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Many soldiers in Ukraine will long be left with the mental toll of trench warfare

ARI SHAPIRO, HOST:

The brutal fighting in eastern Ukraine evokes memories of World War I. Soldiers are dying in trenches. Artillery rains down. The violence can be difficult to comprehend. And as NPR's Nathan Rott reports, there are concerns about what this type of warfare could be doing mentally to those on the frontlines.

(SOUNDBITE OF PLASTIC FLAPPING)

NATHAN ROTT, BYLINE: Through three sets of plastic barriers in the back corner of an infectious disease hospital in southeast Ukraine, two Ukrainian soldiers are resting on narrow cots. Constantin, who's recovering from shrapnel wounds in his leg, is playing solitaire on his phone.

You winning?

CONSTANTIN: (Through interpreter) Of course.

ROTT: Always winning.

UNIDENTIFIED INTERPRETER: I always win. Yeah.

ROTT: Sergiy, who's dealing with an illness and severe concussion, sits up to greet us.

How are you?

SERGIY: (Non-English language spoken). Normal, OK.

ROTT: Doing OK.

SERGIY: Just OK, yeah.

ROTT: We've agreed not to give Sergiy or Constantin's last names, as is now protocol with the Ukrainian military. We've also agreed not to reveal the exact location or name of this hospital. Medical facilities like schools and shopping malls become a common target in Russia's war.

SERGIY: (Through interpreter) War is a terrible thing.

ROTT: Terrible and made worse, both soldiers say, by the unusual type of war this has become.

CONSTANTIN: (Non-English language spoken).

ROTT: "Sometimes you just lie in the trench with your gun," Constantin says. "And you think, why do I even need this gun? - because there's nobody to shoot. The fighting is all happening from a distance." Still, he and Sergiy, who narrowly avoided being blown up when he got his concussion, plan to return to the frontlines.

You want to go back.

SERGIY: (Non-English language spoken). Yes.

ROTT: Even after having an explosion happen right next to you.

SERGIY: (Through interpreter) Of course. I will be there for my country, for my children when I get better because they outnumber us. That's why we have to go back and we have to protect our country.

ROTT: This is something that Alexander Fedorets hears all of the time.

ALEXANDER FEDORETS: (Non-English language spoken).

ROTT: Fedorets is a psychologist who meets with Ukrainian soldiers back from the frontline. We've met him in a city park in Dnipro next to a memorial for soldiers killed in eastern Ukraine's 2014 conflict.

FEDORETS: (Through interpreter) The thing that brings trauma is not because they have to survive the fighting. It's that they can't fight back and they can't get their wounded that makes the most difficult.

ROTT: By even the most modest estimates, tens of thousands of people have died since Russia's invasion began. Military casualties are closely guarded by both sides, but Ukrainian officials have said that as many as 200 of their soldiers are dying every day. Hundreds more are wounded. And it's the job of licensed therapists like Fedorets and his colleague Tatiana Yermolayeva to meet with them to assess whether they're mentally and emotionally ready to return to the fight.

TATIANA YERMOLAYEVA: (Through interpreter) This war is still very different. And even people who are experienced soldiers - they are broken because of what they see, all the violence that they face.

ROTT: Then there's the civilian soldiers, Yermolayeva says. More than 100,000 civilians have enlisted in Ukraine's territorial defense since Russia invaded in February. Many of the people Yermolayeva has met with were teachers, store clerks, drivers until just a few months ago. The only war they'd seen was in movies. But they wanted to help. That was the case for the 20-year-old son of Olesia Olkhovyk...

OLESIA OLKHOVYK: (Non-English language spoken).

ROTT: ...Another Dnipro-based psychologist who's been meeting with soldiers. Olkhovyk's office is decorated with stuffed animals, entertainment for the families she's been meeting with who have had to flee their homes. Nobody in Ukraine is able to really relax, she says. There's a background tension from air alarms and missile strikes. But for soldiers like her son, it's all pronounced.

OLKHOVYK: (Non-English language spoken).

ROTT: "For example," she says, "we went on a drive with my son in the countryside this weekend, and he tried to check the situation around him all of the time."

He's just super-alert.

OLKHOVYK: Yes, yes, super-alert. This is, you know, how were the people from the front.

ROTT: Olkhovyk and other psychologists NPR talked to for this story say the real challenge will come later, after the war. Many of the soldiers they saw in the years after the 2014 fighting suffered from post-traumatic stress disorder, PTSD. But Ukraine isn't post-anything yet, they say.

OLKHOVYK: (Non-English language spoken).

ROTT: There's a meme in Ukraine now, Olkhovyk says, that jokes, look for a good psychologist now because it'll cost a lot more after the war.

OLKHOVYK: Yes (laughter).

ROTT: I appreciate that Ukrainians have so much humor.

OLKHOVYK: Black humor is the most important thing in our life. Yes.

ROTT: And it will be needed, she says, for a while yet. Nathan Rott, NPR News, Dnipro, Ukraine. Transcript provided by NPR, Copyright NPR.

Nathan Rott is a correspondent on NPR's National Desk, where he focuses on environment issues and the American West.