KYIV, 9 December 2024 - The war in Ukraine is taking an increasingly heavy toll on children's mental health with some children developing speech defects and uncontrollable twitching, while others have terrible nightmares and even scream in their sleep, according to Save the Children.

Analysis of the Save the Children's case management data from January to June 2024 reveals 43% of these children are suffering from psychosocial distress. The data also indicates that children across all regions where the organisation operates show symptoms of anxiety, fear, moodiness, difficulty concentrating and irritability [1].

Alarmingly, case workers have observed that at least five children aged 8 to 16 years old who live in Kharkiv - which is close to the frontline and comes under constant ariel attack - have developed grey hair, with the children's caregivers and doctors attributing this to the war and the extreme stress it's causing the children.

As Ukraine nears three years of full-scale war, reports of mental health complaints - including depression, anxiety and post-traumatic stress disorder - are on the rise, with research showing that adolescents who are exposed to war are more likely to screen positive for depression. It's also been estimated that nearly 10 million of the 37 million people in Ukraine, including 1.4 million children, are at risk of developing or are already living with mental health conditions due to the war [2].

This highlights the need to urgently investigate and address the mental health toll on children, many of whom have been unable to go to school with their friends and can only learn online since the full-scale war started on 24 February 2022. It's estimated that 4 million children across the country have had their educated disrupted due to the war, with around 600,000 students unable to access any face-to-face learning.

More than 3.5 million children and adults have been internally displaced within Ukraine, with many being forced to move multiple times to escape violence and hostilities. Life underground has also become the new normal for most children in Ukraine, as constant air attacks force them into basements, bomb shelters and metros where they can spend hours without adequate food, water and heating. Many children have been separated from one or both parents, while others have lost loved ones killed in the war.

Oleksandr*, 15, and his family, including his mother Svitlana*, 41, are from the Mykolaiv region in southern Ukraine. They lived for months under a makeshift shelter in their living room when full-scale war broke out and their town was occupied. Svitlana said:

"[When the war broke out] we made a "safe" place, in quotation marks, under the table. We placed a table in the corner of the central room, with a couch on one side...and we lived like that for several months...sitting there, terrified, trying to keep the children safe because munitions were flying all around. You feel that it could all come crashing down on you at any moment. We only crawled out to use the bathroom, which was just across the room, and even then, only if we didn't hear anything flying overhead.

"The kids are very withdrawn now. They really need to go somewhere and do something just to start opening up, to talk even a little. Otherwise, they just sit in their rooms, glued to their screens. That's how schooling happens, too. But we're trying to move forward, and my son (Oleksandr) is trying to heal, although I can see he's deeply wounded and finds it very difficult."

Oleksandr received:

"The past few years have been very difficult to study, especially since the full-scale war began. During the occupation, it was especially hard. When the power went out, water supplies were cut off, all the stores closed, and everyone left, there was no talk of any studying. We were surviving, not living.

"After the occupation, different humanitarian aid [agencies] used to come to us. I learned from my mum and decided to try attending one of these workshops (at Save the Children's Digital Learning Centre) to relax after some tough days.

"At first, it was hard and unusual because we hadn't communicated with anyone during the occupation...[but] it helped me open up and changed my sad thoughts after we'd been living under a table in a single room, thinking that life wouldn't go on."

Abeer Jawad, Save the Children's Case Management Technical Advisor in Ukraine said:

"The cases we're managing are becoming more severe and a lot harder to support. We're seeing children who have been evacuated from the frontline areas and separated from their parents, children who have stepped on landmines and now have life-changing injuries, children who have lived in occupied areas, children who have witnessed their parents' deaths - the list is horrifying and endless.

"A lot of war-affected families are also suffering financial difficulties, further compounding children's mental health, as they are often living in poor conditions, leading to feelings of inferiority, stress and anxiety. We met one child who sleeps on a couch with only a jacket to cover him because his parents cannot afford a bed and blankets, while others do not have access to indoor toilets and showers, which is dangerous for children when temperatures drop to -20 degrees Celsius in some areas during the winter months.

"Our case workers are struggling with the emotional toll of the stories they're hearing, the injuries they're seeing and children's acute suffering. We urgently need more mental health and psychosocial support in Ukraine to ensure this whole generation of children can survive and recover from the violence and destruction of the war."

Save the Children has been working in Ukraine since 2014 and scaled up operations after full-scale war broke out in February 2022. Save the Children's case management programme - implemented directly and through partners - delivers dedicated care for at-risk children and their families, including providing cash assistance, organising health and mental health services and providing legal support.

The children's rights agency also has a country-wide network of 28 Child Friendly Spaces for children to play and communicate, as well as providing mental health and psychosocial support for children, parents and caregivers. Its Digital Learning Centres also provide an essential space for children participating in online learning to connect with peers and teachers and access support. Staff in the Child Friendly Spaces and the Digital Learning Centres also identify at-risk children and refer them to the case management team for further support if needed.