Paediatric neurology in Ukraine: a call for help

In Ukraine, before the war, neurological care for children was provided by approximately 700 paediatric neurologists (one per 8400 children). The responsibilities of paediatric neurologists in Ukraine are diverse and include neurorehabilitation for children with acquired CNS injury and psychiatric care for pre-school aged children. Substantial challenges were identified during a 2021 visit of the Training Advisory Board of the European Paediatric Neurology Society to Ukraine. This evaluation noted that physicians trained as paediatricians or neurologists received only 5 months of further specialist training, compared with 2·0–3·5 years in other European countries. The evaluation also noted little involvement of trainees in daily clinical practice and reduced access to up-to-date genetic and metabolic diagnostics and novel therapeutics, such as emergency antiseizure medications, drugs, and gene therapies available in other European countries.
The situation has changed markedly since the start of the Russia–Ukraine war in 2022. By July, 2024, almost 7 million Ukrainian refugees (about 15% of the population and mostly mothers and children) were living outside Ukraine, and almost 4 million people were displaced within Ukrainian borders. The number of paediatric neurologists in Ukraine is now around 300. The shortage of specialists is particularly bad in regions close to the front line. The length of paediatric neurology training is now reduced to 3 months. The constant risk of missile attacks causes fear and anxiety, reducing parents’ desire to leave home and seek highly specialised care in tertiary centres. These circumstances have resulted in delayed diagnosis of neurological conditions. The number of children requiring rehabilitation for CNS injuries has increased due to war-related trauma. There are very few child psychiatrists in Ukraine; therefore, the management of post-traumatic stress disorder in children is now done by paediatric neurology services. We need urgent help to deliver comprehensive services for children with post-traumatic stress disorder.
We call on national governments and medical societies in Europe to support children with neurological disorders in Ukraine. Once the war ends, the country must develop and fund a training programme for paediatric neurologists that is in accordance with the standards set by the European Paediatric Neurology Society syllabus. We call for help to establish systems and funding to ensure that children in Ukraine can access therapies regarded as standard of care elsewhere in Europe. Also, paediatric neurologists in Ukraine need support in managing mental ill health in children with neurological diseases.