Ukraine: Better care for children with complex long-term health needs

This article was exclusively written for The European Sting by Ms. Nataliia Pidmurniak, a dedicated final-year medical student at Bogomolets National Medical University, Kyiv, Ukraine. She is affiliated with the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

In Ukraine, many children continue to be cared for in institutions. Estimates vary widely and suggest that between 90,000-200,000 children reside in these institutions, and approximately 20,000-50,000 of them have disabilities. The children have a range of disabilities including congenital abnormalities of nervous and cardiovascular systems, foetal alcohol spectrum disorders, genetic disorders and chromosomal abnormalities, visual impairments, cerebral palsy and epilepsy.

Factors impacting institutionalisation include poor infrastructure for children with disabilities, including education and community-based therapy services. There is a lack of crucial services, including rehabilitation and palliative care, and support in the community, making caring for a child with complex health needs even more challenging. Social challenges also drive institutionalisation including poverty, social stigma and the lack of support means families are left isolated. An estimated 90% of children placed in institutions have parents or family but are placed in institutions because of the challenges of caring for them in the community. Other factors include the inability of parents to care for their children, neglect or substance abuse. 

Impact of institutionalisation

Children living in institutional environments can suffer significant harm including the impact on their quality of life, their ability to adapt to society, mental health and overall development. Facilities often fail to meet basic needs, address individual requirements and provide basic emotional and social stimulation. Institutionalisation can lead to poor physical and mental health outcomes, stunting and a lack of development from inadequate nutrition, and infectious disease. Children who have been institutionalised can be left with difficulties processing and integrating sensory information, poor language development, damaging behaviours and significantly shortened life expectancy. Staff to child ratios are often inadequate, leading to inappropriate methods of restraint and a lack of supervision means children are not provided with adequate sanitary care, or assistance with feeding.

Reform and impact of war

Before the war, the government had adopted the National Strategy on Reform of the Institutional Care System (2017-2026), however there have been delays in implementation and children with disabilities have been excluded included in these reforms. The war has made the situation for children with complex long term health needs even more desperate. Whilst children with more mild disabilities are being evacuated, many children have been moved from facilities in the east of Ukraine to inadequate facilities in the west leading to overcrowding, further reduced staff ratios, and a lack of medical records leaving staff looking after children with no background information about their condition and care needs. In some cases, children have been returned to their families without support or guidance to ensure the child’s health needs are adequately supported. The European Commission has provided 230 million in humanitarian aid to the Ukrainian government which brings an opportunity to ensure disabled children benefit from the assistance provided to Ukraine.

About the author

Nataliia Pidmurniak is a dedicated final-year medical student at Bogomolets National Medical University, Kyiv, Ukraine. Her commitment to healthcare advocacy is evident through her participation in global summits and conferences. Notably, as the President of the Ukrainian Medical Students’ Association, Natalia actively engages in post-war reconstruction discussions, representing the needs of Ukrainian students. In her role as a National Exchange Officer, Natalia secured 120 contracts for professional and research exchanges, adjusting terms swiftly after the invasion to preserve 90% of spots for Ukrainian students. Nataliia’s international involvement extends to collaborations with WHO. She contributed to the WHO report on Patient Safety, and participated in Youth Consultation with WHO representatives. Currently serving as an Assistant Manager at Imperial College London, Nataliia focuses on research related to patient safety and the quality of medical education during wartime, showcasing her dedication to advancing healthcare on a global scale.