The impact of "the war that drags on" in Ukraine for the health of children and adolescents: Old problems in a new conflict?

The early months of 2022 have already included several distressing world events. From the ongoing COVID-19 pandemic, to protests against vaccine mandates and COVID-19 restrictions, to the Russian invasion of Ukraine. Escalating conflict in Ukraine poses an immediate and growing threat to the lives and well-being of the country's 7.5 million children. Humanitarian needs are multiplying - and spreading by the hour. Children have been killed. Children have been wounded. They are being profoundly traumatized by the violence all around them. Hundreds of thousands of people are on the move, and family members are becoming separated from their loved ones.

The last eight years of conflict in eastern Ukraine have caused deep and lasting damage to children on both sides of the line of contact. This letter to the editor is intended to understand the suffering extends throughout the country. Hundreds of thousands are without clean water, electricity or water due to infrastructure damage. UNICEF is working to increase humanitarian delivery in the east and expand across the country as needed (UNICEF, 2022). The escalating conflict in Ukraine poses an immediate and growing threat to the lives and well-being of the country's 7.5 million children. Hundreds of homes have been damaged or destroyed, while damage to civilian infrastructure has left hundreds of thousands of people without safe water, electricity or water (Brasil et al., 2022). Meanwhile, hundreds of thousands of people are on the move, most of them women and children. After eight years of conflict in eastern Ukraine, children and their families also need systematic protection services to address gender-based violence, violence against children and to access psychosocial care. Mine risk education and mine victim assistance are critical as explosive ordnance contamination remains a major source of threat to life, safety and stability (BBC, 2022).

After the invasion of Ukraine by Russia on February 24, 2022, the world watches with concern and insecurity the economic, political and social consequences of the war. According to the Ukrainian government, since the beginning of the conflict, at least two thousand civilians have been killed and schools and kindergartens, among other social facilities, were destroyed in the process (CNN, 2022a). In this context, what will be the impact of this war on Ukrainian children and adolescents? According to the OCHA, 250,000 children now regularly experience shelling and are exposed to land mines and unexploded remnants of war, making them more prone to injuries and mental health issues. In eastern Ukraine's war zone, 12 conflict-related civilian casualties were recorded among children by the Office of the U.N. High Commissioner for Human Rights (OHCHR) last year alone (Cincurova, 2022). Three boys and one girl were killed because of land mines and unexploded remnants of war while eight more were injured during explosions and shelling, making this zone particularly dangerous for its youngest population, who are frequently exposed to mines while traveling to and from school. In the front-line village of Novomykhailivka, volunteers recently decided to paint drawings on the walls to teach children how to avoid mines while playing outdoors. In one school in Krasnohorivka, therapists had to teach children basic breathing exercises to protect them from panic attacks (UNICEF, n.d.).

The “Global Burden Violence” it is estimated that approximately 2 billion children in the world have experienced violence, with 200 million in 1990 to 357 million in 2016 growing up in war zones (Stanton et al., 2021). According to data from the United Nations (UN), Ukraine has at least 7.5 million children who are exposed to the hardships of war (e.g. lack of clean water or electricity), including due to armed conflicts prior to the current one - as in breakaway regions of Donetsk and Luhansk (UNICEF, 2022). The UN still estimates that at least 13 children have already been killed by March 1, 2022 (CNN, 2022b). The consequences of armed conflicts are devastating on the health of children and adolescents: (i) lack of housing; (ii) neglect and/or deprivation of education, sport and leisure; (iii) exposure to malnutrition/hunger; and (iv) exposure to infectious diseases. This causes increased infant morbidity and mortality, incidence of congenital diseases and hormonal changes such as dwarfism (Mohseni et al., 2020). Furthermore, exposure to violence during childhood increases the chances of chronic noncommunicable diseases in adulthood such as diabetes, cardiovascular disease, chronic lung diseases (such as asthma and chronic obstructive pulmonary disease (COPD) and cancer) (Chiang et al., 2016).

It is also important to highlight the impacts on the mental health of Ukrainian children and adolescents in this conflict. Wars, as well as natural disasters, increase the chances of anxiety disorders, post-traumatic stress disorders, depression and suicide in those exposed to them; as well as arouse negative feelings such as guilt, anger, sadness, anguish and loneliness (Gonçalves Júnior et al., 2020; Brazil, 2022). These effects are even felt over the long term. A French study showed that the impacts of the war in Sri Lanka are still perceptible in the discourse of parents to children (Edward et al., 2020) even years after the experience. Demonstrating the medium and long-term impact on victims and their generations. Children are now affected by fighting and security incidents. The long-term psychological effects of such trauma for children remain worrisome. Teachers report signs of psychosocial distress among children triggered by loud noises, and recent estimates suggest that more than 1 in 4 children require psychosocial support (Cincurova, 2022). For kids, the most important step for parents is to create a space that allows for listening. UNICEF said more than 200,000 children needed urgent and sustained psychosocial support after living through more than three years of violence. They are in Donetsk and Luhansk oblasts, within 10 miles of each side of the “contact line” (Theirworld, 2022). One in four children in eastern Ukraine is suffering from severe trauma and fear. Behavioural changes in children as young as three include severe anxiety, bed-wetting, nightmares, aggressive behaviour and withdrawing from families and communities.

Another concern is the quality of life of Ukrainian children and adolescents who are refugees in other countries. According to the United Nations High Commissioner for Refugees (UNHCR), the latest available data showed that 874,026 people fled from Ukraine to neighboring countries in the last seven days (BBC, 2022), most of them children and women. They add to the more than 21.3 million refugees in the world who experience: (i) difficulties in accessing information due to language differences; (ii) sociocultural differences with the countries in which they will take refuge; (iii) overcrowding of camps, intensifying close contact, as not all families of Ukrainian children and adolescents can or have relatives to turn to; and (iv) overloading local health systems and volunteer teams with the large number of individuals (Gonçalves Júnior et al., 2020; Hvass & Wejse, 2017).

Armed conflicts are always threats to freedom, justice and democratic values. Ukraine is currently experiencing a situation whose potential is catastrophic for its future, as, in addition to the loss of life, it compromises the mental and physical health of its children and adolescents. On these occasions, international mobilization and solidarity is essential, through agencies such as the UN, UNICEF, Red Cross, UNESCO, among others, together with the Governments of free countries and civil society to protect life in its most delicate form – childhood and adolescence. Taking care of our children, in addition to a humanitarian duty, is proof of a world that looks to the future. While the whole world is watching this region now—including leaders in Moscow, Washington, Brussels, and Kyiv—the people living on the front line say they want peace and are exhausted.