Since the missile attack on Okhmatdyt, the war on Ukrainian healthcare has affected the country’s demographic future, amidst falling birth rates and an exodus of young women.

The dawn of8 July 2024 was already sleepless in Kyiv. Since the previous night, a wave of attacks on the Ukrainian capital had kept its inhabitants awake and the siren blaring.

At 09:52 it rings again

At 10:42, fifty minutes later, a Russian Kh-101 cruise missile hit the Okhmatdyt paediatric complex in Kyiv, the largest children’s hospital in Ukraine.

It hits the paediatric toxicology and dialysis block, causes part of the roof to collapse, shatters the glass panes of the wards with hundreds of children hospitalised in all the surrounding wards. Two adult women died, a paediatric educator whose identity is not confirmed and Dr Svitlana Lukyanchuk, 30, a paediatric nephrologist originally from Lviv.

A further 16 people are injured and among them seven are minors, according to the Ukrainian Ministry of the Interior and Médecins Sans Frontières. At the time of the attack there are 627 children in the hospital, 94 of whom will be rushed to other facilities in Kyiv. The images of doctors evacuating young patients still on drips, beds dragged through the rubble and volunteers digging with their bare hands turn the attack into a symbol of the extreme vulnerability of childhood in a country under missiles.

What is Okhmatdyt

Okhmatdyt is the national reference centre for paediatric oncology, transplantation and rare diseases: to strike it means interrupting treatments that cannot be transferred elsewhere, moving small, complex patients in emergencies, and turning a sanctuary of child protection into a space exposed to the elements of war.

Two years earlier, on 9 March 2022, a Russian bombardment hit theNo. 3 paediatric hospital in Mariupol. In four years of the war of aggression, attacks on maternity wards and children’s hospitals in various regions have been documented, such as the maternity hospital in Vilniansk, Zaporizhzhia oblast, where the infant Serhii, son of Mariia Kamianetska, was killed by a missile in November 2022.

Last night, 13 January, the latest example in chronological order: a drone struck a children’s sanatorium in the Shevchenkivskyi district, Kharkiv

For mothers and children, the war on paediatric healthcare is a daily experience. In Okhmatdyt, the attack has interrupted chemotherapy cycles and bone marrow transplants, forcing immunocompromised patients to be transferred to less well-equipped facilities or improvised wards in basements. In the towns near the front, paediatrics moved to bunkers, with irregular visits and vaccinations, difficulties in refrigerating medicines and long journeys under sirens to reach the emergency rooms that were still operational.

On the maternity front , the UN and various organisations report an increase in complications in pregnancy and childbirth: more premature births, more emergency caesareans, less regular antenatal care, here a sad etc.

The drama of attacks on the country’s paediatric hearts

The UNFPA warns that attacks on maternity and birth centres are putting women and newborn babies directly at risk in a context where the remaining facilities are working at capacity limits, while health workers – almost all of them women – are forced to work under prolonged stress. Maternal mortality has increased by 37%, pregnancy complications such as uterine ruptures, by +44%, are also on the rise.

UNFPA points out that more than 80 maternity and neonatal facilities have been damaged or destroyed, out of more than 2,700 health facilities affected in total, ‘the attacks are forcing women to give birth in increasingly dangerous conditions’, in open violation of the protection that international law guarantees to maternity services.

All this builds on a pre-existing demographic fragility. Already in 2021, the Ukrainian fertility rate was around 1.1 children per woman; the war caused it to plummet to around 0.9 in 2022 and then towards 0.7 and even 0.6 in the following years, among the lowest levels recorded in the world. Live births dropped from 278,000 in 2021 to 190,000 in 2023, with 2024 projected to be a new low.

Economic uncertainty, fear for safety and forced separation of couples drive many to postpone or give up motherhood: if children’s hospitals and maternity wards are no longer safe places , the cost of having a child increases even further.

To denatality is added exodus

Almost three million Ukrainian women have left the country, mostly young women of reproductive age. This means that these women who could have had children in Ukraine in the next 10-20 years will have them, if they want to, elsewhere.

Lastly, even before the war, denatality, emigration and high mortality were driving an ageing population, now estimates indicate a population 20-30% below pre-invasion levels by 2050.

In this context,the strange Russian habit of targeting children’s hospitals and maternity wards should be read as part of a systematic pattern: targeting centres such as Okhmatdyt carries enormous symbolic and practical weight.

The burden of conflict on the future that is born

The war accelerates the processes that empty the country from within: fewer children, more young women abroad, more men and women of working age killed. Kyiv’s ‘demographic reconstruction’ plans – birthrate incentives, refugee return, family policies – start from an already eroded base and have to deal not only with the physical rubble, but with people’s confidence in being able to raise a child safely.

When a missile shoots down a children’s hospital, it affects not only the children who are hospitalised, but also the decisions to stay or leave, to have a child or wait, to imagine the future in Ukraine or elsewhere, and thus ultimately the number and face of tomorrow’s Ukrainians.

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The stolen children of Ukraine: six faces of the Russian deportation of minors; N.Schiavo- L’Europeista