War may raise the level of distress and post-traumatic stress disorder (PTSD). The study explores the extent to which 4 factors determine levels of PTSD and distress symptoms of Ukraine civilians (without developing PTSD) during the current war.

The data were collected via a Ukrainian internet panel company. 1001 participants responded to a structured online questionnaire. Path analysis was conducted to identify predictive indicators of PTSD scores.

PTSD symptoms positively correlated with respondents’ level of exposure to the war and their sense of danger, and negatively correlated with well-being, family income, and age. Females scored higher on PTSD symptoms. Path analysis showed that higher exposure to war and higher sense of danger increase PTSD and distress symptoms, whereas higher well-being, higher individual resilience, and being a man, as well as older age decrease their level. Despite the strong effects of the coping suppressing factors, most respondents did not reach the critical level of PTSD or distress symptoms.

At least 4 positive and negative factors account for people’s coping with stressful experiences: previous traumatic experiences, individual level of pathology, personality attributes, and socio-demographic characteristics. The balance of these factors protects most people from PTSD symptoms despite their being affected by war traumas.

The aim of this study was to evaluate the change in knowledge and skill confidence after implementation of a chemical, biological, radiological, nuclear, and explosive (CBRNE) training course during the Russia-Ukraine War.

Pre/post-test study in the Ukrainian cities of Kyiv, Dnipro, Zaporizhzhia, and Odesa. Fifteen CBRNE courses were conducted over a 3-mo period, August to October 2022. Change in knowledge and skills confidence were evaluated with pre/post-course written exams and practical skill assessments that were observed during the training exercises. Changes were analyzed based on nonparametric Wilcoxon matched-pairs signed-rank testing. Pre/post self-efficacy surveys were analyzed with McNemar’s test for paired data. Course evaluations were conducted with standardized questions which assessed instruction quality, teaching relevance, knowledge gained, and post-course skills confidence.

A total of 523 participants registered and completed 1 of the 15 courses. Overall mean pre-course test score: 57.8% (SD 20.7%); mean post-course test score: 81.4% (SD 11.3%); participants with increasing test scores: 90.7%; mean difference in score (95% confidence interval) 23.6% (21.2%-25.9%), P < 0.0001. Pre/post self-efficacy surveys (4-point Likert scale) noted participants recognized signs and symptoms of a CBRNE incident, and necessary skills to manage CBRNE exposures, P < 0.0001.

The implementation of this CBRNE course for front-line providers in Ukraine was successful. To our knowledge, it was the first implementation of a field course during the current Russian-Ukraine war. Future research should evaluate knowledge retention and impact of our innovative Train-the-Trainer model. Further iterations should emphasize expanding the quantity of training equipment and practical skill sessions.

The main objective of this study was to summarize the Hybrid War’s core characteristics and humanitarian and medical impacts.

A Systematic Literature Review according to PRISMA guidelines, using the following keywords, ‘Hybrid War,’ ‘Humanitarian Law,’ ‘Human Rights,’ ‘Lawfare,’ and search engines PubMed, Scopus, Web of Science, and Gothenburg University’s database to collect literature from 2000 to 2022 in English was conducted. The eligibility of qualified articles was assessed, an inductive qualitative thematic analysis was applied, and the scientific evidence of each selected piece was evaluated.

The objectives of a Hybrid War are to achieve the tactical and strategic goals in a battle rather than to save civilian lives. It involves networks of state and non-state actors with various means of military and militia influences and strategies, creating difficulties in implementing, controlling, and evaluating the International Humanitarian Law’s “A State responsibility” principle, to gain insight into an armed conflict. It targets populated civilian areas and raises ethical and moral concerns by using Lawfare.

Hybrid War’s multi-domain action should be met with multi-dimensional approaches and a doctrine of ‘acceptable losses.’ Its characteristics and consequences should be learned and taught. Several measures need to be implemented to counteract its impacts, and a flexible surge capacity should be designed, planned, and executed.