HORLIVKA, Ukraine — Whenever the bombs fell, the men and women in the psychiatric ward would huddle in terror around fellow patient Valentina Izotova, a stout, maternal-looking woman, and she would read to them from her favorite book. They hardly understood a word, but her voice soothed them.
The hospital in Ukraine's war-torn east has been shelled eight times since the conflict started more than a year ago, blasting a huge hole in a wall, shattering windows and terrorizing patients. Long suffering from the trauma within their minds, they now suffer the trauma of war, abandonment and a shortage of psychiatric medication.
"People lived so peacefully, there was at least some joy," said Izotova, who teared up as she spoke. "And now we only wait for the next explosion, wait for someone to start shooting. We are disturbed and worried."
The suffering is manifest even on days when there is no fighting. Patients wander the corridors aimlessly. Their emaciated faces stare out from beds. Endlessly, they mumble the same, incoherent phrases.
The staff — what's left of it — face the crushing struggle of caring for confused and vulnerable charges with insufficient manpower and constant anxiety about how to obtain the medication that can bring the patients a measure of peace, as fighting between Ukrainian forces and pro-Russia rebels gathers new force after a lull.
The hospital, like scores of others in the rebel-controlled east, is plagued not only by the bombs and bullets but by an effective government economic blockade. The government has stopped sending pensions and other social payment to the rebel-held territories, and residents can get the money only by traveling to government-controlled areas. Getting the paperwork to do so is laborious. The trip itself can be stressful and perilous, and many of those in most need of money have mental or physical ailments that prevent them from traveling at all.
"When war started in July last year, our financing was stopped; no salaries, no drugs, no food. We had emergency rations, which every hospital had at the beginning of the war, that's why we could survive a few months," said chief doctor Tatiana Sergunova. In April, rebels began paying some pensions, but "it's a blockade, it's impossible to bring medicine here."
The international aid group Doctors Without Borders, known by its French acronym MSF, said psychiatric patients across eastern Ukraine are suffering from a lack of basic care.
"The problem of drugs in psychiatric hospitals is severe problem. So we visit these institutions, find that they have lack of drugs to treat all these patients," said Franklin Friaz, an MSF medical coordinator. "For example antibiotics, painkillers, and most important for them is psychotropic drugs."
Even when it has money, the hospital can't buy the required medications because pharmacies don't have them in stock. Major humanitarian organizations like MSF also have difficulty finding the drugs needed by the mental patients. That means there's sometimes no respite from mental suffering even as war drives it to unbearable levels.
The Horlivka hospital itself is fitfully recovering. The broken windows have been repaired, and some new staff has been hired, though they are inexperienced. "I have to work for two people now," said one of the doctors, Evgeniy Menyaenko.
And more demands may be placed on its hard-pressed staff. Loic Jaeger, the Ukraine emergency coordinator for Doctors With Borders, said requests for mental health support are rising from people not afflicted by mental illness, but unable to shake the trauma of war.
That could strain the Horlivka hospital, which has only one psychologist to care for the 30 patients already there with serious psychological damage from the conflict.
"Around 80 percent of people who come to us now need help in dealing with losses, losses of family members," said psychologist Victoria Yarotskaya. "They see the mutilated bodies of relatives, pieces of bodies."
Tatiana Anatolievna and her 3-year-old grandson Vadik — neither of whom suffer from psychiatric illness — come to the Horlivka psychiatric ward for trauma treatment. Anatolievna said that her grandson was recently holed up in the family apartment for two weeks to protect him from shelling. One day, the family took Vadik outside for a breath of fresh air. A bomb fell, killing the boy's mother in front of his eyes.
The boy screamed "unbelievably loud," clinging to a scrap of his mother's jacket. These days, Anatolievna said, he has withdrawn into himself: "He is like in a shell."
Jim Heintz in Moscow contributed to this story.