The impacts of war on children with cancer – ensuring continuation of care for those whose lives depend on it

As the war in Ukraine intensifies, hundreds of children with cancer have been forced to flee homes and hospital beds all over the country and undertake dangerous journeys in the hope of reconnecting with the treatments they need to survive.

Undergoing chemotherapy treatment for a bladder tumour, 8-year-old Leonid was forced to leave a Kyiv hospital as the shelling escalated. He and his mother, Anna, set out in search of safety and treatment.

“The road was long and scary, and Leonid was terrified of the shelling and the bombs,” Anna said.

Leonid arrived safely at the Western Ukrainian Specialized Children’s Medical Centre in Lviv, near the Polish border, and resumed his cancer treatment. Unfortunately, Anna learned that her son’s tumour had grown.

“We want to go to Poland as soon as possible so our son can have regular treatment,” she said. “We don’t want to wait. No one is sure what will happen.”

WHO is coordinating with partners on humanitarian health assistance, both within Ukraine and on its borders, and providing supplies, technical support and surge staff. The Organization is setting up a Ukraine support hub in Poland and working to ensure that neighbouring countries have the infrastructure and expertise to serve a massive influx of refugees. More than 3 million people have fled the country, according to United Nations estimates.

To finance the response, WHO has launched a health emergency appeal for Ukraine. Local and international organizations are working against the clock to reconnect paediatric cancer patients with their treatments.

Children from all over Ukraine are being stabilized at the Western Ukrainian Specialized Children’s Medical Centre, then transported by ambulance to the Unicorn Marian Wilemski Clinic in Poland for triage. From there, they are sent with family members to children’s oncology centres in Poland, elsewhere in Europe and farther afield.

Yulia Nohovitsyna, working for a charitable foundation, said that about 170 children have benefitted from the referral system so far.

One of those is Anastasia, a child from Kyiv. She arrived with her mother, Natalia, in Hamburg, Germany, on 7 March, and has resumed her treatment for acute lymphoblastic leukaemia. Five days earlier, the mother and daughter had fled the Okhmatdyt National Children’s Specialized Hospital, which had come under artillery fire.

“It was impossible to continue treatment with the alarms, the sirens and the likelihood of the destruction of the capital,” said Natalia. “I am very grateful to everyone who arranged the evacuation of children, and those doctors who took us for treatment in Germany.”

Cancer is among the major challenges of the health emergency in Ukraine, WHO Director-General Dr Tedros Adhanom Ghebreyesus said this week. Dr Tedros also pointed to lack of treatment for respiratory and cardiovascular diseases and other problems.

Serving as Ukraine’s staging area for young cancer patients in transit, the Western Ukrainian Specialized Children’s Medical Centre is coping with dwindling supplies and a surge in ill, often traumatized patients – 6 months’ worth of admissions in 1 week.

“We are preparing for the worst: securing the windows, preparing space to evacuate in the basement. But it’s not adequate for our patients,” said Dr Severyn Ferneza, one of the Centre’s physicians, who fought back tears in an interview with WHO staff. “I don’t even want to think of what would happen if this hospital ceases to be able to function. No one else could manage.”

Although chemotherapy continues, patients still have to be whisked to bomb shelters about 4 times a day when air-raid sirens sound. Many of the children have already experienced shelling in cities like Kharkiv and Kyiv, and are terrified by the sirens. A psychologist has been working with the children twice a week, but hospital staff say the need for such services is far greater.

“Cancer itself is a problem, but treatment interruptions, stress and risk of infection mean that hundreds of children might die prematurely,” said Dr Roman Kizym, Head of the Centre. “We believe that these are the indirect victims of this war.”

Arthur, 6 years old, is among the newcomers to the Centre. He has acute myeloid leukaemia, a blood cancer. “We are grateful for this chance to survive and continue treatment,” said Alina Mykolaivna, the boy’s mother. “If we interrupted the treatment, then all the chemotherapy blocks that Arthur had been doing before would have been meaningless.”

Dr Kizym praised the international coordination that has already led to the evacuation and treatment of many patients. “Nevertheless, this is a difficult moment,” he said. “Some treatments, such as bone marrow transplants, which I worked so hard to make available in Ukraine, are now impossible. It is impossible to bring in donor bone marrow.”

The hospital’s transplant facility sits unused, a grand-opening ribbon hanging on the door from before the outbreak of the war.

One of Dr Kizym’s patients is Leonid, the boy with the bladder tumour. He is responding well to treatment, his mother explained, but seems indifferent. “He wants to go back home,” she said. “He misses home.”

Editorial changes were made to the content of this article on 17 March 2022 to clarify Dr Roman Kizym's quote.