Ukraine's children of war: The mental scars of conflict

"I saw a lot of machinery, soldiers, and I saw the explosions," says 8-year-old Ivan (full name not disclosed). "When there was heavy shelling I got afraid and hid under the table. It's scary to hear it."

Ivan is one of 215,000 children internally displaced in Ukraine since the conflict between the military and pro-Russian separatists began in the east of the country two years ago. He currently lives with his mother Angela and older brother in the steel town of Mariupol. They fled their village in east Ukraine after it was taken over by pro-Russian separatists.

Over 9,000 people have died during the conflict, which started in April 2014. Many who fled came to Mariupol, a strategically important port city near the rebel-held areas in the east. Last January, 30 people were killed when separatists attacked the city.

"At first, we thought we were safe here, but on the 24 [January] we were under attack. I just came back from my night shift as a paramedic, and when I entered the apartment, the shelling began," says Angela.

"My older son was there and he got hurt. He was thrown out of the bed by the effects of the explosives. We thought we were safe here until that moment. Now, it is more safe despite that we constantly hear fighting," she adds.

Unicef says 200,000 children need psychosocial support in Ukraine, where the images and sounds of war can lead to unhealthy or regressive behaviour. Children can become more shy, fearful or aggressive even when they are in safe environments.

"Two years of violence, shelling and fear have left an indelible mark on thousands of children in eastern Ukraine. As the conflict continues, we need to reach these children urgently to meet their physical as well as psychological needs," says Giovanna Barberis, a Unicef representative in Ukraine.

When talking about Ivan, Angela notes, "He was afraid to fall asleep alone or to take a bath alone. Somebody had to be with him all the time until he fell asleep or until her finished taking his bath... somebody had to be there.

"While talking to my child, I kept noticing this nervous tension. When he talks, he's nervous and confuses words. He was not like that before. That all happened when the war started.

"His reaction to any gunshot was that he starts hiding, under the chair, under table or under the bed. He did it subconsciously. He was just focused on his fears," she adds.

Ivan regularly sees a psychologist with his mum and takes part in a programme helping children deal with psychosocial issues run by a local youth group organisation, along with Unicef. One survey showed almost 40% of children in conflict-affected areas in Ukraine need such help.

"Ivan's mother told me that he had started regressing a lot in his articulation. After this conflict he began speaking poorly. Before, he talked in a more or less proper way. Now, he misses sounds when he talks. He simply stopped trying," notes Maria Pronina, Ivan's psychologist who works with the Mariupol Youth Union.

"He started being afraid of many things, even coming up and meeting the other kids on the street, riding a bike, all the usual things kids do. He started being so cautious that he stopped developing.

"Currently, we really work on his self-confidence. The fears that recently appeared are slowly going away and I see every time that Ivan becomes more and more self-confident.

"We make special exercises for him based on his interests so he can speak better and overcome his fears when there is no reason for them. It's now a month since I've been working with Ivan and he has really progressed more than I expected," she adds.

Programmes are often run at youth centres in large cities, but they are too hard to reach for some children, especially for those closest to the frontlines. So in some cases, workers go to the children instead.

The programme aims to provide them with a protective environment to relax, play and express their feelings. However, reminders of the conflict are never far behind. After a second ceasefire agreement at the end of last year, fighting significantly decreased. But shelling continues in villages around Mariupol. The children living in the town of Talakovka can still hear fighting nearby.

"Last summer, I came out of our house and saw a rocket fly near me. I was afraid that it would hit our yard. That summer, there was intensive shelling and my father laid down mattresses in the basement. I went to the basement with my grandma and stayed there," says Valeria, an 11-year old living in the town of Talakovka.

"Last time shelling happened when I was home, we heard sounds of shelling. We went outside and we listened and my father said it was flying in our direction. My grandma took all the warm clothes and said we will go to the basement if it gets closer.

"I was afraid a bit, but my relatives told me everything will be OK. In fact, nothing horrible happened. On television, people say that in some villages there is constant shelling, but they got used to it.

"My mother and father suggested my grandmother and I move from here, but we decided to stay because I was born here. I don't want to leave. It's still a bit scary of course, like when you go to school in the morning. You feel uncomfortable in an open space, but I didn't want to leave.

"At the beginning I felt terrified, but now I am used to it. It's nothing new for me," she adds.

The conflict is still preventing those living in the country in getting their lives back to normal. Two years on, international monitors have warned of increasing violence in eastern Ukraine, with UK foreign secretary Philip Hammond noting in March that pro-Russian rebels continue to violate the extended ceasefire agreement that was agreed on 12 February.

"I'm not sure of anything any more. If they release this territory we'd like to go back. There's a big house with all the necessities. Here, we rent a two-room apartment and all the things in there aren't ours. We weren't able to take our things when we left," says Angela.

"It's hard, I'm afraid. I haven't been back home in a long time, for about a year, maybe even two years. I miss my home and keep asking my mother to go back. All my friends are there," Ivan adds.