_________ Jessica Aldrich Strassman, MSW, LCSW, DSW Student, University of Pennsylvania, School of Social Policy & Practice, Philadelphia, PA. Sara L. Schwartz, PhD, MSW, Clinical Associate Professor, University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, CA. Eugenia L. Weiss, PhD, Associate Professor, University of Nevada, Reno School of Social Work, Reno, NV. Ann Petrila, MSW, MPA, Professor of Practice, University of Denver Graduate School of Social Work, Denver, CO. Copyright © 2022 Authors, Vol. 22 No. 1 (Spring 2022), v-x, DOI: 10.18060/26263 This work is licensed under a Creative Commons Attribution 4.0 International License. Everyone’s War Becomes My War: The Far-Reaching Impact of the Invasion of Ukraine Jessica Aldrich Strassman Sara L. Schwartz Eugenia L. Weiss Ann Petrila The invasion of Ukraine has been difficult to watch for individuals around the world. Feelings of disbelief and helplessness arise as violent images of murdered children, bombed apartment buildings and shelters, and fleeing families waiting in freezing temperatures at border crossings flash across our screens. This is especially challenging for survivors of World War II (WWII) and their descendants, particularly Holocaust survivors of Eastern European and Ukrainian descent. The impact, however, is not limited to this population and has been felt by survivors of war crimes committed in Bosnia, Syria, and elsewhere. World War II Re-Traumatization For WWII survivors and their families, the constant barrage of media about the attack on Ukraine has been excruciating, particularly for Ukrainian Holocaust survivors. At the start of WWII, Ukraine housed the largest Jewish population in Europe but 1.5 million were killed during the war (United States Holocaust Memorial Museum [USHMM], 2021). Twenty percent of the population resided in Kyiv at the time of the war where over 33,000 Jews were murdered over two-days at Babyn Yar, a ravine located outside the city (USHMM, 2021). The memorial for these Ukrainians was recently damaged by a Russian missile (Bloomfield, 2022). Watching the war rage in the Ukraine brings up painful memories for survivors and reminds them of their own trauma, with some speaking about their experiences for the first time (Cohen, 2022). Kira Brodskaya, 90-year-old Queens, New York resident and Ukrainian Holocaust survivor, cries every day as she watches the news unfold remembering when Hitler bombed her neighborhood in Kharkiv when she was nine (Cohen, 2022). Gdalina Novitsky, age three and living in Kyiv when the Nazis invaded, was forced to flee with her mother and leave behind her disabled grandmother who was murdered, along with her great grandparents, at Babyn Yar (Bahrampour, 2022). Erica B., founder of the American Kriegsenkel website, whose father was forced to flee WWII Poland at age 13 shares: What I am watching, and reading is literally my family story, repeated and played out again some 80 years later. The split-second decisions whether to flee or to stay. The looks of the traumatized women and children as they go into the unknown….that sound (the air raid siren she heard in a news report)...that about:blank ADVANCES IN SOCIAL WORK, Spring 2022, 22(1) vi sound…that gets at something deep in me. (personal communication with Erica B, April 11, 2022) Bosnian Re-Traumatization The primary narrative of the media covering the war in Ukraine is that nothing like this has happened in Europe since WWII. Bosnians watching this reporting are painfully aware that this is not accurate as they view scenes that are regrettably familiar to them, especially those who lived through the war that began in 1992. Bosnia was also a sovereign European nation attacked by a neighboring country, in this case by Serbian forces and the Bosnian- Serb Army. The intention was to “ethnically cleanse” the country of non-Serbs with the primary target being the Bosnian Muslims. By the end of the war 100,000 people had been killed and tens of thousands had become refugees (International Committee of the Red Cross [ICRC], 2015). The capital city of Sarajevo was under siege for 1,425 days with constant shelling and no food, water, or electricity. Ultimately more than 11,000 civilians (Morrison, 2021), including 6,000 children (Sabic, 2020) were killed in the city. In the town of Srebrenica in eastern Bosnia, more than 8,000 Muslim men and boys were massacred over a period of 6 days in July 1995, a slaughter that was later ruled a genocide (ICRC, 2015). Mass graves were found throughout Bosnia. Systematic rape and sexual violence were used as weapons of war (Bassiouni & McCormick, 1996), and the same atrocities are now being uncovered in Ukraine. Images and stories from the cities and villages of Ukraine have retraumatized Bosnians of all ages. As shared by a Bosnian woman on social media, “Every time a war starts, near or far, the trauma returns. Back to square one. Everyone’s war becomes my war…” (Buturovic, 2022). Far Reaching and Long-Lasting Effects of War Related Trauma The long-lasting mental health impact on war survivors is well-documented. Of particular concern today is that mental health symptoms can resurface or intensify when new stressors arise (Comtesse et al., 2019; Frounfelker et al., 2017; Schock et al., 2016). Refugees are at risk of long-lasting mental health symptoms and higher rates of anxiety, depression, and PTSD than non-refugee populations with symptoms that can remain elevated years after displacement (Bogic et al., 2015). As of mid-2021, the United Nations Refugee Agency (UNHCR) reports 82.4 million people have been forced to flee their homes, and a staggering 26.4 million are refugees (UNHCR, 2021) who have been forcibly displaced worldwide because of persecution, violence, and human rights violations. This alarming rate does not include the residents of Ukraine forced to flee their homes, currently estimated to number over 10 million (BBC News, 2022). World War II and Bosnian Survivors Research focused on WWII survivors of Holocaust, forced migration, and the civilian population, have demonstrated adverse mental health outcomes. Frounfelker et al. (2017) surveyed 3,370 WWII civilian survivors in Europe and Japan and found respondents who had been in a war zone had higher lifetime risk of major depressive disorder (MDD) and Strassman et al./EVERYONE’S WAR vii anxiety disorder than other respondents. MDD was more elevated in the early years after the war while anxiety increased over time (Frounfelker et al., 2017). Survivors of World War II’s forcibly displaced population (“expellees”) now living in Germany were surveyed and, sixty years later, demonstrated significantly more anxiety symptoms and less resilience than non-displaced participants (Kuwert et al., 2009). The long-term psychological distress of 299 adult male Bosnian war survivors were measured over an eleven-year period and adverse mental health consequences were found to last as long as fourteen years, especially when paired with current stressors (Comtesse et al., 2019). Schock et al. (2016) echoed these findings when they conducted a longitudinal study assessing the impact of new traumatic or stressful life events on pre-existing post-traumatic stress disorder (PTSD) in refugees seeking asylum in Germany from 2009-2011. The study determined that stressful life events may lead to an increase in existing PTSD symptoms as well as significant increases in PTSD avoidance (Schock et al., 2016). Descendants of War Survivors: Intergenerational Trauma and Mental Health Impact The children and grandchildren of war survivors are shown to exhibit adverse psychological outcomes in comparison to a non-traumatized population. This intergenerational trauma was first documented in 1966 when higher rates of psychological distress were found among some children of Holocaust survivors (Danieli et al., 2015). More recently, Sangalang and Vang’s (2016) systematic review addressing intergenerational trauma in refugee families found increased risk of PTSD, mood, and anxiety disorder symptoms in more than half of the studies examined. Bezo and Maggi (2015) conducted a three-generation study of the Holodomor (“murder by hunger”) genocide against the Ukrainians by the Russians from 1932-1933 (p. 88). They found that the trauma still exerts an emotional and behavioral influence on survivors, their children, and grandchildren decades later (Bezo & Maggi, 2015). In the last months, many descendants of war trauma survivors have begun to share their stories of how they were impacted by the attack on Ukraine. Stories they were told by their grandparents are now playing out in real time, sometimes in the same geographic areas of their ancestors. “It’s as though I’m reliving the trauma of my ancestors while simultaneously experiencing the trauma that is unfolding actively….the persecution and sense of fear that was and is being felt is very much living within me” (Sudakov, 2022). Additional Stressors to be Considered While the outpouring of refugee support has heartened many, it can rankle other refugee communities who have not been as warmly welcomed into Europe or into the United States. Ten European Union member countries have built over 1,000 miles of walls to keep out refugees from Africa and the Middle East (Sajjad, 2022). Families who settled long ago may also experience stress as they watch how Putin has so rapidly changed the narrative about Ukraine citizens. In 2016, abrupt changes in the United States political ADVANCES IN SOCIAL WORK, Spring 2022, 22(1) viii climate, immigration policy, and media rhetoric on refugees led to fear, anxiety and feeling “othered” by individuals who migrated to the United States (Funk & Shaw, 2021). Re-traumatization of symptoms can be exacerbated by the continual play of tragic images on screens. These are often unfiltered and originate from eye-witness experiences that can result in frightening images (Spangenberg, 2022). Viewing this content can cause re-traumatization for anyone already working to manage symptoms of PTSD but especially for war survivors, refugees, and their children. Additionally, the international pandemic has led to increased isolation and difficulty accessing support. New York resident, Bordskaya, notes that the pandemic has left her and other elderly immigrants feeling more alone during this challenging time (Cohen, 2022). Social workers around the world can expect to see traumatized refugees from the Ukraine and should begin to prepare themselves for assisting with war-related traumas and forced migration. As these are not typical topics covered in graduate social work curricula or continuing education training, it is essential for social workers to become aware of the connection between historical trauma and mental health. It is especially important for clinicians to include geo-political history and intergenerational trauma in their clients’ biopsychosocial assessments to recognize the potential for increased stress brought about by the invasion of Ukraine for war crime victims and their descendants. References Bahrampour, T. (2022, March 20). For Holocaust survivors from Ukraine: Russian invasion stirs painful memories. The Washington Post. https://www.washingtonpost.com/dc-md-va/2022/03/16/ukraine-holocaust-survivors- recall-past/ Bassiouni, M. C., & McCormick, M. (1996). Sexual violence: An invisible weapon of war in the former Yugoslavia (NCJ Number 166393). US Department of Justice, Office of Justice Programs. https://www.ojp.gov/ncjrs/virtual-library/abstracts/sexual-violence- invisible-weapon-war-former-yugoslavia BBC News. (2022, April 7). How many Ukrainians have fled their homes and where have they gone? BBC News. https://www.bbc.com/news/world- 60555472#:~:text=More%20than%2010%20million%20people,the%20war%2Dtorn %20country%20itself Bezo, B., & Maggi, S. (2015). Living in "survival mode:" Intergenerational transmission of trauma from the Holodomor genocide of 1932-1933 in Ukraine. Social Science & Medicine, 134, 87-94. https://doi.org/10.1016/j.socscimed.2015.04.009 Bloomfield, S. J., Eizenstat, S. E., Holt, A. M. (2022, March 1). Museum statement of damage to Babyn Yar. United States Holocaust Memorial Museum. https://www.ushmm.org/information/press/press-releases/museum-statement-on- damage-to-babyn-yar Bogic, M., Njoku, A., & Priebe, S. (2015). Long-term mental health of war-refugees: A systematic literature review. BMC International Health and Human Rights, 15(1), 1- 41. https://doi.org/10.1186/s12914-015-0064-9 https://www.washingtonpost.com/dc-md-va/2022/03/16/ukraine-holocaust-survivors-recall-past/ https://www.washingtonpost.com/dc-md-va/2022/03/16/ukraine-holocaust-survivors-recall-past/ https://www.ojp.gov/ncjrs/virtual-library/abstracts/sexual-violence-invisible-weapon-war-former-yugoslavia https://www.ojp.gov/ncjrs/virtual-library/abstracts/sexual-violence-invisible-weapon-war-former-yugoslavia https://www.bbc.com/news/world-60555472#:~:text=More%20than%2010%20million%20people,the%20war%2Dtorn%20country%20itself https://www.bbc.com/news/world-60555472#:~:text=More%20than%2010%20million%20people,the%20war%2Dtorn%20country%20itself https://www.bbc.com/news/world-60555472#:~:text=More%20than%2010%20million%20people,the%20war%2Dtorn%20country%20itself https://doi.org/10.1016/j.socscimed.2015.04.009 https://www.ushmm.org/information/press/press-releases/museum-statement-on-damage-to-babyn-yar https://www.ushmm.org/information/press/press-releases/museum-statement-on-damage-to-babyn-yar https://doi.org/10.1186/s12914-015-0064-9 Strassman et al./EVERYONE’S WAR ix Buturovic, A. [@amila295]. (2022, February 24). Every time a war starts, near or far, the trauma returns. Back to square one. Everyone’s war becomes my war… [Tweet]. Twitter. https://twitter.com/amila295/status/1496732078184017922?cxt=HHwWhMC5waT5 usUpAAAA Cohen, H. (2022, March 16). Ukraine invasion retraumatizes US Holocaust survivors. Jerusalem Post. https://www.jpost.com/diaspora/article-701330 Comtesse, H., Powell, S., Soldo, A., Hagl, M., & Rosner, R. (2019). Long-term psychological distress of Bosnian war survivors: An 11-year follow-up of former displaced persons, returnees, and stayers. BMC Psychiatry, 19(1), 1-10. https://doi.org/10.1186/s12888-018-1996-0 Danieli, Y., Norris, F. H., Lindert, J., Paisner, V., Engdahl, B., & Richter, J. (2015). The Danieli inventory of multigenerational legacies of trauma, Part I: Survivors' posttrauma adaptational styles in their children's eyes. Journal of Psychiatric Research, 68, 167–175. https://doi.org/10.1186/s12888-018-1996-0 Frounfelker, R., Gilman, S. E., Betancourt, T. S., Aguilar-Gaxiola, S., Alonso, J., Bromet, E. J., Bruffaerts, R., de Girolamo, G., Gluzman, S., Gureje, O., Karam, E. G., Lee, S., Lépine, J. P., Ono, Y., Pennell, B. E., Popovici, D. G., Ten Have, M., Kessler, R. C., & WHO World Mental Health Survey Collaborators. (2017). Civilians in World War II and DSM-IV mental disorders: Results from the World Mental Health Survey Initiative. Social Psychiatry and Psychiatric Epidemiology, 53(2), 207-219. https://doi.org/10.1007/s00127-017-1452-3 Funk, M., & Shaw, A. (2021). “I remember when Donald Trump was elected. It broke a lot of refugees’ hearts”: Refugee perspectives on the post-2016 U.S. political climate. Advances in Social Work, 21(4), 1100-1123. https://doi.org/10.18060/25184 International Committee of the Red Cross. (2015, July 10). Remembering nine ICRC employees killed 20 years ago in Srebrenica. International Committee of the Red Cross. https://www.icrc.org/en/document/remembering-nine-icrc-employees-killed- 20-years-ago-srebrenica Kuwert, P., Brähler, E., Glaesmer, H., Freyberger, H. J., & Decker, O. (2009). Impact of forced displacement during World War II on the present-day mental health of the elderly: A population-based study. International Psychogeriatrics, 21(4), 748-753. https://doi.org/10.1017/S1041610209009107 Morrison, K. (2021, April 19). How the siege of Sarajevo changed war reporting. Aljazeera. https://www.aljazeera.com/features/2021/4/19/how-the-siege-of-sarajevo- changed-journalism Sabic, A. (2020, December 11). Sarajevo agrees new memorial for child casualties of siege. Balkan Transitional Justice. https://balkaninsight.com/2020/12/11/sarajevo- agrees-new-memorial-for-child-casualties-of-siege/ https://twitter.com/amila295/status/1496732078184017922?cxt=HHwWhMC5waT5usUpAAAA https://twitter.com/amila295/status/1496732078184017922?cxt=HHwWhMC5waT5usUpAAAA https://www.jpost.com/diaspora/article-701330 https://doi.org/10.1186/s12888-018-1996-0 https://doi.org/10.1186/s12888-018-1996-0 https://doi.org/10.1007/s00127-017-1452-3 https://doi.org/10.18060/25184 https://www.icrc.org/en/document/remembering-nine-icrc-employees-killed-20-years-ago-srebrenica https://www.icrc.org/en/document/remembering-nine-icrc-employees-killed-20-years-ago-srebrenica https://doi.org/10.1017/S1041610209009107 https://www.aljazeera.com/features/2021/4/19/how-the-siege-of-sarajevo-changed-journalism https://www.aljazeera.com/features/2021/4/19/how-the-siege-of-sarajevo-changed-journalism https://balkaninsight.com/2020/12/11/sarajevo-agrees-new-memorial-for-child-casualties-of-siege/ https://balkaninsight.com/2020/12/11/sarajevo-agrees-new-memorial-for-child-casualties-of-siege/ ADVANCES IN SOCIAL WORK, Spring 2022, 22(1) x Sajjad, T. (2022, March 9). Ukrainian refugees are welcomed with open arms – not so with people fleeing other war-torn countries. American University School of International Service. https://www.american.edu/sis/news/20220309-ukrainian- refugees-are-welcomed-with-open-arms-not-so-with-people-fleeing-other-war-torn- countries.cfm Sangalang, C. C., & Vang, C. (2017). Intergenerational trauma in refugee families: A systematic review. Journal of Immigrant and Minority Health, 19(3), 745-754. http://dx.doi.org/10.1007/s10903-016-0499-7 Schock, K., Böttche, M., Rosner, R., Wenk-Ansohn, M., & Knaevelsrud, C. (2016). Impact of new traumatic or stressful life events on pre-existing PTSD in traumatized refugees: Results of a longitudinal study. European Journal of Psychotraumatology, 7, 32106. https://doi.org/10.3402/ejpt.v7.32106 Spangenberg, J. (2022, March 9). How war videos on social media can trigger secondary trauma. Deutsche Welle. https://www.dw.com/en/how-war-videos-on-social-media- can-trigger-secondary-trauma/a-61049292 Sudakov, M. (2022, March 4). My family survived the Holocaust. Now, the invasion of Ukraine is a trauma trigger. Themighty.com. https://themighty.com/2022/03/russia- ukraine-trigger-trauma-intergenerational/ UNHCR: The UN Refugee Agency. (2021, November 10). Refugee data finder. UNHCR The UN Refugee Agency. https://www.unhcr.org/refugee-statistics/ United States Holocaust Memorial Museum. (2021, September 29). Mass shootings at Babyn Yar (Babi Yar). United States Holocaust Memorial Museum. https://encyclopedia.ushmm.org/content/en/article/kiev-and-babi-yar Author note: Address correspondence to Sara L. Schwartz, USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, 90089. Email: saraschw@usc.edu https://www.american.edu/sis/news/20220309-ukrainian-refugees-are-welcomed-with-open-arms-not-so-with-people-fleeing-other-war-torn-countries.cfm https://www.american.edu/sis/news/20220309-ukrainian-refugees-are-welcomed-with-open-arms-not-so-with-people-fleeing-other-war-torn-countries.cfm https://www.american.edu/sis/news/20220309-ukrainian-refugees-are-welcomed-with-open-arms-not-so-with-people-fleeing-other-war-torn-countries.cfm http://dx.doi.org/10.1007/s10903-016-0499-7 https://doi.org/10.3402/ejpt.v7.32106 https://www.dw.com/en/how-war-videos-on-social-media-can-trigger-secondary-trauma/a-61049292 https://www.dw.com/en/how-war-videos-on-social-media-can-trigger-secondary-trauma/a-61049292 https://themighty.com/2022/03/russia-ukraine-trigger-trauma-intergenerational/ https://themighty.com/2022/03/russia-ukraine-trigger-trauma-intergenerational/ https://www.unhcr.org/refugee-statistics/ https://encyclopedia.ushmm.org/content/en/article/kiev-and-babi-yar mailto:saraschw@usc.edu