In the middle of the street, Tatiana Chernienko, 56, grabs my hands and presses them against her shin to feel the small and rock-hard little lumps beneath the skin.
Ever since the mortar shelling in August 2014, Tatiana's body has been full of metal splinters.
"Look," she says in an urgent tone, showing where her skin is marked by a big scar. "I barely had enough money to pay for this operation. And these," she pulls away her clothing. "I cut out myself. If I don't do my exercises I will become paralysed."
She stumbles off across the dusty dirt road back home, leaning on her stick.
The Eastern Ukrainian town of Mariinka is suffering deeply from the wounds of war. On every street there are damaged or burnt-out houses. The centre of the small town, just a stone's throw from the rebel capital Donetsk, is deserted. Mine dumps rise next to the village where the pro-Russian rebels are encamped. Shots are fired back and forth each night. The few inhabitants are left to their own devices.
Alissa, 9, and her mother live at the edge of the village, in the field of fire. Each day, for the past year-and-a-half, they have sought refuge in the air-raid shelter where the ground trembles due to the many explosions.
"When she sleeps she flails her arms wildly. Are they nightmares?" asks Oksana Miroshnichenko. "The minute the shooting starts I give her tranquillizer tablets. A small pot of Valerian is at the ready in case we have to run." Recently a psychologist visited her school, says Alissa. She asked her to make a drawing of her hand and to draw all her favourite things in the fingers using colours. She took a crayon to draw thin lines around her hand and then drew colourful roller skates, embroidery and knitting needles in the fingers. Alissa put her handiwork to the side and embraced herself as if to hold herself together. "This is what we must do when we're scared," she says.
In the evening, all hell breaks loose again. From the nearby control post the Ukrainians return fire. Ra-ta-ta-ta-ta. "Sometimes I just lose it and scream at my own child," Oksana says. "I don't want to do that anymore."
Mariinka lost its pride last summer when, after fighting for several months, the pro-Russian rebels captured Donetsk International Airport and marched on to this once-lively mining town. The Ukrainian soldiers withdrew to the edge of the village, set up control posts and dug trenches in the fields.
"There was a tyre factory, a bread factory and a tile factory. They all came down," says Raisa Zizeevskih, 77.
The mines became inactive as well. Dmitriy Alexandrovich, 35, living across the street, lost his job two years ago when the mine pumps were shut down because of the war.
Now the mine is filled with water and he is at home, where he has barricaded the windows with massive blocks of stone. "In the Soviet days, it was the miners that fed the country," Dmitriy says. His parents and grandparents also worked at the mine.
"They earned 30-times the salary of a teacher. It gave them status, despite the fact that there wasn't anything to buy in those days."
Now the miners are out of work and the war appears to have finished the industry.
This is why so many people in Mariinka are aggressive and bitter, explains Dmitriy. War brings out the worst in them. "There was a man who always had a house full of guests. Nobody pitied him when his house was hit by a bomb. 'Fix it yourself', is what people said. Some even threatened to point out those that they hated to the separatists."
Others didn't hesitate to show kindness, such as when one of the residents shared his house with three other families after their homes were destroyed.
And then there were the volunteers, a new phenomenon in the former Soviet Republic of Ukraine, says Dmitriy. "They come from afar in their own cars and they bring things to help the people in need."
Oleg Tkachenko, 47, is one of those volunteers. He is a chaplain in a Baptist community in Slavyansk, about 100 kilometres north of Mariinka. He has his own metal processing company and in his free time he organises church services in Mariinka.
"The people are wounded emotionally," says Oleg. "Imagine, you are a citizen of a state, you have children and plans for the future - and then it all suddenly comes to an end. You're a dropout. Nobody cares about you anymore. And you feel betrayed."
During the church service the chaplain prays with those who want to. Although there are no tears, you can see the dejection and pain in the eyes of those present.
"Even a psychologist would quickly need psychological help here," Dmitriy says. "The traumas you see in Slavyansk after only four months of war, and here, the end is not yet in sight. But then again, who listens to a psychologist when shrapnel is flying past your head?"
On the face of it, life in Slavyansk is back to normal. The city was recovered by the Ukrainian army from the separatists in the summer of 2014 after a pro-Russian rebel occupation that lasted four months. The battle for the city was a fierce one.
That calm, however, is only on the surface, says psychologist Mariana Basova, who works in Slavyansk. "Everybody is terrified. I was recently on a bus when one of the tyres punctured. It produced a hissing sound and there was a blind panic, with all the passengers throwing themselves to the floor."
Only in institutions where psychologists operated before the war started, is psychological help available. Mariana works in a rehabilitation centre for children from dysfunctional families.
The adolescents in particular have issues, she says. One example is 17-year-old Szymon. "After the shootings, he remained angry and bitter and was adamant to go to the front."
Mariana tried to talk him round for months. When his term at the centre ended, she took him to the university. "I waved goodbye to him. He left shortly after and is now fighting on the side of the separatists."
She knows of no one getting professional help outside her centre. "There are traumatised people all around me but no one knows what to do about it."
Oleg says: "The Soviet mentality of never asking for something is deeply anchored here. People from the Eastern Ukraine are not used to make [making] their needs known. We are not able to formulate why we feel depressed. We'd rather suffer than ask for help."
Tatjana Grida, a psychiatrist and trauma therapist in Kharkiv, the biggest city in Eastern Ukraine, says history is to blame.
"In the Soviet days, psychiatrists were used to punish people with deviating opinions. Dissidents were declared insane in order to try and break them. Some were even subdued with medication."
This is why there is still a taboo on psychological help.
"The first response I get when offering help is 'No thanks, I'm fine!' Nobody wants the label of being ready for the clinic."
For Mariana it was the first opportunity to share her war experiences. "We slept in the corridor for weeks," she says. "I was heavily pregnant at the time. There were missiles flying through the street and machine guns firing from within the bushes. When it really became too much we left for Russia, crying our eyes out."
And still it is not over. At work they practise evacuating the children each week. Each day, columns of army vehicles pass on their way to the front.
Talking is important for relief workers as they are often traumatised themselves, says Tatjana.
In her free time, she holds courses for social workers in the war zone, such as those in Mariupol, the front-line city on the Black Sea. "The psychologists work with fugitives there. Their own house, however, has also been destroyed. They not only have to deal with their own problems but treat people for war traumas as well - which is something no one in Ukraine has any experience in."
As Mariupol was bombarded several times, Tatjana had to make use of the air-raid shelter as well. "Even for myself I find it difficult to talk about that experience."
There is always the danger of post-traumatic stress disorder if you don't take the time to cope with a trauma, Tatjana says.
Many don't have a choice though, they have to survive. Like 21-year-old Sergej Tretiakov, when he saw a mortar grenade drop on his parental home. His little brother was thrown against the wall of a room, his mother was covered by debris and the house was in flames. Sergej's father tried to make the best of a bad job and Sergej drove his mother to the hospital, albeit too late. At the door the doctor concluded that shrapnel had pierced her heart. Six months later, his father died of a heart attack.
Sergej now looks after his 12-year-old brother. He cannot leave Avdiivka because he has a job in the café at the still-functioning carbon factory and there is no such thing as unemployment benefits in Ukraine. It is still dangerous in the city, and recently the café was hit by a grenade, killing three people.
Sergej's wife gave birth to a son, Dmitriy, in January. He is now trying to rebuild the family home with his own hands. "I must go on. Dmitriy is my reason to live".
According to Tatjana, many war victims only run into issues at a later time. "You can relive traumatic events years later. You get flashbacks and you experience it all again as if it is happening for the first time. Then you become a danger to the people around you because you will try to defend yourself again. The lack of understanding in your environment leads to depression and suicide."
The psychologists are doing great work, says Tatjana, but it's not enough. "It is a huge problem. Eastern Ukraine is collectively traumatised."
The shortage in help could lead to a social and political catastrophe, she warns, and with the deep economic crisis, this could be fatal to the country. "What people in war zones experience a lot is a lack of understanding. For the rest of Ukraine the war seems very far away."
Tatjana is looking to train more volunteers and psychologists but this type of expertise must be found abroad, in other countries which have experienced war.
Currently everything rests on the shoulders of a few volunteers; people such as Tatjana and the church of chaplain Oleg. He organises children's summer camps to temporarily remove youngsters from the atmosphere or war and to unburden parents. In the past year, more than 10,000 children went on holidays to Kharkiv province or the Carpathian Mountains.
"After only a few days you see them blossom," he says. "We want to make this help more structural by having the children spend all their vacations away from home."
Many volunteers are exhausted, says Tatjana. "I've been doing this stressful work alongside my regular job for two years now. I don't know how much longer I will be able to carry on."
Michiel Driebergen is a freelance correspondent from the Netherlands, based in Krakow, Poland.
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