More than 300 million people live outside their country of birth, and armed conflicts have reached their highest levels in decades. Yet relatively little is known about how people living abroad cope when violence breaks out in their homeland. In a new House of Sustainable Society (HoSS) working paper, authors Mounir Karadja (Uppsala University), Akib Khan (Stockholm School of Economics), and Linna Martén (Stockholm University), examine this question by studying Ukrainians living in Sweden before Russia’s full-scale invasion of Ukraine in 2022.

The researchers analyze administrative data covering more than 10,000 Ukrainians who were already living in Sweden when the war began. By comparing them with similar migrants from other countries and tracking outcomes before and after the invasion, the study shows how the invasion affected mental health, employment, and earnings.

“Our findings show that the consequences of war extend well beyond national borders,” says Akib Khan, Postdoc and House of Sustainable Society-affiliated researcher. “People who are physically safe may still experience significant psychological and economic impacts when family and friends are exposed to conflict.”

Stress, work, and support from afar

The study finds that psychiatric medication increased by around 30 percent among Ukrainian expatriates in the first quarter following the invasion. The initial spike was driven by medications for anxiety and insomnia, which treat acute symptoms of mental stress. Antidepressant use began rising in the second half of 2022 – consistent with a shift from acute to longer-term conditions – and continued growing through 2024.

At the same time, the researchers observe a seemingly contradictory pattern. Employment and earnings increased among Ukrainians living in Sweden. To explain these findings, the researchers propose two mechanisms through which war can affect expatriates.

First, a mental health channel: concern for the safety of family and friends, together with the collective trauma of witnessing one's home country under attack, worsens mental health and raises the costs of working.

Second, a financial provision channel: the displacement, lost income, and destroyed wealth of loved ones raises the need to send support. When the second force dominates the first – as the evidence suggests it does – migrants work more despite worsening mental health.

This effect was strongest among individuals that came from regions that experienced heavier exposure to the war, which is consistent with a greater concern for relatives and need to provide financial support.

Balancing financial responsibility and emotional strain

The results show that Ukrainians were more likely to hold multiple jobs and spent less time unemployed. However, these jobs were often lower quality and lower paying than those held by comparable coworkers. Evidence suggests that many expatriates accepted lower wages and increased their work effort in response to growing financial responsibilities.

The study also highlights the importance of local communities. Municipalities that received larger numbers of Ukrainian refugees experienced smaller negative mental health effects among Ukrainians already living there. The findings suggest that social connections and stronger diaspora networks may help buffer some of the psychological costs of conflict.

A global consequence of modern conflict

The results replicate in survey data from Europe and the United States, suggesting that this issue extends far beyond Sweden. With more than 300 million people around the world living outside their country of birth, it becomes clear that the human costs of war can extend far beyond those directly exposed to violence.

“Our results point to a previously understudied margin of adjustment to conflict,” says Akib Khan. “Conflicts affect not only those who flee and those who remain, but also millions of people living abroad who stay deeply connected to events at home.”

Working paper:

Beyond the Battlefield: The Impact of War on Expatriates' Health and Livelihoods

Authors:

• Mounir Karadja, Uppsala University
• Akib Khan, House of Sustainable Society, Stockholm School of Economics
• Linna Martén, Swedish Institute for Social Research, Stockholm University