On Ward 15

The regional psychiatric hospital on the outskirts of Odesa serves a population of around 2.5 million. It’s surrounded by a high wall; the way in is through a set of rusty gates. It was purpose-built in 1892. When Frantz Fanon visited psychiatric hospitals in the Soviet Union in 1960, he remarked that ‘you’re watched everywhere there’ and ‘even the toilets have no doors.’

The levels of surveillance and lack of privacy haven’t changed much in Odesa. When I visited recently with a local NGO, the conditions on the crowded wards reminded me of a field hospital. The mattresses on the iron-framed beds are thin, and the sheets were often dirty. A few patients were tied to their beds. Some appeared to be scared of being hit by the nurses, who didn’t hesitate to shout at them.

Oleksandra Pavlenko, the 26-year-old volunteer I was accompanying, has been visiting the hospital every week for the last two years. When she pushed a trolley full of cakes and fresh fruit into the courtyard of ward 16, she was met by a chorus of thanks from sixty or so elderly women. Pavlenko knows their names, their dietary restrictions and sometimes their diagnosis (for many of them, a form of dementia).

Ward 15 is mostly male, but some women share their rooms with up to seven men. The ward was especially dismal: not much light, loose floorboards, leaking pipes and single-glazed windows that mean it’s sweltering in summer and freezing in winter. The electricity shortages caused by the Russian targeting of power stations have resumed as winter approaches, making everything worse. There’s no TV, no radio, no books, no personal belongings. Patients simply wait out their treatment. Some have physical problems such as bedsores brought on by their confinement.

After taking over the food deliveries – the previous manager had burned out and moved to Iceland – Pavlenko, while continuing her studies and working different jobs to make ends meet, set up an NGO called Include, with the aim of renovating the wards.

In July, she helped deliver wheelchairs that had arrived covered in soot from a burnt-out clinic in Germany. One of the nurses joked that they were ‘good enough for Ukraine’. The official documentation was prepared and signed, but once the wheelchairs reached the hospital, there weren’t enough to go round and nurses were reduced to haggling over how many should go to each ward.

Although Ukraine’s constitution contains a vague promise of free healthcare for all, a WHO report from 2024 estimates that around half of spending comes from the pockets of patients and their relatives. Many of the payments are informal, and it’s difficult to measure where they go.

Ukrainian psychiatry has suffered from a chronic lack of funding since before the war. It remains highly centralised, and focused on pharmacological in-patient therapies. Ukraine has more psychiatric beds per capita than many countries in Western Europe, but that’s because they long since moved to a more community focused model of care. In the Ukrainian system ten years ago, hospitals sucked up as much as 90 per cent of the meagre mental health budget, leaving little to no funding for intermediate forms of intervention. There was often no alternative to either being left in the care of relatives already fighting for economic survival, or being institutionalised in sometimes inhuman conditions. In 2000, German psychiatrists visiting Ukraine said there was an urgent need for new drugs and proper training as well as such basics as bedding and building materials.

This doesn’t mean nothing has changed. Treatment protocols have been aligning with WHO standards, and corruption is less of a problem than it was. Since 2017 the Ukrainian government has been trying to provide more care in the community. But in the name of deinstitutionalisation, funding for places like Odesa’s psychiatric wards has been decreasing for the last five years. As far as the well-being of current patients is concerned, the move is premature. Conditions won’t improve for those too ill to leave, and those who are discharged re-enter a society at war, already struggling to reintegrate more than a million veterans – some of whom are winding up on ward 15.