up. He took us to Urzuf [on the coast southwest of Mariupol]. As displaced people from Mariupol, we were told to go to Urzuf sanatorium. We were given free shelter and free food. We could change and wash our clothes because nobody had bathed for a month.

The next day we left [Urzuf] and went to Berdiansk [a city 80km west of Mariupol, under the control of Russian troops]. At the sports centre were lines of displaced people waiting for the humanitarian bus. We waited for several days. We did not know when the buses would arrive. Thank God those buses came.

When we arrived in Zaporizhzhia [the largest city in the region, located near the demarcation line between Russian and Ukrainian forces], I felt my soul lighten. It had taken us four or five hours to get there and the buses were checked every 2km by the military. When we finally crossed the demarcation line, all the people breathed as one. Ukrainian soldiers met us there and escorted us to Zaporizhzhia. We were taken to kindergartens, where we were fed and given small mattresses to sleep on.

From there, we took the train to Khmelnytskyi. When we were approaching Vinnytsia – I don't know why, and even though it wasn't my destination – I decided to get off the train. We settled in a hotel. With the help of my eldest son, who sent us money, we found an apartment and I got a job as a teaching assistant in a kindergarten.

For a year I was constantly stressed. My legs started to hurt, my body tore and split. I realised that I was getting worse, day by day and month by month. I didn't know what to do, whether or not to go to work. I'm generally positive but I didn't know how to move forward with my life. Eventually I had to quit my job at the kindergarten. I couldn't understand the situation, no matter how logical I was about it. I couldn't find a way on my own to have my health back.

The longer you put off seeing a psychologist, the worse it gets for you. One day, I was at the I'Mariupol centre, and I met Mariana, one of the MSF health promoters. The day before, my son and I were talking about a good place to find a psychologist. But we didn't have money to pay for psychotherapy. Mariana gave me the phone number of MSF’s centre. I called it and went there the following Monday at 9 am. After that I came once a week for consultations and each time I was greeted with a smile. I am very grateful. After all the exercises and talks with the psychologist, I felt like a new person. I started to think much more positively.

I'm working again, this time as a pharmacist's assistant. My three children, aged 35, 30 and 20, are all fine. My mother has moved in with my daughter, who lives nearby. They look after each other now and we have regular video calls.”