Children with cancer hold signs that says “Stop War” in the bomb shelter located in the basement of … [+]
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As Russia’s invasion of Ukraine nears it’s three week mark, almost 3 million people are reported to have fled the country so far, many to neighboring countries such as Poland, Moldova and Slovakia. Among the most emotive images to have come out of Ukraine since the invasion began are those of sick children sheltering in basements of hospitals, medical staff and their families doing everything they can to continue their care under rapidly deteriorating circumstances.
Some of those pictured are children with cancer and they and their families face multiple additional barriers making leaving Ukraine even more difficult than for others. Many children undergoing cancer treatment will be medically fragile due to their cancers and treatments, requiring them to stay in hospitals with medical staff. Some will need to be attached to drips and machines and many are vulnerable to infection due to compromised immune systems, making evacuating them progressively more difficult as the war continues amid the ongoing Covid-19 pandemic.
“We estimate there are between 2,000-3,000 children on active treatment for cancer in Ukraine right now,” said Dr. Asya Agulnik, Director, Global Critical Care Program and Eurasia Regional Program at St. Jude Global at St. Jude Children’s Hospital in Memphis, TN. “Many of the hospitals have been affected by either bombings or air raids, where they’ve had to move patients to bomb shelters”
Hospitals have been targeted in the conflict, with several attacks on healthcare facilities resulting in the deaths of patients and healthcare workers. Other than these obvious risks, children with cancer have unique health needs making the situation especially precarious for them.
“Children with cancer require treatment with certain protocols and sequences of medications that have to be delivered at a specific frequency and most of those medications come from outside the country,” explains Agulnik, saying that there are shortages of both chemotherapy and supportive care drugs such as antibiotics in Ukraine now.
In the earlier stages of the war, the hope was to provide logistical support to hospitals and medical teams to continue to provide care, but the rapidly escalating situation is meaning that this is increasingly not a viable option.
Children with cancer are sheltering in the basements of hospitals as makeshift bomb shelters as … [+]
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“The overall aim is to provide good quality cancer care to these children in a safe way, what we’re hearing from our partners on the ground is that many of them feel that that is no longer possible in Ukraine,” said Agulnik.
St. Jude is part of an international team also including the International Society of Pediatric Oncology, who are trying to coordinate the transfer of children with cancer and their families to centers outside of Ukraine so they can continue their treatment. Many of those who have left Ukraine are currently in Poland due to geographical proximity, but efforts are being increasingly made to transport the families to other centers in Europe. As part of this effort, on Monday, the BBC reported that 21 children with cancer were evacuated to the U.K. to continue their treatment.
“The only information we had was that there would be 21 children, all with cancer needing therapy of all ages, and these children had undergone a very difficult time evacuating from Ukraine,” said Dr. Michael Griksaitis, consultant pediatric intensivist at University Hospital Southampton, in England who led the medical team on the flight to Poland and back. “We did not know any clinical or demographic details until we landed in Poland, which obviously made planning very difficult for the transfer as we had to attend prepared for all eventualities” he added.
“We went prepared to deal with all minor problems (e.g. travel sickness, tooth ache, headache) right through the ability to deliver an emergency anesthetic and provide full life support for these children, and also the accompanying siblings and adults, who also may have had medical needs. We provided a variety of medical care during the trip, but the major care we provided was emotional support. This was made possible by play therapists and translators alongside our team,” said Griksaitis.
The children and their families have been transferred to pediatric oncology centers across the U.K. to continue their treatment.
Although many children with cancer have been evacuated to hospitals in other parts of Europe, some are travelling further, with the Hospital for Sick Children in Toronto, Canada announcing that it is expecting 2 patients from Ukraine in the coming days.
Speaking on Friday 11th March, Dr. Agulnik said no children with cancer had yet been transferred to U.S. treatment centers, but “it’s definitely in the works and we expect that it will happen in the next few weeks.” As for how many children with cancer remain in Ukraine? Nobody exactly knows. Around 400 children are known to have been evacuated or to be in the process of being evacuated through the international program to help them. But others likely travelled with their families to safer countries themselves and many are still likely to be in Ukraine.
“There are many patients still left in Ukraine, but I’m not sure how many. There are also a significant number of patients who we know, can’t be transported, either because they are in a place that is unsafe, and transport is not possible, or because they’re medically not stable for transport,” said Agulnik.
