Almost four years of grinding warfare in Ukraine has taken a terrible toll in terms of battlefield casualties. It is also causing “profound psychological harm” to Ukraine’s civilian population, according to a recently released report.

Behind the front lines, “the war has severely destabilized social and familial structures,” according to the report titled The Rise in Violence Among Civilians in Ukraine, published by the Washington-based New Lines Institute.

The report’s three authors conducted a clinical survey of Ukrainian civilians during the first year of the Russia-Ukraine war, which began in February 2022, finding that 75 percent of respondents manifested PTSD symptoms, while 66 percent showed signs of moral injury. The US Department of Veterans Affairs defines moral injury as actions that occur in “unusually stressful circumstances” in which “people may perpetrate, fail to prevent, or witness events that contradict deeply held moral beliefs and expectations,” causing feelings of “guilt, shame, disgust and anger.”

The trauma experienced by Ukrainian civilians is linked to a rise in aggressive behavior, the report states, noting that in 2023, reported cases of domestic violence across Ukraine rose 20 percent over the previous year. Registered crimes shot up by 80 percent over the same timeframe.

“Prolonged exposure to conflict, destruction of infrastructure and the breakdown of social networks contribute to rising interpersonal violence within civilian life,” the report states. “Evidence from previous wars suggests that trauma exposure, including PTSD and moral injury, can increase aggression among affected populations, creating a feedback loop in which societal violence escalates even in areas not directly attacked by military forces.”

The report recommends a variety of steps to address the mounting damage done by war-induced trauma, including systematic research and the development of outreach programs offering “parenting support, youth mentoring, and trauma-informed psychosocial care, to protect children and adolescents from war-related violence.” Other programs should be designed to address ancillary factors that contribute to domestic violence, such as alcohol abuse, the report suggests.

“Effective implementation requires coordination across multiple sectors and levels, including individual, family, community and national systems, as well as investment in mobile and community-based services,” the report states.