PURPOSE: There are often high rates of mental disorders in low- and middle-income countries during humanitarian crises, but the prevalence of somatic distress (SD) is underreported in the existing health service research. We aim to examine the patterns of SD among internally displaced persons (IDPs) in Ukraine, who were forcibly displaced due to the ongoing conflict in the country's eastern region. METHODS: The study design was a cross-sectional survey of 2203 adult IDPs throughout Ukraine. The survey collected data on sociodemographic characteristics, traumatic life events (Life Events Checklist), utilisation of mental health care services, and self-reported outcomes of SD (Patient Health Questionnaire 15), anxiety (Generalised Anxiety Disorder 7), depression (Patient Health Questionnaire 9), and post-traumatic stress (PTSD Checklist). Descriptive and multivariate regression analyses were used. RESULTS: Over half of respondents (n = 1142, 55%) were identified as being at risk of SD (PHQ-15 score ≥ 6), and the prevalence of moderate (n = 377, 18%) and high severity SD risk (n = 275, 13%) was substantial. There were significant associations (p < 0.05) between SD and age, female gender, economic status, self-reported depression and post-traumatic stress, and multiple trauma exposures. Being at risk of SD was also significantly associated with increased functional disability. Use of mental health care services was low across this population and only high SD risk seemed to be a reliable predictor of care-seeking behaviour. CONCLUSIONS: There is a significant risk of SD among IDPs in Ukraine. Our results illustrate the need for targeted health service research and regional programs to ensure that mental health needs are appropriately met.