Paediatric refugees from Ukraine: guidance for health care providers

Authour:  The Migrant Health Reference Group of Paediatrics Switzerland and the Paediatric Infectious Disease Group in Switzerland.

Location: Switzerland

Summary

When the Russian army invaded Ukraine in February 2022, Ukrainian residents started migrating to neighbouring countries. Those fleeing the war were mainly women and children since few men were allowed to leave Ukraine. This caused most child refugees to be separated from their fathers.

While some refugees managed to leave early, others experienced attacks, hiding in bomb shelters and enduring a long and insecure journey. Even before the start of the current escalation, the conflict in the eastern part of Ukraine led to the internal displacement of more than 200,000 children, and many others have experienced attacks, e.g. on schools. During transit, overcrowding, poor shelter and vulnerability may further put refugees at increased risk for infectious diseases.

Between March and April 2022, members of the Migrant Health Reference Group of Paediatrics Switzerland and the Paediatric Infectious Disease Group in Switzerland, used a modified Delphi process to create 50 recommendations for healthcare providers working with paediatric refugees from Ukraine. Individuals less than 18 years old were defined as paediatric refugees from Ukraine. The threshold for a recommendation was met if more than 80% of the working group members voted for full agreement on the item. One of these recommendations focused on mental health.

How does this research apply to my work?

For refugee families coming from a war zone, even if they have not been directly exposed to violence, it is important to detect the warning signs of psychological suffering, in paediatric patients as well as in their main caregiver. These include:

• sleep disorders
•  nightmares
• behaviour changes
• hypervigilance
• bedwetting, anxiety attacks
• and mutism.

 
Recommendations for mental health:

• Assess for signs of psychological distress, examples included above.
•  Evaluate needs of children, adolescents, parents or caregivers for mental health support or specialized care.\
• Enquire whether the family, child or adolescent feels safe now, and if not, evaluate appropriate next steps and act.

 
The authors noted that an empathic approach, while giving overall support, is essential. This entails a willingness to listen when caregivers or children want to share. They however cautioned not to push persons to talk about hurtful issues if they are unprepared to do so.  Potential questions on how to guide discussions on mental health are also included in the article.

What should I take away from this research?

Stress is accumulated through the experience of war: violence brought by other human beings, the loss of objects and family structure, and aspects of exile. The absence of parental support may further aggravate the situation. The experience of war and exile may aggravate pre-existing mental health issues. Good living conditions, positive experiences and a sense of security are very helpful to regain wellbeing and trust in life. Children, adolescents and family members may be reassured that reactions to issues like flashbacks and sweating are common in people with similar experiences. A reduction of stressors, not staying alone, doing something that increases overall wellbeing and sense of security, distraction and removing from a triggering situation, etc. may help.

What is the next step?

Although the recommendations were created for healthcare providers in Switzerland, the mental health recommendations may be relevant for healthcare providers in Canada. The authors stated hat the recommendations are based on current evidence and may need to be adapted to individual situations and once further evidence becomes available.

To read the full article, click here.