On March 2, a bus filled with Ukrainian children was getting ready to leave Odesa for the border of Moldova, Ukraine’s closest neighbor.
As the port city on the Black Sea braced for an onslaught from Russian tanks and artillery, St. Jude Children’s Research Hospital was working with allies on the ground to secure transportation and evacuate children with cancer. The kids were ready to go.
Then bombs rained down on Odesa.
“They could not move,” 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, said to The Cancer Letter.
“These kids will probably never be able to get out of Odesa.”
Source: Shutterstock
Similar scenarios are playing out across dozens of cities across Ukraine, especially in border provinces, experts say, as civilians try to escape intensifying bombardment and Western European, American, and global health organizations scramble to help evacuate patients and health professionals from cities under siege.
The United Nations notes that as many as 7 million Ukrainians have been displaced, with more movement expected across the region. At this writing, more than one million Ukrainians have fled the country, according to UN estimates.
“I have worked in refugee emergencies for almost 40 years, and rarely have I seen an exodus as rapid as this one,” UN High Commissioner for Refugees Filippo Grandi said in a statement March 3. “And unless there is an immediate end to the conflict, millions more are likely to be forced to flee Ukraine.”
The World Health Organization estimates that at least 3.8 million Ukrainians affected by the crisis are in need of health services. How can U.S. and international health organizations help?
Beyond sending supplies, academic centers and health groups in the U.S. can support humanitarian efforts by leveraging or establishing relationships with Western European institutions to organize and support care for displaced patients, experts who are coordinating evacuation efforts in Ukraine say.
The majority of the children that we are hearing from are trying to escape from these situations, and that’s what we’re trying to do, to try to help them get into Poland safely, or try to get them into other countries in Europe in an organized manner.
Carlos Rodriguez-Galindo
“The situation is dire,” St. Jude’s Rodriguez-Galindo said. “It is chaotic and catastrophic, with a very unsafe environment, right now with a full deployment of the Russian army. It’s very difficult for physicians, for patients.
“There have been news about children with cancer trying to be protected from all the bombing and the instability by going down to underground facilities in hospitals.”
Basic healthcare infrastructures—not to mention cancer care—are crumbling throughout the region, U.S. and European experts said.
“Essential health services have been disrupted and are collapsing and jeopardize the treatment of chronic/non-communicable diseases, including diabetes, cancer, and cardiovascular diseases,” WHO officials said to The Cancer Letter. “Access to primary, secondary and emergency healthcare services and medicines has been disrupted on both sides of the contact line.”
According to Ukraine’s Ministry of Health, more than 100,000 Ukrainians are diagnosed with cancer each year—that’s the number of patients who have recently received or are actively receiving care.
“We hear that they are running out of supplies, that they cannot access medications and much of the equipment that is required to prepare and deliver chemotherapy, etc.,” Rodriguez-Galindo said. “For pediatric cancer patients, which is the population that we are trying to assist, the situation is as bad as you can see on TV.”
WHO has convened national, regional and international partners to support a coordinated response to managing cancer care needs among refugees from Ukraine across Europe, André Ilbawi, WHO focal point and technical officer for cancer control in the Department of Noncommunicable Diseases, said to The Cancer Letter. The first WHO consultation took place on March 3.
“WHO also recognizes the need to address internally displaced cancer patients and coordinate with the Ministry of Health of Ukraine to support domestic needs, including procurement support and maintaining essential health services,” Ilbawi said.
As the war in Ukraine escalates, international health organizations are focused on setting up a regional coordination task force to respond to disruptions in the product procurement and supply chain for drugs and medical supplies.
“The oxygen supply situation is nearing a very dangerous point in Ukraine,” WHO officials said. “Trucks are unable to transport oxygen supplies from plants to hospitals across the country, including the capital Kyiv. The majority of hospitals could exhaust their oxygen reserves within the next 24 hours. Some have already run out. This puts thousands of lives at risk.”
Global health experts say there is a need for coordinated action—with European health authorities as well as professional societies—to facilitate transportation for patients at functioning hospitals and cancer centers in Ukraine and get them to healthcare institutions outside the country where there is capacity to meet their needs.
“The immediate health priorities include providing the fleeing population with access to EMS and to surgical services to treat trauma caused by violence and military operations,” WHO officials said. “Additional priorities include provision of access to essential healthcare services and medication including for mothers and children, HIV and tuberculosis patients as well as patients suffering from NCDs, access to mental health and psychosocial support.”
Ukraine’s remaining cancer networks, which were fragmented to begin with, are now focused on evacuating patients to the west, sources say. In areas where movement has been prohibited by Russia’s encircling armies and ongoing shelling, healthcare workers and patients alike are sheltering in place.
“The majority of the children that we are hearing from are trying to escape from these situations, and that’s what we’re trying to do, to try to help them get into Poland safely, or try to get them into other countries in Europe in an organized manner,” Rodriguez-Galindo said. “We cannot oversee everything, because everything happens so quickly. So, we just try to provide a system for an organized transfer of patients, using Poland as the best route, just because it’s usually what works best.”
Individuals and organizations interested in supporting St. Jude’s efforts in Ukraine can contact the hospital here.
Ukrainian physicians and healthcare workers appear to be staying put to continue providing first aid and essential health services.
“What we hear is that the doctors are staying there. And so, that worries me a lot,” Rodriguez-Galindo said. “It’s difficult to reach out to them, just because they’re so busy—they try to simplify the conversations—but they are there.”
The U.S. government is sending nearly $54 million in humanitarian assistance to Ukraine, Secretary of State Antony Blinken announced Feb. 27—nearly $26 million from the Department of State and $28 million from the U.S. Agency for International Development. USAID administrator Samantha Power traveled Feb. 28 to the Poland-Ukraine border in a show of solidarity.
On March 3, the U.S. Department of Homeland Security granted Temporary Protected Status for 18 months to Ukranians on U.S. soil.
U.S. institutions interested in sponsoring Ukrainian physicians, health professionals, and scientific experts in STEM fields can do so through existing immigrant and non-immigrant pathways. These include the J-1 exchange visitor program, H-1B temporary work visas, or employment based immigration processes, federal officials confirmed with The Cancer Letter.
At this writing, nearly 1,000 labs around the world—primarily in the U.S. Germany, Switzerland, Sweden, and Poland—have expressed support for Ukrainian scientists.
The full list of institutions, which includes employment and funding information, is available here.
UMANA, U.S. cancer groups: Reaching Ukrainian refugees
Urgent non-government initiatives to transport humanitarian and medical supplies from the U.S. to Ukraine, via Poland, are also underway.
The Ukrainian Medical Association of North America, a nonprofit composed of 19 branches throughout the U.S. and Canada, is leading one of these efforts, which includes working with international delivery companies to charter planes and get supplies to the frontlines.
Solomiya Grushchak, a physician and a member of UMANA, is involved in scaling up the organization’s humanitarian response.
“Refugees have been displaced to Poland and are trying to connect with people from Chicago through the Ukrainian relief efforts to get supplies,” Grushchak, chief resident at the John H. Stroger, Jr. Hospital of Cook County, said to The Cancer Letter. “That includes not only medical supplies, but also humanitarian aid—things like non-perishable food, diapers, clothing, blankets, sleeping bags,”
“For medical support particularly, the Ukrainian Medical Association, obviously, wasn’t expecting this atrocious geopolitical crisis of such magnitude, and are adjusting our strategies and optimizing procedures as we go along.”
A conversation with Grushchak appears here.
Grushchak’s family is in Ukraine. “My close family is in Lviv and Ivano-Frankivsk, which is on the western side, closer to the Polish border,” Grushchak said. “They haven’t decided to leave, even with all the resources that we’ve provided them to try to move forward with either a visa to the United States or to Poland.”
“Ukrainian Medical Association of North America stands with Ukrainian people in their hour of need,” UMANA President Olena Gordon said to The Cancer Letter. “In partnership with the Ukrainian government, we are centralizing the collection of medicine and medical supplies destined for Ukrainian hotspots.
“We are in particular need of medicine, so please reach out to us at umanahelpua@gmail.com. For monetary donations, please go to umana.org. 100% of the funds will go to aid the Ukrainian people.”
In terms of immediate patient placement and care, most of the medical and humanitarian aid will need to originate in Europe or be channeled through Western European countries, St. Jude officials said.
“A good network in Europe will be critical for that. That’s the main help,” Rodriguez-Galindo said. “If The Cancer Letter reaches some of these centers, obviously, that would be great. And that is at two levels: One is medical care, so that these kids do not have interruption of care. They can be seen at the right time. Some of them were ready to receive a bone marrow transplant, others needed surgery. The institutions have to be responsible for that.
“And second is family and psychosocial support. We’re not only talking about the children, but also the entire family.”
The unprecedented influx of Ukrainian refugees into Poland over the past week means that the surplus of patients in need of care will have to be transferred to neighboring countries—an effort that will require greater regional coordination and fundraising.
“The system in Poland is going to be saturated in the next few days. Now, the next step is to start moving patients, as they cross the border to Poland, directly after the first assessment, to Germany, institutions that have already opened their doors,” Rodriguez-Galindo said. “So that’s probably the second phase—start moving people to Germany.
“As other institutions in other European countries volunteer, then we need to develop the next phase, which is where to send patients, how to send them, how to coordinate that transportation for families, etc., which is more complicated. But that will be the next step.”
The American Society of Clinical Oncology is working with its European members and international partners to respond to the crisis.
“We and our members are providing active support for oncology care in Ukraine and in countries that are receiving these displaced patients to help avoid life-threatening disruptions in their cancer care,” ASCO officials said in a statement.
More than 179,000 newly diagnosed cancer patients are among the “Ukrainian people suffering from Russia’s unprovoked aggression,” the American Cancer Society said.
“We are committed to leveraging our expertise and vast network to help Ukrainian cancer patients and their families, as well as the Ukrainian oncology research and care community,” ACS said in a statement.
Russia’s war on Ukraine threatens years of research collaborations and community building, the American Association for Cancer Research said.
“The AACR is outraged at the widespread suffering and death stemming from Russia’s shameful invasion of Ukraine and joins the world in calling for an immediate end to this unjustified aggression,” AACR said in a statement.
The American College of Surgeons said several communities within the U.S. are organizing efforts to support refugees from Ukraine. “We encourage all ACS members to consider helping to provide these groups with much needed material or financial support,” ACS officials said in a statement.
St. Jude, WHO: Getting Ukrainians to Western Europe
While many healthcare workers have stayed in cities under siege, some have evacuated to hospitals closer to the western border, as patients move with them.
Many of the nation’s state-of-the-art health facilities, including Kyiv’s National Cancer Institute, are concentrated in the capital city—the Kremlin’s primary military and political target. Community services throughout the provinces that provide cancer care are also experiencing similar disruptions, as supply lines are cut and care is interrupted as patients and their families make the hazardous trek to western Ukraine and Poland.
“When the crisis started, immediately, our partners in Ukraine, hospitals as well as foundations, asked for help, ‘Can you guys help us coordinate?’” St. Jude’s Rodriguez-Galindo said. “Together with them, on the ground, we developed this plan.”
St. Jude’s efforts focused first on evacuating critical patients from Lviv—the closest major Ukrainian city to the western border—to Poland, opening up hospital beds for patients that fled from Kyiv.
“We moved this first batch of patients as soon as possible,” Rodriguez-Galindo said. “Over subsequent days, we moved in different batches, 20, 15, 25 at a time, from Kyiv to Lviv. These children could stay in Lviv. Those that require immediate care, who are not in good condition, are transferred to another country.”
That process required setting up an operations hub, which coordinates immigration with partners in Poland and keeps track of patient records.
“In a very structured manner, what we did is create a virtual command center to facilitate that,” Rodriguez-Galindo said. “That means keeping a registry of all the patients that need to move, with medical records for all of them.
“We have a group of volunteers that are translating these records, whether the records are in Russian or in Ukrainian, into English rapidly within six to eight hours. In the U.S., honestly, what we have been asking, as we have been developing this structure, is for more help from volunteers with language skills.
“So, that has been going on for five or six days. Now, with the bombing, it is going to be stopped.”
St. Jude is able to quickly scale up its triage and evacuation capabilities for children with cancer because of existing partnerships with four cancer programs in Ukraine. The collaboration created a platform for health systems assessment at the country level, which brought Ukrainian physicians, Ministry of Health officials, and professionals at health foundations together to develop national plans.
Where are all the other children? That’s what I don’t know. How many of them haven’t been able to leave, or decided to stay? How many have crossed the borders, and now are somewhere in Europe, but without us knowing?
Carlos Rodriguez-Galindo
“Obviously, all this is now falling apart, because of what we are seeing,” Rodriguez-Galindo said.
Transportation for cancer patients is conducted through the consulate of Poland in Lviv, and buses or private cars are escorted by police to the Polish border.
“We work with the Herosi Foundation in Poland and the Tabletochki Charity Foundation in Ukraine. The Herosi Foundation receives these patients, and they have their own arrangements with volunteers and buses that then distribute these patients to Polish institutions that have accepted them,” Rodriguez-Galindo said. “Then, depending on diagnosis and age, they stay in Kraków or they go to Warsaw, or they go to other places.”
St. Jude officials estimate that almost 100 children with cancer have made it to Poland thus far, through their network’s efforts. More than 100 children are on the move, and are expected to reach the Polish border in the next day or two.
St. Jude estimates that there are at least 1,500 to 2,000 children with cancer in Ukraine who are on active treatment, not only for new diagnoses, but also for ongoing therapy.
“I have shared with you maybe a few hundred; so, where are all the other children? That’s what I don’t know,” Rodriguez-Galindo said. “How many of them haven’t been able to leave, or decided to stay? How many have crossed the borders, and now are somewhere in Europe, but without us knowing?”
St. Jude is also keeping tabs on another group of patients that may be en route to Moldova or to Romania, and the hospital is working with partner foundations and institutions in those countries to track patient outcomes.
“These patients then eventually get situated in any of those countries, but many of them, I believe, are seeking care in other European countries,” Rodriguez-Galindo said. “As we started creating this system, we were linked to several organizations in Europe that were also trying to create a platform for that. That side of Europe represents, for this particular purpose, the national societies—the national societies of pediatric oncology in Germany, in Spain, and Italy, they’re trying to put all this together.”
Much of this propaganda war actually didn’t work to Putin’s benefit, because Ukrainian people are very prideful and they’re willing to sacrifice and uphold their traditions and their culture even in times of crisis.
Solomiya Grushchak
St. Jude is building a registry of institutions across Europe that are willing and able to take Ukrainian patients. This resource logs the capacity of these institutions, and information on whether the governments are providing free care for these patients.
“This is how we have set it up so far. The majority of countries or governments in Europe have expressed complete support, and that all refugees will have access to free healthcare,” Rodriguez-Galindo said. “And in many countries, this has been made specific as well for childhood cancer. We feel comfortable with that. Poland was the first one.
“We are trying to work as well with Doctors Without Borders and the Red Cross, just to leverage some of their capacity on the ground, now during war times. CCI, Childhood Cancer International, a parent organization with multiple branches in Europe—they have mobilized all their resources to support logistics, families, and patients,” Rodriguez-Galindo said.
The resistance by Ukrainians is proof of their collective strength and commitment to a free Ukraine, said Grushchak, the Chicago physician with family members who have chosen not to leave Ukraine.
“They, I think, are hopeful that all of this ends and they’re just very prideful and they love their country. They love their life in Ukraine,” Grushchak said.
“I think that goes to show that much of this propaganda war actually didn’t work to Putin’s benefit, because Ukrainian people are very prideful and they’re willing to sacrifice and uphold their traditions and their culture even in times of crisis.”
Updates from WHO officials on the ongoing crisis follow:
- WHO is working closely with our offices in Ukraine and neighboring countries, as well as partners to rapidly respond to the health emergency triggered by the conflict and to minimize disruptions to the delivery of critical healthcare services. WHO continues to deliver much-needed support on urgent health needs.
- The WHO director-general has announced the release of a further US $3.5 million from WHO’s Contingency Fund for Emergencies (CFE) to purchase and deliver urgent medical supplies. WHO’s humanitarian health support is expected to increase following further needs assessments. This assistance complements the trauma care and medical supplies which WHO helped to pre-position in health facilities.
- Partners involved in the implementation of the Regional Refugee Response Plan (RRRP), including WHO, is assisting 2.4 million refugees and asylum-seekers in neighboring countries.
- WHO country offices in Poland, Republic of Moldova, Hungary, Romania, Slovakia, and in other European countries are working closely with Ministries of Health to address the immediate health needs of refugee arrivals. All offices are scaling up capacity through staff deployments. In neighboring countries, WHO is operating under the interagency response as part of the RRRP coordinated by UNHCR.
- The WHO emergency center in Poland will be used to deploy emergency medical supplies to support the immediate needs of affected population both inside and outside Ukraine
- WHO, working with international partners, is working toward the following actions for cancer care among refugees: convene strategic partners; formulate a compelling narrative and integrated plan; invest effectively to make an impact; and monitor implementation and promote accountability.
Statements from U.S. cancer groups and professional associations follow:
American Society of Clinical Oncology
ASCO stands with our Ukrainian members, the worldwide oncology community, and healthcare providers around the globe in condemning Russia’s unprovoked war on Ukraine. We call for an immediate cessation of these hostilities and demand full protection and safety for all Ukrainian patients, healthcare workers, and medical facilities.
As a global cancer society, ASCO represents oncology professionals in Ukraine and its neighboring countries including Poland, Romania, Moldova, Slovakia, and Hungary, now receiving thousands of fleeing Ukrainians. From within Ukraine and the surrounding regions we are hearing daily reports of cancer treatment interrupted by acts of war, including damage to medical facilities and shortages of critical supplies. Countless patients now need to find cancer care in new and unfamiliar surroundings with limited medical records and minimal resources.
Together with our European members and international partners, we and our members are providing active support for oncology care in Ukraine and in countries that are receiving these displaced patients to help avoid life-threatening disruptions in their cancer care.
Interruption of life-saving cancer care simply adds to the massive pain and needless suffering caused by war. We are compelled by our vision of a world where cancer is prevented or cured and every survivor is healthy, to work together with all of our members to protect the health and well-being of people with cancer everywhere.
American Cancer Society
More than 179,000 newly diagnosed cancer patients are among the Ukrainian people suffering from Russia’s unprovoked aggression. Disruptions to cancer treatment pose a grave risk to their very survival. As a global organization, the American Cancer Society stands in solidarity with all Ukrainians. We are committed to leveraging our expertise and vast network to help Ukrainian cancer patients and their families, as well as the Ukrainian oncology research and care community.
American Association for Cancer Research
As the world’s first and largest organization dedicated to accelerating advances against cancer, the AACR and its more 50,000 members from around the world stand in solidarity with the citizens of Ukraine during the Russian attack on their country.
Ukrainian cancer patients of all ages are vulnerable especially at this time while their care is interrupted by acts of war, criminal attacks on medical facilities, and dwindling food and supplies.
As a global cancer research organization, the AACR is committed to supporting its members in Ukraine and the entire Ukrainian cancer community. We call for the immediate protection and safe passage to other countries of all cancer patients and of the cancer researchers and medical providers who are needed to maintain the momentum of cancer discovery and care.
Progress against cancer depends on the scientific and clinical contributions of experts from around the world to maintain the high quality of our medical research enterprises and healthcare services. This abhorrent war, which has been instigated by Russia’s leaders, is isolating and interrupting the lifesaving work of scientists and clinicians in Ukraine and Russia, threatening years of effectiveresearch collaborations and community building. Limiting the exchange of innovative ideas, practices, and data across borders will significantly retard cancer research and have an adverse effect on public health.
The AACR is outraged at the widespread suffering and death stemming from Russia’s shameful invasion of Ukraine and joins the world in calling for an immediate end to this unjustified aggression.
American College of Surgeons
With anguish, we are following the developing human tragedy in Ukraine. The loss of life is profound, and the destruction of infrastructure is devastating. The American College of Surgeons denounces this violence leading to unnecessary suffering and loss of human life.
This is a complicated emergency that places innocent people in peril and in harm’s way of armed conflicts. It will lead to food and water insecurity, limited—or no—access to medical care, and will separate and displace families and friends away from their homes without a safety net.
Even though many of us live at least a continent and ocean way from this escalating tragedy, we encourage all to act in good faith from afar. Now is the time for all of us to help, in any way we can, to mitigate the suffering of people who are in desperate need.
Several communities within the U.S. are already organizing efforts to support refugees from Ukraine. We encourage all ACS members to consider helping to provide these groups with much needed material or financial support.
This article from National Public Radio lists organizations that are already working to make an impact. We’re also aware of these two groups:
- Cleveland Maidan Association—Assistance to Ukrainian refugees
- Razom for Ukraine
If you know of other relief efforts of which we should be aware, please feel free to share that information with us. Groups that offer medical assistance are of particular interest, but right now, assistance will be needed to support all facets of the refugees’ lives.
We thank you for your support as we all keep those affected by this tragedy in our thoughts and prayers. Further updates will be forthcoming, as appropriate.
European Society for Medical Oncology
ESMO expresses profound sadness about the unfolding tragedy in Ukraine and the suffering of people. We would like to confirm our solidarity and unconditioned support to all oncology professionals and cancer patients, with no geographical boundaries.
The Society is currently reviewing possibilities to be of concrete help for our members and their patients, in collaboration with national and transnational oncology societies, as well as the International Cancer Foundation.
Our thoughts are with all those who are suffering, and we call for a rapid return to peace.
