Eighteen-month-old Mykola held his mother’s finger as he walked up the corridor of the national children’s hospital in Kyiv, his still unsteady legs eager to continue his desire to walk.

Mykola spent all of his short life in the hospital. His cancer was diagnosed at birth, just a month before Russian troops invaded Ukraine.

“It’s like you have two wars to fight,” said his mother, Anna Kolesnikova. “Two wars in your life: one is to save your child’s life, and the other war is for your country.”

Across Ukraine, families of children with cancer face the dual suffering of a life-threatening disease and a country engulfed in war. For many, the Russian invasion meant displacement from their homes, fear of airstrikes and separation from loved ones, including family members serving in the military.

But despite the new difficulties, the conflict also contributed to the development of Ukrainian pediatric oncology, experts say, thanks to greater cooperation with international partners at this critical moment.

However, for families like the Kolesnikovs, the war only compounded their pain.

Mykola was born in Kherson in January 2022 with a malignant tumor that distorted his face and neck and left him with only one functioning eye. He was sent to Ohmatdyt Children’s Hospital in Kyiv almost immediately for chemotherapy and surgery.

He and his mother spent weeks sheltering in the basement of the hospital so that Mykola could continue treatment even when Kyiv was under attack.

Their hometown in the Kherson region of southern Ukraine was soon captured by Russian forces and remains under occupation. Mrs. Kolesnikova, 32, has remained in Kyiv with Mykola, while her husband, her older son and her parents remain on the other side of the front lines, which can seem like the other side of the world.

“I’m separated from my family,” she said. “And I am constantly worried for the life of my child and for the lives of my parents and my other son.”

She feared the worst when the Nova Kakhovka dam was destroyed last month, flooding part of the Kherson region, but her family was unscathed.

At the start of the war, many children with cancer were hastily evacuated to other European nations, or further afield. The evacuations, coordinated with SAFER Ukraine in partnership with St. Jude Global, ensured that their treatment could continue without interruption.

“We had a lot of attention to save this large, vulnerable group of children,” said Dr. Roman Kizyma, a pediatric oncologist and the acting director of Western Ukraine Special Children’s Medical Center.

Since then, Ukraine’s approach to childhood cancer care has changed, said Dr. Kizyma, 39. Since last summer, the focus has been on capacity building within the country. While some children with complex needs are still sent abroad, most now remain in Ukraine.

With new coordination with international partners, growing ties with European hospitals, new training opportunities, and more experts providing assistance in the country, Dr. Kizyma said he hopes to see pediatric oncology strengthened in Ukraine.

“I think the level is increasing, and maybe it will be even higher,” as a result of the war, he said, pointing to more specialized treatments in regional hospitals since the war began.

Many childhood cancers are curable, but the outlook depends on where a child receives care. In the richest countries, with greater access to treatments and medicines, more than 80 percent of children with cancer survive at least five years. In low- and middle-income countries, the rates can be lower than 30 percent, according to the World Health Organization.

Yulia Nogovitsyna, the program director for Tabletochki, the leading Ukrainian pediatric cancer charity, said they estimate that about 60 percent of children in the country are successfully treated.

“There is still a gap between Ukraine and high-income countries, and you want to bridge this gap,” she said.

Tabletochki, which is funded by international donors including Choose Love, provides assistance such as housing, medicine and psychological support for children with cancer and their families, as well as palliative care support, and also buys equipment and medicine and provides training for health workers.

There were some hopeful signs even in the middle of the war, Ms. Nogovitsyna said, with an increase in practitioners trained abroad.

“Education and training can change things more than just renovation and more than medicine,” she said.

But there are also new challenges. The charity has long relied on crowdfunding donations, but has struggled to raise money inside Ukraine during the war, and is seeing higher levels of poverty among families it supports.

And it can no longer reach children in Russian-occupied areas.

“This is the worst thing, because some of the children, they are in a palliative state, so they are dying,” she said, and need morphine or other crucial pain relievers. “Look, we can’t do this. So, children are just dying of pain, and this is very tragic.”

For some children, the war also delayed diagnosis and treatment.

Sasha Batanov, 12, was in a hospital in Kharkiv, bedridden with severe back pain, in February 2022 when the Russian invasion began and the hospital was evacuated. He was taken home, and sheltered there for weeks.

“I tried to calm him down,” said his mother, Nataliia Batanova. “Though I noticed something was up.”

They didn’t know it yet, but Sasha had leukemia. If he could have stayed in the hospital, it would have been caught earlier, his mother said.

It would be July before the cancer was diagnosed and he was transferred to Kiev for chemotherapy. Sasha also needed a bone marrow transplant, which he received this April.

Currently, Sasha, his mother and his brother live in an apartment in Kyiv while he continues treatment. His father is a soldier, fighting in the east of the country, adding to their fears. But Mrs. Batanova has hope.

“We are happy that we have this life today, this very moment,” she said. “This is what the war and this life have taught us.”

For children with cancer and their families, it can be a struggle to find even a small sliver of normalcy as personal and national crises converge.

Viktoria and Serhiy Yamborko hoped that a summer camp in the Carpathian Mountains of western Ukraine earlier this month would give them time to make some happy memories with their 5-year-old daughter, Varvara, whose cancer was diagnosed last year.

They traveled there with Tabletochki, which runs camps for children and their families to swim, hike and relax.

With nervous excitement, Varvara, wearing a small riding cap, was helped onto the back of a horse for a road trip, the pine forests stretching out in the valley below. Mr Yamborko, 50, took a video on his phone while Mrs Yamborko, 38, held her daughter’s arm.

“These rehabilitative moments, although they are few, they help you carry on,” said Mr. Yamborko, who said they also relied on their deep Orthodox faith to sustain them.

The family is originally from Kherson, but was in Kiev at the start of the war and fled to the relative safety of western Ukraine for a few months. That was when they noticed changes in Varvara, who fractured three bones in a short time and grew increasingly unwell.

Last summer, when they returned to Kyiv, they received the diagnosis they feared.

“It felt like the end of the world,” Ms Yamborko said, describing her difficulty in dealing with the news, while also fearing for family still living in Kherson. “I thought that was it.”

Varvara endured months of intensive chemotherapy and other treatments, and was released from the hospital this summer. She continues to receive outpatient care, but her energy and fighting spirit have returned, her parents said.

With a lilac baseball cap covering her short hair that has started to grow back, Varvara said excitedly that her favorite part of camp is spending time with the other kids.

“It’s great to be around the other parents, you don’t have to explain everything,” Ms. Yamborko said. “Here, we understand each other without words.”

Even for children in remission, like Anna Viunikova, the war complicated ongoing care. Anna, 10, received a bone marrow transplant and chemotherapy for leukemia before the war, and her dark auburn hair grew back.

But the war shattered her family’s attempts to resume a normal life. Russians occupied their village in the Kherson region. Her mother feared for their safety, and for Anna’s ability to get regular checkups, so last summer, Anna and her parents fled to Kyiv.

“I want everything to be good,” said Anna. “So I can just sit and eat watermelon. To be able to walk and ride a bike, like before. But it will not be the same as it was.”

Oleksandr Chubko and Daria Mitiuk contributed reporting.

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