More than 850 children with cancer have been evacuated or are in the process of evacuation from Ukraine, 45 days after a collaboration of international organizations began transporting pediatric cancer patients out of the country.
The operation is still going strong, with only about 100 children on the evacuation list remaining in Ukraine, said Yuliya Nogovitsyna, program director of the Kyiv-based Tabletochki Charity Foundation.
“Just yesterday, we took children out of Kherson. They have been for more than a month under occupation, and they are still under occupation, but we found cars and drivers who were ready to risk their lives and go to the city and take children out,” Nogovitsyna said to The Cancer Letter. “It was a risky operation. Nobody gave any guarantees that they would not be shot on their way. But we managed to do this, and these children are already safe in Lviv, in the west of Ukraine, where I am now as well.”
Transporting children to the Western Ukrainian Specialized Children’s Medical Center in Lviv is only the first step in relocating pediatric oncology patients to hospitals in Europe and North America.
Main institutions conducting the operation include St. Jude Global, the Polish Society of Pediatric Oncology and Hematology, Poland’s Fundacja Herosi, and Tabletochki, which supports Ukrainian children with cancer.
“Our partnership started in 2018, and we could never have forecasted that we would need St. Jude in such a capacity, as our principal international partner, to take children out of Ukraine and triage them among European and North American hospitals,” Nogovitsyna said. “We could never have thought of it.”
Last month, The Cancer Letter spoke with Carlos Rodriguez-Galindo, director of St. Jude Global, chair of the Department of Global Pediatric Medicine, and executive vice president at St. Jude Children’s Research Hospital, about the U.S. side of the operation (The Cancer Letter, March 4, 2022).
Each organization plays a specific role in the evacuation process. After pediatric oncology patients are assessed in Lviv, Tabletochki arranges a convoy—including buses, ambulances, police escort, and Polish embassy escort—to transport groups of children across the Polish border.
A train equipped with medical supplies then transports these children to the Unicorn Clinic of Marian Wilemski in Bocheniec, Poland, a resort-turned-medical hub, where Polish, German, and American physicians triage the children. After a few days, the pediatric oncology patients and their families are sent to their final destinations.
Where the children go depends on their specific medical needs and the healthcare capacity of destination hospitals, Nogovitsyna said.
“Poland has almost exhausted its capacities,” Nogovitsyna said. “They hosted more than 200 Ukrainian kids with cancer, which is a big number for pediatric cancer.
“Germany is also close to their full capacity. They have 170 Ukrainian children with cancer. That’s why the last convoy was distributed among other countries—the Netherlands, Switzerland, Italy, and probably France. These are more distant countries and they still have more capacity to accept our children.”
Another key consideration is the needs of the patients’ families—some travel with up to six or seven siblings, Nogovitsyna said. Other organizations, such as Childhood Cancer International, have partnered to help host families and provide them with interpretation and legal services.
“Everything is for free for these families. They do not pay for anything,” Nogovitsyna said. “They can enjoy free transportation, free medical services, accommodation—those hospitals which are ready to accept them must guarantee that they have capacity, not only to treat patients, but also to accommodate families and provide them with basic things, like clothing and food.”
Across the globe, members of the Ukrainian diaspora have volunteered to translate the medical records of pediatric oncology patients evacuating Ukraine.
“St. Jude arranged a huge team of translators, Ukrainian-English translators, all around the world,” Nogovitsyna said. “They have been translating records from Ukrainian to English without stopping for one month and a half already.”
As the crisis in Ukraine evolves, Tabletochki has not yet shifted its focus to bringing children back into Ukraine, Nogovitsyna said.
“We are still very careful about our plans,” Nogovitsyna said. “Of course, we want the war to end as soon as possible so we can rebuild the Ukrainian pediatric oncology service, but if the families come and say that they want to be evacuated, we help them. This pathway, it still works, and we ask not to close it.
“Once we understand that everything is safe and stable, we will come back to Kyiv again to resume our assistance programs in their full scope, and we will focus on rebuilding the Ukrainian pediatric oncology service—and I am sure that in partnership with the local doctors and international partners, we will make it stronger and better than before.”
Once children do return to the Ukrainian healthcare system, Nogovitsyna said she is concerned about catching up on pediatric cancer screenings missed due to the Russian invasion.
“I think that we will have this problem for many months, when the children will present at very advanced stages, or even they will die being undiagnosed,” Nogovitsyna said. “It’s the same situation that we had everywhere in the world during the COVID pandemic.”
Donations to support Tabletochki’s efforts can be made at GlobalGiving.
Nogovitsyna spoke with Alice Tracey, a reporter with The Cancer Letter.
Alice Tracey: First of all, I’m interested in hearing about your organization. How did this collaboration with St. Jude begin?
Yuliya Nogovitsyna: I work for the Tabletochki Charity Foundation, I’m the program director. It’s the biggest childhood cancer NGO in Ukraine.
We’ve been working in this for more than 10 years, and we used to be number one in crowdfunding—fundraising from people—so we are not sponsored by any big corporations or political parties or government. We really fundraise from people, companies, and so on.
We are located in Kyiv, but we support children with cancer all over Ukraine, regardless of where they are treated, regardless of their diagnosis—as long as it’s a hematological or oncological disease and they are under 18 years old, they can become children under our care.
We used to have lots of assistance programs. So, we fundraise, and we do not give money to a hospital—we implement our own assistance programs. We buy medicines, equipment, some disposables, and we make renovations in different hospitals where cancer kids are treated. We train doctors—send them to study visits, international conferences, pay for English courses, and so on.
We provide palliative care, because in Ukraine, palliative care is underdeveloped. We have a team of palliative care specialists, psychologists, and doctors. We have psychosocial rehabilitation for childhood cancer survivors.
We have psychological counseling for families at any stage of the patient pathway, starting from diagnosis through treatment, and either to remission or to palliative care, end of life, and grief support.
That’s what we used to do, before the war started.
I manage all these programs, and I have a team of 13 coordinators who are in charge of these specific programs. The war changed everything radically because many of these programs became obsolete—it’s just impossible to implement them any longer.
We refocused on three major things. The first one of our priorities is to evacuate children with cancer from Ukraine. We started it very early, I think two or three days after the war outburst. We understood that it is not possible to treat children in such conditions, when the hospital can be hit by a missile. There are air strike alarms, and the children had to be put in basements or bomb shelters.
Of course, this disrupts any intravenous administration of drugs, any surgery, any radiation therapy. So, it doesn’t make sense even to start it, because physicians don’t know whether they will be able to finish it. Also, all supplies were interrupted—medical supplies—and food and water.
In the first days of the war, we helped with supplies as well, because children were still in hospitals, they could not go anywhere. They were short on everything. Among our numerous partners—like supermarkets, agriculture producers, other companies—we asked them whether they could provide their goods for free to the hospitals, and many of them agreed.
We of course focused on Kyiv because we are located here. All major cancer centers are in Kyiv, because it’s the capital of Ukraine, and it was among the first to suffer from Russian missiles.
The most difficult thing was logistics for transport, because suppliers said, “Yes, you can take from our stock, from our warehouse, but we cannot bring it to you,” and it was a challenge to arrange transportation.
Several times these cars, which brought the products, were shot—one driver was even wounded. But in general, we focused on evacuation of children, both from Kyiv and other cities, especially those under the most severe attack.
Just yesterday [April 11], we took children out of Kherson. They have been for more than a month under occupation, and they are still under occupation, but we found cars and drivers who were ready to risk their lives and go to the city and take children out.
It was a risky operation. Nobody gave any guarantees that they would not be shot on their way. But we managed to do this, and these children are already safe in Lviv, in the west of Ukraine, where I am now as well.
So, how did this process evolve? We are very lucky to have St. Jude Global as our international partner. Our partnership started in 2018, and we could never have forecasted that we would need St. Jude in such a capacity, as our principal international partner to take children out of Ukraine and triage them among European and North American hospitals. We could never have thought of it.
They have a number of regional initiatives of pediatric oncology and hematology, and one of them was created in the Eurasia region. It unites former USSR republics, and some others, like Mongolia, Poland, Romania, and so on.
St. Jude Global created this initiative and we had several common projects, and semi-annual meetings where we met each other personally. It was a four-year partnership already by the time the war started, and we had developed a very friendly rapport with the St. Jude team.
The very same day the war started, we sent a message that we would no longer be a member of this regional initiative, because we cannot be in one initiative with Russia.
But, we will continue our partnership and cooperation with St. Jude Global, because they are very supportive, very efficient, very helpful, and very pro-Ukrainian—not even pro-Ukrainian, they stand for all children with cancer around the world. That’s the thing.
They put in place, with the Polish Society for Pediatric Oncology and Hematology and the Herosi Foundation, a structure which helped us to safely transport children from Ukraine to Poland, accommodate them in a temporary medical distribution center for a couple of days, and then triage to various European and North American hospitals. Now, almost more than 30 countries are ready to accept our Ukrainian children with cancer for treatment.
Ukrainian children have already been sent to Poland, Germany, Italy, Spain, France, Switzerland, the Netherlands, the Czech Republic, the U.K., the USA, and Canada, and more countries are still willing to admit Ukrainian children for treatment.
The logistics mechanism, as of now, looks this way: our charity foundation, Tabletochki, helps families with the information regarding the evacuation mechanism and directs them to Lviv, in the western part of Ukraine.
In the beginning of the war, we brought children to Lviv in big groups, because we evacuated them from the hospitals where they were inpatient—by buses or by trains. Now, there are no more big groups because most of them were evacuated. There are mostly small groups—two, three families, or just single families. Either we help them with transportation, or we just instruct them where to go, when to go, and they get on their own to Lviv.
In Lviv, we have a very good hospital, the Western Ukrainian Specialized Children’s Medical Center with an excellent pediatric oncology team headed by Dr. Roman Kizyma. They agreed to function as a transfer hub. All children arrive here, they are hospitalized, and their health conditions are assessed. They have some basic treatments if necessary—for example, blood transfusion, or antibiotics, or whatever, just to get the children ready for further transfer.
Then, we arrange a convoy. Earlier, we used to have the convoys twice a week, now we have them once a week, because the current of patients is less significant than it used to be. The convoy consists of several buses, several ambulances—depending on how many children are in severe condition—police escort, and Polish embassy escort, which is necessary for our convoy to be provided with a green corridor at the border.
At the border, especially in March, when all people were fleeing out of Ukraine, there were huge queues. People stood there for more than 30 hours to get out of the country and we could not make our children wait for so long. That’s why the police escort and Polish embassy escorts are needed—they provide free passage through the border.
In Poland, the children are transferred from buses to a medical train, which is fully equipped with all medical appliances and equipment and personnel—they even have an ICU on board, so that these children can be transported safely to the place of their destination, this medical distribution hub near Kielce in Poland.
It’s called the Unicorn Clinic. It’s not a hospital per se. It used to be a resort, but it was transformed into this medical distribution center.
There are Polish, German, and U.S. physicians there who assess and care for the children during this stop-over. The families can stay one, two, maximum three days at the Unicorn Clinic, before they are triaged to their final destination, to the hospital they will be treated in. Children are allocated to this or that hospital, depending on the diagnosis.
They are not sent arbitrarily to whatever destination, but rather, the St. Jude team with their Polish and German colleagues assess every case and they select a hospital which could be most optimal for this diagnosis.
And, of course, country and hospital capacities are taken into account—by now, for example, Poland has almost exhausted its capacities. They hosted more than 200 Ukrainian kids with cancer, which is a big number for pediatric cancer.
For the Polish healthcare system, I think that it’s overwhelming, not only because not only these children arrive, but you can imagine that thousands and millions of other Ukrainian refugees seek asylum there, in Poland, and of course they are a burden for the Polish healthcare system.
Germany is also close to their full capacity. They have 170 Ukrainian children with cancer. That’s why the last convoy was distributed among other countries—the Netherlands, Switzerland, Italy, and probably France. These are more distant countries and they still have more capacity to accept our children.
Everything is for free for these families. They do not pay for anything. They can enjoy free transportation, free medical services, accommodation—those hospitals which are ready to accept them must guarantee that they have capacity, not only to treat patients, but also to accommodate families and provide them with basic things, like clothing and food.
That’s why not only hospitals take part in this initiative, but also local NGOs, charity foundations, and volunteers. They’re involved because they’re responsible for making sure that families have their basic needs met.
Very often, the patients go with several family members—for example, if there are three kids in the family, the mother takes all three of them, or with the granny, or with someone else. There are some families where there are six to seven children.
Of course, the host country has to ensure that the family lives together somewhere and has everything necessary to survive. That’s why, at a certain point, not only St. Jude and national pediatric oncology and hematology associations, but also CCI, which is Childhood Cancer International, joined the initiative and involved their members.
These are grassroots organizations, patient organizations, and they are also heavily involved in hosting families and providing them with interpreters and legal and paperwork support—because every family needs to go through certain legal procedures to get refugee status and enjoy all the privileges and rights, including financing from the state. They also bring welcome packages to their families, and provide accommodation and so on.
So, it’s a lot of work done in collaboration by many, many stakeholders. Every one of these stakeholders is an important part of this process—the Western Ukrainian Specialized Children’s Medical Center, St. Jude Global, national pediatric oncology and hematology associations, the Polish association, the Herosi Foundation, and so on.
One more thing, which I missed—when we learn about children or a family who want to go abroad for treatment, we also request the medical records, and we send these medical records for translation to St. Jude. St. Jude arranged a huge team of translators, Ukrainian-English translators, all around the world. They have been translating records from Ukrainian to English without stopping for one month and a half already.
In the St. Jude registry we have more than 850 patients, most of them already out of Ukraine. Probably up to 100 are still in Ukraine. All their medical records have already been translated. The translators are all around the world, even in Australia. It’s members of the Ukrainian diaspora, who work as medical doctors in the USA, in Canada, in Australia. They provide such valuable assistance with translation. That’s also an important part of this project.
I’m also interested in how things are changing. The crisis in Ukraine is constantly evolving—how has the changing situation affected your work? Are you looking at eventually bringing children back, once the crisis subsides?
YN: We are still taking children out of Ukraine because we cannot be sure that it’s the very end of the war. We are still very tense. We follow the news—today, Putin and Lukashenko met, and we were told that probably Belarussia will allow troops to go through its territory, and probably there will be another strike from the north. We don’t know.
Also, we fear that Russia will want to have some sort of aggressive attack on the 9th of May, because it’s a victory day and they need something symbolic just to support their military spirit. I don’t know. You never know, with Putin, what can come to his mind.
So, we are still very careful about our plans. Of course, we want the war to end as soon as possible so we can rebuild the Ukrainian pediatric oncology service, but if the families come and say that they want to be evacuated, we help them.
This pathway, it still works, and we ask not to close it, this window of opportunity for us to send more children for treatment in safe conditions. St. Jude and all the national coordinators stay engaged, although it’s been quite a long time; everybody’s very exhausted.
We even have a Zoom call every night for one hour—every night, for 45 days. It’s quite late at night in Ukraine, but we must do it, because otherwise it’ll not work. If we want our children to be brought safely to other countries and be assigned to proper hospitals, you need to speak all this through and find the best solutions.
We will have to rebuild the system, which was partly ruined. Of course, not all hospitals were damaged—many hospitals stayed intact. But some teams disappeared because people just left the country, and not all nurses and doctors are here.
The supplies were interrupted—still, we have humanitarian aid, but no centralized government procurement as we used to have before the war. Hospitals still have stock of chemotherapy, antibiotics, etc., due to the fact that there are much fewer patients here, and this stock is not used so rapidly as before. That’s why the hospitals have not run out of any medicines. They do have probably some items missing, but in general, medicines are here.
Many local physicians want to resume activities for different reasons. First of all, they are professionals, and they want to work in their profession. When all the patients are gone, they cannot work any longer.
It’s a big issue for everyone who is a doctor, and for us as a charity, because you must make a hard decision, whether you send a child abroad or you treat the child here, and there are pros and cons for both of these alternatives.
Now, we’ve decided just to describe the alternatives to the families. So, we do not push them to go. We used to push them, more or less, in the earlier stages of the war, because it was 100% evident that it’s not safe to stay here. Purely for safety, every child had to go—but especially cancer kids, because they cannot continue their treatment here under such circumstances.
But now when we see that it’s relatively safe and that many of the hospitals want to resume activities, we just give an option. So, you can either go, and we will help you to go and to be treated somewhere, or you can stay and you will be treated here. That’s how the situation is right now.
What support do you need and how can people help?
YN: It’s one of the most difficult questions—from the very first day of the war, “How can we help you?”
You hear that, and you do not know, because you cannot plan for even one day ahead. You can ask for chemotherapy, but the next day, a missile will hit your hospital and you don’t need this chemotherapy at all. So, it’s indeed very difficult.
I would not ask for medicines right now, because, as I said, many hospitals still have stock, and we do not know how many patients will be treated there. Most of them are already abroad.
Of course, we will face newly diagnosed cases. We are very much concerned that the war disrupted early diagnostics. It has always been an issue in Ukraine, but now it’s even more of an issue because if MRI and CT and so on are not available and not accessible, then it’s very difficult to suspect pediatric cancer.
I think that we will have this problem for many months, when the children will present at very advanced stages, or even they will die being undiagnosed. This may happen, and this will happen, and this is already happening.
It’s the same situation that we had everywhere in the world during the COVID pandemic, when it started, and nobody wanted to go to a hospital because everybody feared COVID. There was a decline in the incidence of pediatric cancer, and later on, they presented just at stage IV of their disease. Now we see the same, but in a war context.
We will have patients here, I’m sure they will appear, but we have some humanitarian assistance, and I don’t think we need more pediatric cancer medicines at this particular moment.
As a charity, our second focus—we have, as I told you, three focuses. One is evacuating children, and the second is supporting these families abroad. We now contact them family by family. I have 16 people on my team who are just making calls and text messages to these families, trying to find out where they are, are they okay, what do they need, and trying to connect them with local charities and local communities so that they can support each other and know that they’re not alone there. We also provide money to the families for them to buy food, clothes, and so on. So, we spend money on supporting families abroad.
Our third focus is to make supplies available to local hospitals. We extended our focus not only to pediatric cancer centers, but other hospitals as well. We help military hospitals, adult oncology hospitals, and so on. We buy medicines, equipment, and other supplies they need.
Of course, our foundation would be grateful if your readers and subscribers could support us and our activities. We can accept money at GlobalGiving.
Once we understand that everything is safe and stable, we will come back to Kyiv again to resume our assistance programs in their full scope, and we will focus on rebuilding the Ukrainian pediatric oncology service—and I am sure that in partnership with the local doctors and international partners, we will make it stronger and better than before.
We do not want to fundraise in Ukraine because, in Ukraine, everybody donates now to the army, and it’s understandable. It’s priority number one, to support our military forces, because they defend our motherland. If they fail, the country fails. The whole country is now united by the idea that our army is to be supported, and they are our heroes.
Of course, we get some donations from Ukrainian people, because they have their monthly subscriptions to our charity foundation, but we do not push local people to give more money to us. We understand that people give for other reasons, and these reasons are even more important.
It’s our survival. But, we see that many other countries are ready to help, and they’re willing to help, and they don’t know how to do this. That’s why we decided to invigorate our international fundraising activities.
I’m very grateful to be able to learn more about all that you’re doing. I don’t have any other specific questions, but is there anything that we’ve missed?
YN: The evacuation of children with cancer from Ukraine—this project is named SAFER Ukraine—is a very unique and unprecedented project. I’m happy to say we, the pediatric cancer community, were the first to put in place such a coordinated logistical mechanism.
Now, all other international and local societies, organizations, associations, and ministries come to us, to St. Jude, and ask, “How did you do this? Could you share your experiences with us? We want to copy and make a replica.”
But it turns out that it’s not so easy to replicate this unless you have such great international partners, and unless you have such great local partners, like this hospital in Lviv, which, during one month, admitted 400 children with cancer. When you think of this, it’s just incredible, how much work was done and is still done here, and how much work is done in Poland too, with all this triaging.
Some cases, they sound unbelievable—when children are taken from the Polish border to a hospital by military helicopters, military planes, when they fly on presidential planes. When everything ends, we can write a storybook about all these incredible things.
Some children were welcomed by Lady Macron in France, and another group by Jill Biden in the U.S. Yet another group flew with the president of Poland to Rome, where Pope Francis had invited them.
But some families are not content or satisfied—they say that the food is not Ukrainian, or the doctor’s visit is scheduled one week later. We deal with very difficult cases and complaints. We keep in touch with the families and try to mitigate this and facilitate discussions.
We understand that very often, such discontent is a result of stress and psychological trauma from the unknowns and uncertainty which they face, because they’re in a foreign country, and they do not speak the language—almost no families speak any language but Ukrainian and Russian. It’s a big challenge for them. And the clinical process is different from in Ukraine.
I understand that all these things have to be explained many, many times and communicated very clearly. Sometimes a lack of communication results in misunderstanding or discontent.
But ultimately, I believe that it’s a huge achievement, a huge effort, a huge mission, which we have. I don’t know any other precedent of such a massive evacuation of children with cancer.
We are very grateful to everyone who is involved in this process because they’re just so motivated and so committed to be a part of the process and to support us, to help us. They try to take the workload from our shoulders just for us to feel more relieved.
The time will come, and I hope that all these countries which support us now, will support us in rebuilding the Ukrainian pediatric oncology service.
Well, thank you. I appreciate you sharing all this with me. Let’s keep in touch.
YN: Thank you.
