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Ukraine’s children desperately need more than shelter and food

While the immediate priorities of food, acute health care and protection will be taken care of, too many children are stressed, grieving and disoriented.
Children swing on a swing set
Children swing on a swing set next to a shelled apartment building in Borodianka, Ukraine on Wednesday.Alexey Furman / Getty Images file

There are two things that Ukraine needs right now. First, this deadly war of attrition and destruction must end. Second, the younger generations of Ukrainians must be healthy, educated, resilient and ready to take on the enormous task of rebuilding their country.

I can’t comment on what it would take to bring lasting peace to the region, though my friends with relevant expertise say it’s at least possible. But I do know a good deal about what Ukraine’s children and youth will need, starting right now. 

The tough reality is that the region’s health care and rehabilitation systems, its schools and social support capacities, which were stretched prior to the war, are struggling to keep up with needs.

Since the war began, UNICEF estimates that nearly two-thirds of Ukraine’s children have been evacuated from eastern cities under siege to relatively safe havens like Lviv in the west of the country or outside Ukraine altogether in host countries, predominantly Poland. 

I traveled to the region in April and May, eager to see for myself what it’s like on the ground in this very grave crisis for millions of Ukrainian children.   

First on the agenda in Lviv was visiting a hospital caring for child victims of war. Even being a  director of a pediatric intensive care unit early in my career didn’t quite prepare me for the level of pediatric trauma that I saw in a matter of several hours in that facility. 

I saw a 10-year-old girl with severe shrapnel injuries to her head and right shoulder. Her physical recovery was progressing, but she had seen her parents killed by Russian soldiers just outside their apartment building in a suburb of Odesa. I can’t begin to guess how or when her psychological recovery will happen.

A girl rides a scooter near destroyed buildings during attacks in Irpin
A girl rides a scooter near destroyed buildings during attacks in Irpin, Ukraine on June 2, 2022.Natacha Pisarenko / AP file

And then there were 11-year-old twins, beautiful kids who were among the scores injured or killed when, according to Ukrainian officials, a Russian missile hit the train station in Kramatorsk as people waited to evacuate. The boy had gone to get snacks for the trip and was essentially unharmed, but his sister lost both legs. Their mom had lost a leg and sustained severe injuries to her arm.

These stories are heartbreaking, but just outside the hospital walls is a different set of challenges for the child survivors of the war that may actually sabotage Ukraine’s long-term future. Too many children are stressed, grieving and disoriented, and many have not been in school since the invasion began.

Shelters for refugee children and families in Warsaw, Poland, and internally displaced children in Lviv are filled with kids languishing in unfamiliar settings. Most dads are off fighting, leaving moms struggling to keep up spirits and figure out how to provide basic necessities for the long haul, knowing that many of the cities they fled could well be uninhabitable for years, if not decades.

To be clear, the staff members serving these families in both cities are wonderfully caring, but internal strength is not inexhaustible even for the most resilient mothers and children. Time eventually erodes the capacity of almost anybody to cope with persistent adversity.

The tough reality is that the region’s health care and rehabilitation systems, its schools and social support capacities, which were stretched prior to the war, are struggling to keep up with needs. The Lviv region now needs to provide for the nearly 2 million internally displaced children and adults who have been sheltering there since late February. Warsaw alone has welcomed at least 300,000 Ukrainians, swelling its population by 17% in the past three months. 

While I am hopeful that the immediate priorities of food, acute health care, protection and shelter will be taken care of, thanks to humanitarian response organizations such as UNICEF, Save the Children, International Medical Corps and the like, how and where displaced Ukrainian children will get the mental health care they need is not clear. And what about educational continuity? Can the schools of Lviv or Warsaw and the other host communities accommodate the hundreds of thousands of children who have arrived from eastern Ukraine? 

In the refugee havens outside Ukraine, language barriers, not just available classroom space and the number of teachers, are yet another challenge. Internet-based distance learning systems, which children have been using during the war, can certainly help. But many kids do not have access to tablets or laptops. Even for those with the hardware, there is little evidence to document the uptake and effectiveness of distance learning as a replacement for in-classroom learning. 

As far as mental health support is concerned, every teacher, health care worker and political leader I spoke to in Lviv expressed concern that so many of the internally displaced children who are now being sheltered in the region have suffered psychological trauma. The children had fled in fear for their lives from Russian brutality, lost loved ones and friends, and missed the dads who were off fighting. 

Although the challenges facing Ukraine’s children are formidable, it’s worth reminding ourselves that they are not insurmountable.

And in a Warsaw high school, I met Ukrainian teenagers who clearly were suffering in silence, already displaying evidence of post-traumatic stress, such as difficulty sleeping, disassociation from others and depression.

A big problem with the inevitable disruption caused by war is that children who lose ground academically or suffer from persistent, untreated psychological trauma (or both) may have significant challenges to the possibility of leading productive, successful lives in the future. 

That’s a worry because once the war is over, in addition to the massive and costly need to physically rebuild Ukraine, all Ukrainians must be ready and able to assume responsibility for its recovery. 

Although the challenges facing Ukraine’s children are formidable, it’s worth reminding ourselves that they are not insurmountable. A new organization Ukraine Children’s Action Project, which I’ve co-founded along with my wife, Karen, is working with leaders in Warsaw and Lviv to think through strategies that can make a difference for children who, through no choice of their own, have been thrust into a world of disorientation, fear and stress. 

But I should underscore that these challenges must be met by international organizations collaborating with local efforts. I have met extensively with the mayors of Lviv and Warsaw, along with members of their administrations. Lviv Mayor Andriy Sadovyi is working on a plethora of impressive plans to accommodate the displaced Ukrainians who have sought refuge in his city. And the dynamic mayor of Warsaw, Rafal Trzaskowski, is determined to provide proper support for the Ukrainian refugees -especially children — who have settled there. 

So here’s what needs to be done going forward.

To begin with, there is broad agreement that more teachers and mental health professionals must be identified and hired. However, all such professionals need to be fluent in Ukrainian and specifically trained to deal with children who have been psychologically traumatized.  

Second, every school-age displaced Ukrainian child must be enrolled in school or a good quality remote learning program. Ukraine Children’s Action Project will be supporting the development of special schools in Warsaw and Lviv designed to provide a full range of “wraparound” support (social services, counseling, nutrition and so on) for displaced children.   

In addition, supportive summer programs with the same mission as the specially designed schools would benefit many children.

Finally, many children who have been evacuated to safety from war zones may have undiagnosed or undertreated health problems that interfere with learning. Such concerns include visual problems, behavioral issues and even hunger. 

The good news here is that the programs being used for the Ukraine Children’s Action Project are among the ones that Karen and I developed over 35 years as part of the Children’s Health Fund. In other words, we already have initiatives designed to identify and mitigate so-designated “health barriers to learning.”

But does this remain an ambitious agenda? Yes. However, as the more immediate needs of Ukrainian children are understandably being prioritized, addressing their mental health and access to education will prove just as crucial. Ukraine cannot afford to lose a generation of children if it is to secure a post-war future of hope and possibility.