Over the past five days, as Russia's invasion has continued, the basements of Ukraine's children's hospitals have become bomb shelters for the country's youngest cancer patients.
Thin mattresses, pillows and blankets cover the floors of underground hallways as the sound of explosions and gunfire can be heard above. Parents speak quiet reassurances to their sick children, encouraging them to eat or sleep.
Doctors and nurses try to provide the limited treatments they can, despite dwindling supplies of necessary medications, as well as food and water.
"These children suffer more because they need to stay alive to fight with the cancer — and this fight cannot wait," Dr. Lesia Lysytsia said over the phone from the basement of Okhmatdyt, a Kyiv children's hospital, the country's largest, where sirens warn of bombings every few hours and child victims of the battles are treated.
A number of kids have access to only a basic form of chemotherapy right now. Other treatments have been interrupted, raising concerns that the children could relapse, not achieve remission and grow sicker.
If the interruption of treatment continues, "our patients, they will die," Lysytsia said.
"We will calculate how many people or soldiers have died in attacks, but we will never calculate how many patients weren't diagnosed of a disease in time, how many patients died because they didn't receive treatment," she said. "It's an epic amount of people."
Some kids' blood counts grew so low and supplies so short at Kyiv Regional Oncology Center that doctors started doing blood transfusions from parents to the children, said Julia Nogovitsyna, the program director at Tabletochki, the country's largest child cancer charity.
Although the situation is increasingly untenable, evacuating the sick is difficult. Hospital staff members don't know how long travel will take, what medical supplies will be needed for the journey and what dangers they might encounter on the road.
"Patients and their parents ask me if it's safe, and I say, 'I don't know,'" Lysytsia said. "I don't even know if it's safe to go outside. It's possible they go out near the hospital and they'll be attacked."
Nevertheless, for those children who can’t wait, Nogovitsyna and doctors like Lysytsia are working with other Ukrainian medical professionals to get them to a medical center in Lviv in western Ukraine, where supplies are more plentiful and conditions are safer. From there they hope to move some of the sickest children to Poland, where officials have promised them medical care.
Yet the number of patient beds in Lviv is shrinking, and crossing the border to Poland is difficult as hundreds of thousands of Ukrainian residents try to flee the country. Nogovitsyna said tension and fear at the border have prompted refugees to throw rocks at cars with sick children inside or even to hit the vehicles.
"There are so many people, and they are so furious that they just hit every car that is trying to pass by," Nogovitsyna said by phone Monday. "Today we had a doctor go with a patient, and we are lucky to have a police car go with them. Otherwise they would have been torn apart for trying to go ahead of the queue."
More kids will be following that path out of the country soon.
Fourteen children from Kyiv were put on a bus Monday to Lviv, typically a three- to four-hour journey. After eight hours of circuitous routes and checkpoints, they most likely had five more hours to go, Nogovitsyna said from her home outside Kyiv.
A couple are following the bus in a car with their 37-day-old baby girl, who was born with leukemia. Under normal circumstances, the child would be transported to Lviv by ambulance as quickly as possible, Nogovitsyna said.
“She is the most difficult one out of all patients,” said Nogovitsyna, who has been working to translate patients' records for the Polish doctors who will treat them. “I don’t know how she will survive this.”
The group will be joined Tuesday in Lviv by a second bus of around 20 children. From there, police will escort them to the Polish border.
Dr. Roman Kizyma, the lead pediatric oncologist at the Western Ukrainian Specialized Children's Medical Center, is working to get some of the kids ready for the journey and welcoming new patients from Kyiv and Kharkiv, Ukraine's second-largest city.
While Lviv is safer, Kizyma said over the phone that sirens warn of bombings every few hours. Staff members have made it into a game with the younger kids. Whenever the bomb sirens wail, the children are told they must run as fast as they can to the “dungeon,” although the sickest kids who are on oxygen have to be left behind in their beds.
"It is traumatizing," said Kizyma, who has sent his family to live in the mountains.
The game is less convincing for kids over age 10, who are angry and scared. Their reactions are painful to see; Kizyma said some of them are working with hospital psychologists.
For most of the children, even though they are closer to the border, evacuating is an unlikely option because Polish hospitals would become overloaded and many families have other kids who aren't sick or care for elderly relatives.
The number of patients being moved is small, Nogovitsyna said, considering that 1,000 children in Ukraine are diagnosed with cancer every year.
Kizyma, who is also an officer in Ukraine's reserve military, said he believes Ukrainians can still live relatively normal lives in Lviv. His hospital is working to get more medical supplies from partners in Europe, but the city still suffers the occasional attack.
He said he and other staff members "will stand here until the last moment."
"If we leave here, a lot of children we are determined to take care of will die," Kizyma said, adding he will take up arms against Russia if necessary.
Nogovitsyna and Lysytsia shared similar sentiments.
Nogovitsyna said she spent the first few days of the conflict crying. Now she doesn't shed many tears. She doesn't sleep or eat much, either. She's fully committed to ensuring the safety of these kids.
"My worst fear is that I won't be able to help them anymore," she said.
Lysytsia, who is camped out in the basement of her Kyiv hospital with her family, said she plans to remain there for as long as it takes.
"We will do everything that is important for our patients," she said, "and we will stay until the end."