KYIV, Ukraine — Using his small blue crutches, Daniil Avdieienko, 7, gestured toward two deep brown stains on the cement floor of the entryway to his apartment building.
The patch on the right, just inside the door, was his blood, he explained. Then he pointed at the other blood stain: “This is from my mother.’‘
Daniil and his parents were running to a basement shelter in central Chernihiv, a northern city where fighting raged in the early days of the war, when shrapnel struck him in the back. Eventually, he had to have 60 centimeters, or nearly two feet, of his intestines removed. Seven months later he is still recovering from his wounds, and will likely need several more surgeries, as will his parents, both of whom suffered serious leg injuries.
But while his physical injuries are on the mend, he is still grappling with the psychological trauma of the attack.
“I am scared when the siren is on,” he said softly as he sat with his parents, Nataliia Avdieienko, 32, and Oleksandr Avdieienko, 33, referring to the air raid alarm that warns of potential Russian strikes. “I am afraid because the tanks might be coming.”
The conflict in Ukraine has brought pain and hardship to tens of thousands of civilians, but among the more wrenching consequences is its affect on a generation of children like Daniil who will be confronting physical and psychological pain, many for the rest of their lives. For those who have suffered serious wounds or the traumatic loss of a parent, their path forward will be immensely challenging, experts say, as long-term psychological and medical support can be elusive in a country embroiled in conflict.
Daniil’s parents say his behavior has changed in noticeable ways. He now clings tightly to a teddy bear that he performs “surgery” on, they said, a reminder of his own numerous medical procedures.
He has lost interest in the matchbox cars he used to love, his father said. Instead, he plays war games with his stuffed toys, where sometimes they are fighting off Russian tanks, and sometimes killing imaginary zombies. He doesn’t like to leave his mother’s side. Thunder frightens him.
“It wasn’t like this before the war,” Mr. Avdieienko said.
Still, Daniil has also come a long way since the attack in March, thanks in part, his mother said, to exceptional care from Ohmadyt Children’s Hospital in Kyiv. Immediately after the attack, the family members had been rushed to three different hospitals, but in April they reunited at Ohmadyt, the country’s leading pediatric hospital. There, Daniil was able to see specialist doctors and psychologists, before being released and returning home to Chernihiv at the end of the summer.
Dmytro Holovachuk, one of the orthopedic surgeons who treated Daniil, said the pediatric doctors here are increasingly treating wounds they never saw in children during peacetime. The high velocity and destructive power of modern weapons can leave children with large and complex injuries to bones and soft tissue.
“We didn’t have any experience with how to treat such severe children’s injuries,” said Dr. Holovachuk, adding that doctors across the country are now sharing their expertise and regularly learning new treatment options, sometimes with international guidance.
Dr. Holovachuk said he was equally concerned about how the war has reached into the psyche of the nation’s youngsters. Aside from being injured themselves, many have lost parents or other family members.
“These events will definitely affect the whole generation of kids, that’s for sure,” he said. “These kids don’t have the ability to study properly, they don’t feel comfortable in their homes, they don’t have the ability to eat well.”
Olena Anopriienko, the director of the hospital’s psychology department, said the staff is trying to instill a sense of normality and security as much as is possible. Children who stay for longer periods attend the on-site “Superhero School” to keep their education going and take part in weekly activities, like concerts and painting classes, intended to lift their spirits.
Many of the youngsters suffer from severe anxiety or PTSD, she said.
“If it’s a war trauma, it is very difficult to provide the sense of safety for that child,” she said. “Because the child understands that the war is not over.”
Despite their ordeal, many children push ahead with resolve, and even alacrity. Maryna Ponomariova, who is 6, has been working closely with psychologists, physical therapists and teachers since she came to Ohmadyt hospital this summer, weeks after a devastating May 2 attack on her home in the southern Kherson region.
Her left leg had to be amputated below the knee because of shrapnel wounds, and she is now learning to walk again.
Maryna grins widely, her tongue pushing against the space left by her missing two front teeth, as she walks up the hallway, a tiny prosthetic fitted to her right leg. She walks with determination, and with the assistance of her favorite rehabilitation doctor, Nazar Borozniuk, who makes her laugh even as she completes difficult exercises.
It’s her enduring positivity that has carried her and her family this far, said her mother, Nataliia Ponomariova.
“The doctor who we are working with now, he told us the truth, he told us it would be difficult,” she said. “It’s hard to make prosthetics for little kids, but there is no other way.’’
“She has faced and accepted the fact she is going to have an iron leg, she understands she had to go on and that she will be alright,” Ms. Ponomariova, 41, added.
Still, a series of strikes in central Kyiv in recent weeks, close enough to be clearly heard at their temporary housing, left Maryna shaken, her mother said.
“When she saw this, it hit her again,” Ms. Ponomariova said of the bombing. “The psychologist has been working with her, but then it was all reversed again. She was screaming that morning.”
While the anguish has reached children across the country, those living nearest the battle lines in the south and east have experienced some of the worst of the war.
Kateryna Iorhu, 13, sat on the couch in the newly rented apartment she shares with her aunt, grandmother and younger sister in Kyiv, lifting the leg of her lilac-colored sweatpants to show where an explosion ripped large chunks of flesh from her bone.
Metal pieces of shrapnel poke up under her skin like small pebbles. They lodged themselves there in April, when Kateryna, who is from a village in the Donetsk region, was struck as she was trying to flee with her family.
But Kateryna and her younger sister Yuliia, 9, carry an even more painful burden. The girls were at a train station in Kramatorsk in April with their mother, Maryna Lialko, and their aunt, waiting to travel to the safety of the country’s west, when a missile plunged into the crowd standing outside.
Yuliia and her aunt were inside the station. A stranger shielded Kateryna with his body, likely saving her life even as he lost his own. The family found their mother’s body in the city morgue the next day.
Maryna Lialko had raised the girls alone after their father left the family, their grandmother, Nina Lialko, said.
“She was devoted to these two girls,” she said.
Kateryna was discharged this fall from Ohmadyt hospital, where she received psychiatric and physical therapy, and the girls are now in Kyiv living with their grandmother and aunt.
The aunt, Olha Lialko, said she has seen a shift in their personalities. Kateryna is increasingly turning inward; she speaks very little and struggles to maintain eye contact. Yuliia still can’t fully comprehend the loss.
“Katya is very closed; she keeps it all to herself,” Olha Lialko said. “Yuliia is missing mom a lot. She needs attention, she likes to cuddle.”
The family is trying to help the girls process their loss. And occasionally they see glimpses of the girls they knew before the war.
They dye their hair wild colors and play with makeup. They fight as only sisters can, and cling closely to each other for company.
But no one knows what will come next for them. Their life is on hold. They attend school online and have few friends in the new city. The family is unable to return home to Donetsk but unwilling to commit to staying in Kyiv.
“It will be very difficult for them to live without her,” their grandmother said. “This life has no sense at all.”
Oleksandra Mykolyshyn contributed reporting