Ukrainian refugees cope with trauma in NC communities

Published by The Hussman School of Journalism at The University of North Carolina

Brief: This article presents the viewpoints on and experiences of mental health struggles from Ukrainian refugees and refugee resettlement nonprofit workers in Central North Carolina. Refugees identified feelings of loneliness, helplessness, and unhealthy fixation on the war in Ukraine while having mixed perspectives on mental health care. Nonprofit workers identified isolation and inequalities in mental health care access as inhibitors to healing from the traumas of war, loss and resettlement. The article brings to focus the mental suffering that refugees in North Carolina communities experience.

In Raleigh, a woman clicks away at news coverage and internet sites, examining photos and videos of her lost home, Ukraine. Images of dead bodies and destroyed buildings stare back at her soft dark eyes.

The woman, who for privacy reasons will be called Lesya, scrutinizes images and footage daily. She looks to see if loved ones have died in the war that has ravaged her country for more than a year. As she discussed her fixation on the news, she cinched her lips in a tight smile and let go of a quiet coping laugh. Lesya said the worst feeling is a loved one disappearing.

“Nothing else is as bad as that,” she said.

Lesya is 29 and a mother of a 4-year-old child, whom she is living with in a small one-bedroom apartment attached to an elderly woman’s house in Raleigh. She spoke through a close friend as a translator due to language divides. As a result of the war in Ukraine, she said that she has experienced trauma and felt emptiness, pain and helplessness. When she first arrived in the U.S., she could not function normally and found it bizarre that people were going on with their normal lives while she was stuck in place, staring at news coverage.

But, as she settled into her life in the U.S., Lesya decreased her monitoring of information on the war. Life moved on, and she had to support herself and her family

Due to Russia’s invasion of Ukraine in February of 2022, some of the most recent refugees coming into North Carolina are from the country with the now instantly recognizable blue and yellow striped flag. They must adapt to their new communities while coping with the mental health consequences of the trauma they endured. 

Many of the Ukrainian refugees like Lesya came to the North Carolina through the Uniting for Ukraine program, which gives Ukrainians a two-year period of temporary protected status. This status allows individuals from countries the U.S. designates unsafe to remain in the country for a certain period of time without fear of removal. It is different from the legal status of refugee, which is individualized. However, due to their lived experiences of fleeing persecution, violence and war, many temporary protected status recipients from Ukraine identify themselves as refugees.

Lesya is far from the only refugee resettling in North Carolina while managing her mental distress.  Refugees in communities throughout the state cope with trauma in a myriad of ways, but nonprofit workers and refugees acknowledge isolation concerns and barriers to mental health care that can slow the healing process.

Refugees have a high risk for developing mental health conditions like post-traumatic stress and mood and anxiety disorders, according to a 2022 article published in the Risk Management and Healthcare Policy journal. Their experiences of past trauma, potential loss, and resettlement contribute to this vulnerability.

Many refugees call North Carolina their home, making refugee mental health an important issue in our communities, said Jenny Harris, the clinical services manager at World Relief Durham, a Christian humanitarian organization that works to help refugees and other vulnerable immigrants resettle.

In the fiscal year of 2022 as of February 28, 2023, North Carolina has received more than 1,000 people under the legal status of refugee, according to The Refugee Processing Center, a computer system operated by the U.S. Department of State.                  

In regards to temporary protected status, the most recent data are from a November 2022 Congressional Research Service report, which states there are more than 15,000 beneficiaries in the state. The entire U.S. currently protects more than 9,000 temporary protected status beneficiaries from Ukraine, but no data specific to North Carolina were available in the report.

Harris identified finances, insurance coverage, time, and language divides as barriers to care. She has been working in the field of mental health counseling among immigration populations for 15 years in North Carolina.

Harris said one of the barriers refugees must overcome is a lack of accessible interpretation services.

According to Medicaid, all health care providers who receive federal funds from the U.S. Department of Health and Human Services for the provision of Medicaid services must make language services available to individuals with limited English proficiency. This is mandatory under the Rehab Act of 1973 and the Civil Rights Act. Despite these laws, states are not required to reimburse providers for interpretation services.

Harris said many providers cannot afford interpretation fees because the costs are not reimbursed. Also, interpretation services take more time to conduct, which might threaten providers’ productivity standards, as they might have to see a certain number of clients each week.

“It doesn't really incentivize these organizations to take on clients because they have to pay this fee. And then it's additional time,” she said.

Furthermore, there is a lack of bilingual mental health clinicians who speak Spanish and other languages. Cultural barriers also present themselves because the subject of mental health remains taboo for many people.

“A lot of our refugee population, of course, speaks languages from Afghanistan, from Syria, from the Congo, from all over the world,” Harris said. “There's just not a lot of providers that speak those languages and are versed in cultural competency and how to engage with those cultures.”

The time commitment of mental health services is also a major obstacle, according to Harris.

“So, if their kid is sick or if there's an issue with paying a bill, that will, of course, become more important,” she said. “It’s more survival, working on survival skills when people first come, and so sometimes mental health is just pushed to the back.”

Lesya said that she has received mental health support in the past due to her husband’s death and her service as a medical worker from 2015 to 2017 during the earlier years of the Russo-Ukrainian conflict. Lesya has not pursued therapy to treat the trauma she experienced in Ukraine. She is not aware of any government services that accommodate refugees, but said she feels that she does not need it due to receiving therapy a few years prior. Lesya benefitted from her previous therapy experiences, saying they helped her feel stronger.

Even so, Lesya said she feels isolated in her new North Carolina home.

Muragizi “Soni” Miramba is the resettlement programs manager at Church World Service in Durham, a nonprofit organization that works to help refugees resettle. Miramba has worked at CWS for 12 years.

Miramba said that adjusting to a new life in North Carolina is a long process and his clients can experience isolation. Miramba was admitted to the U.S. under the status of refugee and is originally from the Democratic Republic of the Congo. He is now an American citizen.

“Like right now, I'm still adjusting,” Miramba said. “I don't feel like I know what you need to know. And connecting with other people from your country for the first couple of months or for the first year, it's very, very difficult.”

Lesya used to enjoy hiking and traveling as hobbies, but with everything in her life and in Ukraine happening, she does not feel she can pursue them currently as she strives to adapt.

She describes herself as an active and sociable person who creates friendships easily. But she struggles with her social life in the U.S. due to the language barriers. Still, Lesya tries and has even been on a few dates.

She works any job she can, including Uber Eats, babysitting, and reselling goods. She tried to drive people around through Uber, but the app requires one year of licensed driving experience in the U.S. and a clean car title, and Lesya has neither. Other jobs are hard to find due to her language barrier.

Harris said that trauma and mental health issues can affect some people’s daily functioning. She said that for refugees that experience flashbacks, depression or any number of mental health symptoms, keeping and obtaining jobs can be difficult. She also sees this effecting children’s school performance and ability to make friends.

“Unfortunately, sometimes our new arrivals can be quite isolated and it's really kind of scary and hard to develop new relationships sometimes,” Harris said. “Things that people have gone through might keep people feeling quite isolated or fearful to engage with others.”

Even with mental health services, healing from trauma and feelings of isolation or homesickness endure.

A 53-year-old Ukrainian refugee woman living in Chapel Hill said that she struggles with her mental health every day and feels lonely. She has attended mental health support groups, even though she found them to be not very helpful. Due to confidentiality reasons, the woman will be called Vera. Like Lesya and many others, Vera also benefits from the Uniting for Ukraine temporary protected status program.

“I attended online groups, read articles about how to help yourself and your child cope with stress,” Vera wrote over Facebook Messenger. “I can't say that everything is fine. I still miss my home, and so does my son. We are trying to find ourselves in a new place. Difficult. I can't get a job. My son can't make friends. Everyone says that this is still a short time, and more time is needed for everything to return to normal.”

She said anti-depressants maybe could help, but she does not believe in them as she fears they are addictive. She said they could never repair her lost family or her homeland.

Vera has gray hair and thoughtful, searching eyes. When we spoke over Zoom, she recounted her traumas in an honest blunt manner as if she were reading off a grocery list. But, as the interview progressed, the pain Vera experienced became more evident in the high clips of her otherwise constant voice.

She said she feels unstable because she does not know her future or the future of her country. Currently, Vera lives in Chapel Hill with her son and her host family, who occasionally give her access to the family car. Vera said she and her host family do spend time together, but they are often apart too.

Overall, Vera finds herself to be lonely. Still, she is grateful to her host family and recognizes it is hard to open your home to strangers. She found the family through a member of the Lutheran church, and they communicated on Zoom and WhatsApp before she arrived.

Vera and her 14-year-old son are separated from her husband and eldest son, who live in the city of Zaporozhye, which is about 19 miles from the frontlines of the war. Her eldest son is 22 years old, which keeps him in Ukraine because men his age cannot leave. As a student, he is protected from the Ukrainian draft as long as he chooses to continue his studies. Vera’s husband is over 60 and, therefore, is protected from the draft and can legally leave the country. He chose to stay and volunteer in the war effort. Recently, Vera asked him to come to North Carolina to help her manage their youngest son, who she says is depressed and needs his father. The future remains unclear.

“My attitude is sometimes I, myself, want to go to the army and defend Ukraine.  But I have a 14-year-old son that I have to take care of,” Vera wrote over Facebook Messenger. “And, of course, I don't want anyone from my family to die.  But I also cannot influence the choice of my husband or eldest son.”

Vera’s loss and nagging uncertainty are unimaginable to most.

Her mother and older brother are living in the East of Ukraine under Russian occupation and cannot leave due to her 86-year-old mother’s mobility issues. Vera said they are not doing well because her mother cannot receive her pension due to her refusal to receive a Russian passport.

 As she deals with all of these emotional weights, Vera is learning English, looking for work, and taking care of her son.

“All [the] time, I think about this,” she said. “I think about my house, my family, my husband, my older son, my mother.”

Vera said she watches news from Ukraine every day to see if her town has been bombed. She cried after seeing the wreckage of a house she remembers from a town close to hers.

“Sometimes I cry, and I can’t stop,” Vera said