Children's health caught up in Ukraine conflict

Abstract

As well as killing and injuring children directly, Russia's invasion is preventing children from getting the care they need. Saleyha Ahsan reports. A medic in blue scrubs speaks to the camera of a journalist in Russian. “Show this to Putin…the eyes of this child and crying doctors.” UNICEF has warned of a growing threat faced by Ukraine's 7·5 million children as the conflict continues. Children are being killed or wounded through direct attacks by Russian military or they have been forced to flee their homes to an uncertain future. In a statement to The Lancet, WHO called for international humanitarian and human rights law to be upheld. “The number of civilians, including children, dying as a result of the military offensive in Ukraine keeps rising. This must stop. The protection of civilians must be priority number one.” As the war progresses, the stories mount. This story relates to the desperate attempts of doctors to save a 6-year-old girl, wounded during the Russian shelling of a residential area in Mariupol. Her unicorn patterned pyjamas now blood-soaked, her father sits beside her with a bloodstained bandage around his head, his face broken in grief. Doctors desperately try to save her life with cardiopulmonary resuscitation but fail. But children are not only being impacted by war from direct hits. The impact of the war is disrupting essential care that would have otherwise been available. 400 km to the west lies Kherson. The Lancet spoke to Olga (not her real name), a paediatric anaesthetist who also works in the emergency pre-hospital response teams. Part of her job is to ensure access to emergency services for those who need it, but this is hampered by blockades, shelling, and communications difficulties. She describes a case of a baby with breathing problems born in Nova Kakhovka, 100 km from Kherson. He needed specialist care in a neonatal intensive care unit (NICU), which the hospital does not have. Normally, he would have been transferred to the larger hospital in Kherson. Olga's team would have taken him in an ambulance with the correct equipment to take the child to the NICU. Kherson is home to 290 000 people and is 300 miles south of Kyiv. The city is strategically important, sitting on an inlet of the Black Sea. Heavy resistance is still raging, but the mayor of Kherson announced on March 3 that the city had fallen to Russian forces. It is surrounded by Russian military and ambulances are not being granted access. Transport is further hampered by fear of strikes and by the destruction of roads. So instead, the baby was brought to the blockade and according to Olga was “transferred by hands, carried through a long distance of blockades”. The boy is now on a ventilator in a critical condition. Staff are waiting for further roads to be unblocked so the baby can be evacuated to the NICU in Kherson. “Of course this impacts the outcome for the baby”, says Olga. Ukraine's emergency services state that more than 2000 civilians have been killed, including children, and that medical facilities have been destroyed. Irina Anatolyevna, a specialist caring for children with specific physical, mental, and behavioural needs, describes how her children's home in Kherson has been affected. Speaking to WHO, she said, “March 1, was a terrible day for us. The shelling intensified very much. I can’t speak. We were forbidden to leave the houses. Only some employees remained with the children”. The home cares for children from birth to age 4 years, with physical, mental, or behavioural challenges. The home also cares for children with parents who can no longer look after them or children who have been abandoned. “I help develop speech, attention, and memory. But these days, I and all my colleagues, we do not have a specialty, we are all mothers for our children, we do what we can, feed, drink, clean.” During the bombardment, all 58 children together with staff went into the basement. “It was terrible and hard there. We then took them to one of the churches, where they are all now.” In a statement to The Lancet, the International Federation for Emergency Medicine condemned the escalating attacks on health care in Ukraine and on patients “including vulnerable children and babies receiving treatment or shelter inside those facilities”.It described the ongoing disregard for the devastating physical and psychological toll on the most vulner-able patients and their carers as “abhorrent”. Professor Sally McCarthy, president of the Federation said: “It is critical that the ill and injured have a safe haven for the care they require, and protection of health-care workers and patients needs to extend outside of the health-care facility, allowing safe passage to and from the facility, and to safety.” The only option for Anatolyevna's young children is to leave. “We hear gunshots. Everything is closed. Stores are closed. We are asking, we are asking everyone, please let us leave the city and take the children crying to a safe place.” Ukraine's humanitarian disaster: priorities for healthAs the Russian invasion of Ukraine enters its third week, the results of President Vladimir Putin's cruel and destructive onslaught are becoming clearer. At least 352 civilians have been killed and 1684 wounded so far, although Ukraine's State Emergency Service puts the number of civilian deaths at more than 2000. Official sources report that 17 children have been killed and 30 injured. Roughly 2 million people have fled to neighbouring countries. Russian officials have reported that nearly 500 of their troops have been killed; Ukrainian armed forces puts the number at more than 11 000. Full-Text PDF