By: Olena Riga is a Prof of Paediatrics at the National Medical University of Kharkiv, the Consultant to the Palliative Medicine Centre of the University
The devastating humanitarian crisis in Ukraine increases the vital importance of palliative care for children.
Approximate estimates of the number of children who needed palliative care in the Kharkiv region were approximately 9,000 – 10,000 in the pre-war period, including an additional 21,000 – 25,000 family members. As of January 1, 2022, there were 426,000 children under the supervision of health care institutions in the region. 216,900 children lived in the city of Kharkiv, 209,700 children in the rural area.
Before the military conflict, the health care to children 0 – 17 years old in the city of Kharkiv included outpatient care provided by 10 city children’s polyclinics and 2 polyclinic departments that are part of city children’s hospitals, as well as one family medicine department of the city polyclinic. For children from Kharkiv region: In the regions the outpatient medical care was provided by the primary health care facilities by general practice-family medicine doctors, but all children have access to consultative care in all areas of the region by pediatricians. Inpatient medical care was based on the 690 beds that were deployed in two regional children’s clinical hospitals. Currently, these two hospitals are combined into one in 2023. In 2021 and 2022, 9,300 to 17,700 received treatment. It should be noted that in connection with the military operations in the Kharkiv region, the forced departure of the population outside the region, the number of registered diseases decreased by an average of 1.5. Pediatric palliative care was provided in two settings.
There were opened “Department of palliative care – Children’s Hospice” (for municipal children) and the “Regional Clinic Center of Medical Rehabilitation and Palliative Care for Children “Hippocrates”’ (for regional children). The “Department of palliative care – Children’s Hospice” was opened in 2018 and had 20 beds for round-the-clock qualified palliative treatment and care, psychological, social and spiritual support of a sick children aged 1-18 years and members of his family, mobile team. The “Regional Clinic Center of Medical Rehabilitation and Palliative Care for Children “Hippocrates”’ was transformed from Baby Home in 2021 and had inpatient department for children under government care – 15 beds, inpatient department for joint stay with or without parents (individual wards) – 10 beds, mobile palliative team -5 services, children’s hospice 10 beds each institution, as well as centralized supplies at the expense of the State budget.
The history of the Center since the start of the sudden military conflict could look like this
- complete suspension of admission of children and families to the center and placement of Center residents and family members in basements with the provision of possible medical, psychological and volunteer assistance during the massive bombing
- understanding of the loss of some personnel (displaced people)
- providing assistance by telephone to those in need
- evacuation of Center residents, family members and part of the staff to Germany
- preparing the Center for humanitarian shortages (water supplies, food, purchasing generators, medical equipment, preparing for a nuclear disaster and etc)
- As attacks decreased and transport was able to operate in the city, the Center began to provide services to families with children living in the city of Kharkov (15-20/month). Help for families living in rural areas is still not provided due to the impossibility of providing 24-hour stay
- continuation of telephone consultation and opening of a mobile pediatric palliative care team service for urban residents
- support of director of the Center Roman Marabyan, who mobilized into the army from the first day