Please stop the Russian-Ukrainian war – children will be more than grateful

Dear Colleagues,

Our journal devotes intense efforts to children’s health worldwide. This passion drives our daily clinical work, research activity, teaching endeavors and editorial commitments. We hoped that the health catastrophe of the SARS-CoV-2 pandemic would have been able to demonstrate that, as a sole humanity, we are all intricately linked, and if one suffers, all of us do. However, even before this pandemic reaches an end, the Russian invasion and war in Ukraine are now perpetrating destruction, pain, and death. As health professionals devoted to children, we cannot remain untouched by such atrocities.

The consequences of war on children are horrible and multifaceted (Table 1). War affects children of attacked countries, children of attacking countries, and even children of countries not actively involved in the conflict.

Table 1.

Main events associated with war, probable consequences on children and possible solutions. Some aspects concern only Ukrainian or Russian children, whereas other potentially all children worldwide

Events	Consequences	Possible solutions
Attacks	Injured children (higher prevalence than adults) Killed children (higher mortality than adults) Death of parents and family members The insurgence of new conflicts	Stop the war Organization of funerals, body repatriation Support to families, parents, brothers, and sisters (bereavement) Support initiatives in favour of peace from people of the conflicting countries
Recruitment of parents and family members into the army	Separation of families Death of relatives Fear of relative’s loss	Stop the war Support communication with family members Organization of body repatriation, funerals Support to families (bereavement)
Migration	Separation from and of families Separation from their room, house, village, country Separation from their friends and schoolmates Loss of beloved pets, clothing and toys	Stop the war Refugee visas Organization of lodging (e.g., family flats, host of people in private houses, designated areas for family units in asylum-seeking centres) Reconstitution of families Promotion of friendships both among migrants and with the host population Provision of feed and care for pets Donation of clothing and toys
Poverty	Basic needs coverage is not guaranteed Lack of food and clean water Toys and books are unavailable, sports and other hobbies are halted	Stop the war Humanitarian corridors Water sanitation measures Donations of food, clothing, toys Economical support
Lack of power, electricity, fuel	Lack of power, electricity, fuel for habitual life including heating, cooking, food preservation, information, internet, mobile phones	Stop the war Provide local/mobile power, electricity, fuel sources
Lack of school and education	Closed and destroyed schools, danger of travel from home to school Killed, injured teachers Traumatized parents, relatives, friends, teachers	Stop the war Support educational activities in conflicting countries, also using media support Early integration of migrants in school programs of the host countries
Lack of protection and security	Basic needs not guaranteed, such as free movement, sleep disruption Contacts with friends difficult or dangerous Feelings of fear, uncertainty, helplessness, sense of injustice, hate Impaired emotional and social development (undermining the long-term capacity of a population to live peacefully and to build healthy social interactions) [10] Sexual abuse of children due to destruction of family and social structures [11]	Stop the war Psychological support to families Support initiatives for peace worldwide Contacts through technology (phone, internet, …) Wise media coverage, avoiding shocking images during the daytime, reading journals and watching TV with adults (regions outside the conflict area(s)) Initiatives to re-establish a healthy and peaceful societal feeling and “live together” after the war (in both attacked and attacking countries) Education and prevention, surveillance, respect and application of national and international laws
Disruption of health care	Ill children needing medical and hospital care Attacks to hospitals, lack of health personnel Casualties, injuries and traumas Infectious diseases, SARS-CoV-2 recrudescence Lack of clean water and hygiene, malnutrition Access to research, advanced technologies, innovative drugs is limited or impossible (no international supplies, censorship, lack of access to updated information and research)	Stop the war Humanitarian corridors, humanitarian medical missions Transfer and care of ill children outside the war-zone through humanitarian programs Provision of drugs Economic and instrumental support to hospitals and medical activities in war zones Foresee exceptions to international sanctions Prioritize the health of children, who represent the future of humanity
Repression and censorship	Propaganda, misinformation, censorhip Children may have parents that are imprisoned or censored Imprisoned children	Stop the war Stop censorship Respect of national and international laws on child and adult protection Support of initiatives in favour of peace Consider refugee visas also for Russian families leaving their country
International isolation	Access to shared knowledge, exchanges, friendships are limited or impossible Separation of international families	Stop the war Stop censorship Support relationships and shared activities between people of conflicting countries
Global security risks	Extension of the conflict, world war Nuclear threats (nuclear war, attacks to nuclear centrals)	Stop the war Prudent and wise decisions of governments Respect for international laws Avoid war crimes, prosecution of war crimes

In the short term, children of attacked countries bear disproportionate consequences of war. They undergo higher-energy tissue injuries than adults and massive burns, leading to higher mortality [1, 2]. Health care disruption leads to a lack of medicines and halts routine preventive care, including childhood vaccinations. During the war, the lack of medical care terribly affects ill children, and further privations and violence may increase these events in refugee conditions [3, 4]. In the medium-long term, the consequences of family separation, poverty, lack of sanitation, school, friendships, security represent additional burdens and can lead to post-traumatic stress disorders [5].

Also, children from attacking countries are at risk of major consequences: poverty, stigmatization, relatives’ losses, and lack of peaceful and constructive education. These experiences may lead to enduring health problems and affect their life trajectory. There is even the possibility that the current suffering of children from both attacked and attacking countries might stimulate new conflicts in the future.

Finally, even children outside the conflict area suffer. Parents, educators, and health professionals face many challenges in explaining war to children, including: how to deal with the feelings of sadness, helplessness and uncertainty across the world, and how to anticipate a possible recrudescence of SARS-CoV-2, for which migration and overcrowding provide fertile soil for disease spread and mutation development [6].

An increasing number of children in Ukraine are dying every day as a consequence of this terrible war [7], and many other children worldwide are suffering due to this situation. We express our solidarity with all caregivers worldwide who stand up for children's fundamental rights to security and reasonable care in dangerous conditions and at the risk of their own lives and freedom. Meanwhile, we must prepare to face the catastrophic consequences of this war. Pediatricians worldwide will need to offer additional help to support the physical and mental health of refugee children and their families. Shared efforts, efficient use of limited resources, fund-raising initiatives and innovative ideas will be required from all of us. Action to tackle these needs, as well as pertinent research, are urgently needed. Numerous Ukrainian refugees have arrived in many European countries, and we need to benefit from the lessons learned in previous migrant waves [8]. We will continue our daily clinical, research, teaching and editorial work, convinced today more than ever that “whoever preserves a single life, is considered to have spared a complete world” [9].