The cobbled streets of Lviv, blanketed with soft, freshly fallen snow, had an unusual semblance of calm for a Saturday in mid-January. An air raid alert had — once again — suspended life in western Ukraine’s cultural capital and emptied its streets of their normal bustle for more than an hour.

Then, a man’s voice over the city’s P.A. system broke the mandated stillness: “Attention. The air raid alert is over. Leave the shelter of civil protection. Help children and the elderly. Return to your homes and places of work.”

Within moments, a group of teens and their teachers filed out of a government building, where they had been taking shelter. Once out in the open, the teens dispersed and began throwing snowballs at each other. The snowballs flew for the entire 10-minute walk back to their base — the two-story building that houses Caritas Lviv.

Caritas Lviv is one of 40 centers of Caritas Ukraine, the charity of the Ukrainian Greek Catholic Church in Ukraine. Russia’s war on the country brought new challenges for Caritas Lviv, starting in 2014 with Russia’s annexation of Crimea and its occupation of parts of the Donetsk and Luhansk oblasts, and culminating with Russia’s full-scale invasion in February 2022. 

At both times, but more so in 2022, Caritas Lviv transformed into a distribution point of humanitarian aid, as Lviv became a main transit hub for Ukrainians fleeing the country and an important host city for internally displaced people.

According to the United Nations, as of 10 January, the two-year war created 6.3 million refugees, internally displaced 3.7 million people, killed at least 10,233 civilians and injured more than 19,200.

Children have paid a high price in this war. At least 575 children are among the dead and 1,260 are among the injured. More than 2 million children are counted among the refugees, and about 1 million are numbered among the internally displaced, leaving nearly two-thirds of all Ukrainian children homeless.

Children in Ukraine are without adequate access to education and health care, as schools, hospitals, and sources of water and energy have been damaged or destroyed. According to the Ukrainian government, more than 3,790 educational facilities have been damaged or destroyed since February 2022.

Furthermore, the Children of War state portal reports that about 19,500 Ukrainian children have been abducted and forcibly deported to Russia, where their names have been changed, they are subjected to indoctrination, the use of the Ukrainian language is prohibited, and they are placed under Russian guardianship. By mid-January, only 517 of these children were repatriated, according to Dmytro Lubinets, Ukraine’s parliament commissioner for human rights.

With no end to the war in sight, the impact on the mental health and well-being of Ukrainian children has become a growing concern. According to UNICEF, an estimated 1.5 million children are at risk of depression, anxiety, post-traumatic stress disorder and other mental health issues, with potential long-term effects.

Caritas Ukraine recognized the need to mitigate the war’s impact on children early on. By April 2022, only two months into the war, the team at Caritas Lviv had organized child-friendly spaces in dormitories for internally displaced people. Sofia Zotina, a psychologist at Caritas Lviv, recalls the mass migration of people at that time. Children would be in Lviv one day and gone the next.

Zoriana Lukavetska, who leads Caritas Ukraine’s programming for children and youth, says a child’s psyche is quite resilient and can cope with stress, so long as a stable adult is available nearby to turn to for help. However, Ukrainian parents are experiencing their own war-related trauma and life challenges — many of them as single mothers with their husbands fighting on the front — as they look for jobs and try to establish their families in a new city.

Since 2022, 35 Caritas centers across Ukraine, staffed with psychologists, tutors and therapists, have been providing services for children that seek to fill this gap by offering children a safe space to acquire new skills, socialize with their peers, and learn techniques to cope with the trauma of war and loss. To date, the centers have welcomed 152,000 children and 2,250 parents.

While all Caritas centers use a common evidence-based approach in their work with children and their consultations with parents, each center organizes its own social and extracurricular activities. The center in Lviv, for instance, offers cooking lessons for the children that parents can join.

Children who have experienced trauma and severe stress may exhibit changes in their behavior and learning abilities, as well as setbacks in their emotional and physical development. Socializing with other children also can become difficult.

Ms. Zotina in Lviv says it can take these children a long time to form bonds of trust and express their feelings. She recalls some children who eventually admitted not wanting to become friends with others for fear that they may “lose these people.” Others expressed fear about their father or brother fighting on the front line. Some said they were frightened by air raid sirens, and others were unhappy “because they spent four weeks in a basement until they could leave Mariupol,” she says. 

Maria Metsenko, 40, and her family were living in Siversk, close to the front in Donetsk, when the full-scale war began. The air raid sirens were hardly effective, as often the bombing would begin either before or just after the sirens were activated.

“We didn’t even have time to go to the basement [for cover],” says her son, Ilya, 11.

The shelling was incessant, and the family decided to leave for Lviv, where volunteers helped them find an apartment.

“When we left, I kissed the front doors and said I’d be back,” says Mrs. Metsenko. “But those doors are no longer there. There is nowhere to return to.”

Mrs. Metsenko later learned about the Caritas center, where she says they were greeted like family. She has noted positive changes in her son since he started attending the children’s program. Where he was having difficulty speaking about his feelings before, he is now more open and sociable. She believes the program will help him “not harbor some kind of trauma.”

Children experience the trauma of war on multiple levels. In addition to being exposed to extreme violence, they also experience the grief of having lost parents and relatives, their home and belongings, their community ties and their friends.

Liza Vetoshko, 13, from Volnovakha, Donetsk Oblast, misses the city, her friends and walking along the Sea of Azov in Mariupol, an hour’s drive away. Volnovakha has been under Russian occupation since March 2022.

“I cried a lot last year. I was very sad because I didn’t have any friends or anyone to talk to,” she says. “After I started going to Caritas, I got a bright spot in my life. I have many more friends now. It just made me feel better.”

At the foot of the Carpathian Mountains in western Ukraine, Kolomyia amazes with its beautiful architecture and the world’s only museum dedicated exclusively to the pysanka, the traditional painted Easter egg. Painting pysanka is among the activities for children who attend Caritas Kolomyia.

During a workshop in mid-January, psychologist Uliana Romaniuk leads an art therapy session for children and parents. About 10 children who attend Caritas Kolomyia have lost at least one parent in the war.

Mrs. Romaniuk explains the activity to the  25 people present: Draw a one-story house, in which the roof represents their short-term goal or dream, the walls represent the main tasks needed to achieve that goal, and the walk path represents the steps needed to complete each task in fulfilling the dream. On either side of the walk path, they are to draw barriers that could prevent them from achieving their goal.

Each family works on the drawing and then presents it to the group. Yaroslav Dvortsov, 11, explains that his walls represent reuniting with his family.

“I want to return to Kharkiv and everything to be as before,” he says, “so that I will be with my father.”

His father, a policeman, remained in Kharkiv. Yaroslav says the fence he drew as a barrier represents the war and overcoming the barrier is possible by supporting the Ukrainian army to bring about a victory.

Family after family names the war as a barrier, and peace as their dream. After the presentations, the psychologist sums up how one can find something positive, even during a war: There is a reassessment of values, an appreciation of what was not valued before, and an understanding of the importance of family.

For the next activity, the families are asked to use purple felt to make a Pomogaiko, an imaginary hero character in the form of a blot or a star, that is intended to help overcome crises or difficult circumstances. It can be stored in a box or under a pillow and taken out when needed, the psychologist suggests. 

After the session, children blow bubbles as relaxing music plays — and a smile shines on each person’s face.

The view of Kamianske on the approach from the railway station opens onto a large metallurgical plant, heavy gray smoke billowing from its smokestacks. Pollution is a serious problem in this industrial city on the Dnipro River in eastern Ukraine, which has several metallurgical and chemical plants and is in proximity to a storage facility for uranium production waste.

The third-largest city in Dnipropetrovsk region, Kamianske became a refuge for internally displaced people in 2014, when the conflict began in Donbas. At the time, Caritas Kamianske identified the isolation and trauma experienced by children displaced by the conflict and established a child-friendly space, which later became a center.

In 2022, the city became a haven again, but on a greater scale, welcoming 29,000 people who fled the war in Donetsk, Zaporizhzhia and Kharkiv. Oksana Kolotylo, coordinator of Caritas Kamianske, recalls how depressed and scared the people were two years ago when they arrived. The children were afraid of unexpected noises — a passing tram could scare a child — and they had a hard time adapting to the new environment.

The children who exhibited the greatest trauma were those who fled Mariupol under Russian shelling. They would describe how planes dropped bombs continuously and speak about their relatives who were killed.

“It was like something out of a horror movie. When a child tells you this, it’s scary,” says Ms. Kolotylo. It took some children a year’s worth of visits to the center to start speaking about their experiences of the war, she adds.

In addition to age-specific play and art therapy, the center runs a theater program, which helps children process negative emotions and trauma through role play.

Maria Kuskova, 35, from Kharkiv, brings her 8-year-old son, Miron, to the theater group. A tram rumbles along the city rails outside while Miron in the stage area plays an evil character in the limelight of 11 girls.

While Miron is performing, Mrs. Kuskova socializes with other mothers who share her burdens.

“Creativity doesn’t help you forget about the war, but it helps you switch gears. You start to live,” says Mrs. Kuskova.

Adults and children react differently to stress, says Liliya Lytvinenko, a psychologist at Caritas Kamianske. In times of stress, a child’s breathing will slow down, as will the functional systems in the body, potentially affecting a child’s long-term physical health.

The impact of prolonged stress can also inhibit the creation of neurons in the brain, impairing cognitive function, learning and memory. She underlines the importance of monitoring the general health of children experiencing trauma to avoid stress-induced physical and mental illness, as well as developmental regression.

Mrs. Lytvinenko recalls helping a boy from Mariupol, who, at 4 years old, was not toilet trained due to the developmental regression brought on by the circumstances of the war. When the family arrived at Caritas Kamianske, she used games and play therapy for 45 days to help the boy transition out of diapers.

For most Ukrainian children, she points out, these two years of war were preceded by two years of isolation due to COVID-19 lockdowns and distance learning, creating a situation of successive traumas and developmental challenges. She emphasizes the importance for a child to feel that they are part of a community, “that we are not alone.”

“It is very important to be emotionally close,” she says, “to play, to make it clear that we are still alive, and everything is normal: You can develop, rejoice and play, and we can do it together.”

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