Ukraine: „Strong and sustainable for what lies ahead“

Since January 2025, Malteser International's country office in Kyiv has a much larger team of thirty staff members, most of whom are Ukrainian. Has this changed your role?

El Hajj: Yes, the growth marked a transition for me from being very operationally involved to focusing more on leadership, structure, and long-term direction. We moved from an emergency-style presence to a more established country program. I need to make sure we keep the balance between the flexibility needed in a crisis and the stability required for a team of this size. Helping local colleagues to take on more responsibility and leadership is something I see as both necessary and positive. Overall, I make sure that the office is delivering today and is also strong and sustainable for what lies ahead.

Although our Country Office in Ukraine was already established in 2023, the scale-up in January 2025 – when the team grew to around 30 staff – really changed the nature of my role. Earlier, I was directly involved in program troubleshooting, partner follow-up, and many practical decisions. As the office grew, my role naturally shifted away from managing individual issues toward making sure the overall structure works well. Today, I spend much more time ensuring that managers are confident in their roles, that departments coordinate effectively, and that decisions are taken at the right level. My focus is increasingly on mentoring, team cohesion, and creating an environment where people feel ownership of the work, not just responsibility for tasks.

At the same time, the external side of the role has grown. With a larger program and greater visibility, I now spend more time engaging with donors, authorities, and coordination platforms. This helps us stay aligned with evolving needs and ensures that our work in Ukraine is well positioned within the broader humanitarian response.

2025 was the fourth year of war on the whole country. Have you and your team witnessed further deterioration of the mental health of the war-affected population during the last year? If yes, in what way?

El Hajj: Yes, we have. And to understand it properly, you really have to look beyond just the last four years. For many people in eastern Ukraine, the war didn’t start in 2022 – it started in 2014. So, what we’re seeing now is the result of very long-term, accumulated strain.

Over the past year in particular, we’ve noticed a kind of deep fatigue. Earlier, especially at the beginning of the full-scale invasion, people were in survival mode. There was fear, but also a lot of solidarity and a sense of urgency that helped people keep going. Now, after years of uncertainty, displacement for some families more than once, and no clear sense of when things might stabilize, many people just seem emotionally exhausted. We hear more people talking about feeling numb, constantly anxious, or unable to think about the future at all.

With children and teenagers, it’s especially worrying. Some of them have spent most of their childhood with conflict in the background. We see concentration problems, sleep issues, fear linked to sirens or loud noises, and difficulties in social behavior. For them, instability has become normal, and that has a long-term effect on their sense of safety.

Adults, particularly parents and caregivers, are also under huge pressure. They’re trying to keep families functioning while dealing with financial stress, displacement, and worry about relatives, all while carrying their own emotional burden. That often shows up as withdrawal, irritability, or just feeling overwhelmed.

So yes, we do see deterioration – not always in dramatic ways, but in this slow, cumulative wearing down of people’s capacity to cope. It’s less about single traumatic events now and more about the impact of living under constant stress for years. That’s why longer-term, community-based psychosocial support is so important. People need space and support that help them regain some stability and rebuild resilience over time.

In 2024, Malteser International’s partner Mental Health Service won a prize for their work to support medical staff in hospitals in Sumy with training in, e.g., stress relief. How do our overall health activities complement or relieve pressure on the national health system? 

El Hajj: Our health activities are designed to directly ease pressure on the national health system, especially in regions where services are overstretched. In cities such as Sumy, Kyiv, and Mykolaiv where we and our partners work, support to medical staff – including stress-relief training and psychosocial skills provided through partners like Mental Health Service – helps hospital teams cope with the emotional burden of working in a prolonged crisis. This reduces burnout and helps staff remain able to provide care, which is critical in a system under constant strain.

At the same time, our community-based psychosocial activities reduce the load on formal services. Many people experiencing stress, anxiety, or trauma-related difficulties do not immediately need specialized psychiatric care but still require support. Through group sessions, individual counseling, and community center activities, people can access help much earlier and closer to where they live. This means fewer cases escalate to the point where hospital-based services are the only option.

In practical terms, this has made access to support easier. In several of the areas where our partners are active, people who might otherwise have waited months for an appointment with a psychologist are able to receive basic psychosocial support much sooner through community services. Our teams also help identify those who do need more specialized care and support them with referrals, which makes the pathway into the formal system smoother and more efficient.

So overall, our work both strengthens the resilience of health staff and reduces the demand on specialized services, while making it easier and faster for conflict-affected people to receive the kind of support they need.

Some civilians – often elderly people, sometimes whole families – stay despite extremely dangerous living situations, flee only as far as absolutely necessary, or return home as early as possible, even if it is not safe. And many NGO staff – including our own – risk their lives to support those who stay. Why does staying close to home play such an important role for the health and dignity of a person, especially in crises situations? 

El Hajj: This is something we see very often, and from the outside it can be hard to understand. But when you speak with people, it becomes very clear that “home” is not just a physical place – it is identity, memories, social ties, and a sense of control in a situation where almost everything else feels uncertain.

For many older people especially, leaving home can feel like losing the last piece of stability they have. Their daily routines, neighbors, familiar streets, even small things like tending to a garden or knowing where everything is – these are all part of how they cope. When those are gone, the emotional impact can be as severe as the physical risks they are trying to avoid.

From a health perspective, staying close to home often means staying connected to social networks. Family members, neighbors, and community ties are major protective factors for mental wellbeing. People who feel connected and supported cope better with stress and trauma. Displacement, on the other hand, often brings isolation, loss of role, and a feeling of dependency, which can seriously affect both mental and physical health.

Dignity is also a key aspect. Being able to make one’s own decisions – even in difficult circumstances – is part of maintaining a sense of agency. Many people do not want to feel like passive recipients of help. They want to remain in a place where they know how to manage daily life, where they feel they still have a role and some control.

This is why support close to where people live is so important. It is not about encouraging risk, but about respecting people’s choices and helping them stay as safe and healthy as possible in the places that still give them a sense of belonging. In a long crisis, preserving that connection to home can make a real difference for both mental health and dignity.

In Ukraine the link between health and home has become very visible for us in daily work. Health is not only about medical treatment. It is also about stability, routine, social ties, and the feeling of belonging somewhere. When people lose their homes or live for years under threat, their health – especially mental health – is directly affected. Supporting people to stay connected to their communities, or to rebuild a sense of normal life where they are now, is therefore part of protecting health.

I would like to raise one question that feels important in this context: How do we, as humanitarian actors, continue supporting people’s need for safety while also respecting their strong desire to remain close to home, even in difficult and sometimes dangerous conditions? In Ukraine, we see every day that “home” is not just a place, but a source of identity, dignity, and resilience. Understanding that better can help shape how we design support in long-lasting crises like this one.