As Russian shells fall, a race to get children with cancer out of Ukraine

Yevheniia Besidovska, a 9-year-old with a brain tumor, rides a bus on one leg of a long journey from eastern Ukraine. (Oksana Parafeniuk/For The Washington Post)

KIELCE, Poland — On the day the first shells fell, Oksana Besidovska was at home in eastern Ukraine, waiting for biopsy results and a treatment plan that could save her daughter’s life.

Nine-year-old Yevheniia’s brain tumor had returned, and the specialist who had sent the cancer into remission five years earlier was helping again. But the doctor was Russian, based at a hospital in Moscow, and Russia had just invaded their country.

Hiding in the basement of her parents’ village house, where she and her daughter had fled, Besidovska continued to text across enemy lines with the oncologist, pleading for guidance. They never mentioned the Russian shells raining down on Kharkiv and other nearby cities.

“I didn’t want her to stop helping us,” Besidovska said.

The doctor concluded that Yevheniia needed specialized radiation therapy and advised the family to come to Moscow. But Besidovska wasn’t about to cross into Russia — “They are trying to kill us” — and the Ukrainian hospitals nearby were under fire or running out of supplies.

“She needed treatment and everything stopped,” Besidovska recounted. “I knew we had to find it somewhere. We packed our bags to the sound of sirens.”

Over the next 19 days and more than 1,900 miles, Besidovska and Yevheniia found themselves on a grimly specialized track within the massive flow of Ukrainian refugees fleeing for safety: pediatric cancer patients, some of the most fragile cases known to medicine.

Even brief disruptions in the finely calibrated chemotherapy and radiation protocols of the young victims can be disastrous, oncologists say, meaning their transport has to be fast, reliable and supervised even in the calmest of times.

During this war, what has emerged is an elaborate network focused on evacuating some of Ukraine’s sickest kids. Doctors, nurses and specialized volunteers from dozens of countries have cobbled together a pipeline of way-station clinics, buses, ambulances and a hospital train to funnel cancer patients and their families out of the country, to a “Unicorn Clinic” in central Poland, and from there to pediatric centers around the world.

Those who make it out — more than 700 children so far — are becoming some of the most celebrated refugees. One flight to Paris was met by the French first lady. Jill Biden last week visited patients who had been flown to St. Jude Children’s Research Hospital in Memphis.

Besidovska, a 31-year-old manicurist from Sumy, Ukraine, knew none of this when she set out with Yevheniia on March 12. She was simply heading away from the doctor who had once saved her daughter’s life to find someone who could help her now.

Her husband, Oleksandr, also 31, stayed behind, forbidden by law to leave the country. The couple and other family members have joined a group call on the Viber app each morning and evening. “When he answers, that’s when I know he’s alive,” she said.

With two gray duffel bags, Besidovska, her daughter and her 20-year-old sister, Marina, headed by bus to Lviv, a major city near the Polish border that has been a gateway to safety since the war began.

Before the war, the city’s Western Ukrainian Specialized Children’s Medical Center treated about 20 to 30 oncology patients at a time. In the past month, those numbers doubled, then tripled.

The first surges came from pediatric centers in the line of fire. When fighting neared Kyiv’s main children’s hospital, forcing whole wards into basement shelters, hospital and government officials bused cancer patients to an obscure rail siding where they could board trains well away from the chaotic main station.

“People were fighting to get on trains,” said Yuliya Nogovitsyna, a program director with the Tabletochki Charity Foundation, who has worked full time on the pediatric cancer evacuations since the war began.

In Chernihiv, transporting young cancer patients had to be halted two days in a row after local militias sent the buses back to the hospital, Nogovitsyna said. Eventually, all the patients made it to the Lviv facility.

“We had families sleeping in the conference rooms,” she said.

Besidovska and her daughter arrived on March 28 — two days after a Russian rocket blew up a fuel depot near the city. It felt like the war was catching up with them, she said.

But by then, the Ukrainian medical workers and volunteers had gotten help. The Polish Society of Pediatric Oncology and Hematology sent doctors. The Polish government opened a side corridor for cancer convoys to bypass border delays that topped 20 hours on some days. Hundreds of young cancer patients were being ushered through a triage clinic that St. Jude’s international division had set up in a former hotel in Poland, near Kielce.

“They told me I needed to get to the Unicorn Clinic and they could help us,” Besidovska said. “Anywhere is better than Ukraine if they can cure my daughter.”

Two days later, she dressed Yevheniia in a Daisy Duck sweatshirt, zipped their tired duffel bags and climbed onto the red bus that would take them out of the war.

Two buses and eight ambulances followed a police escort to the border — where the convoy promptly stalled in a bureaucratic snag of almost four hours. A nurse told Besidovska that border guards had balked at the bus having Ukrainian plates and a Polish driver. “They needed orders from Kyiv,” she said.

The delay proved costly.

“Unfortunately, one of the children has deteriorated,” Pawel Kukiz-Szczucinski, a Polish oncologist who traveled with the group, said between cellphone calls to arrange an immediate medevac helicopter.

Six other critical patients, by plan, were driven straight to Austria. The rest went down a dirt lane near the border station to find a converted passenger train waiting in a freight yard.

Yevheniia, more bored than fatigued, leaned briefly against her mother as they made their way across the tracks. “That took sooo long,” the girl said of the hours waiting to cross. “I was just looking out the window.”

Besidovska gave her a squeeze, but they had to keep going.

There was no platform. Paramedics helped push and carry patients up a bench they had propped up as a ramp. On board were nurses, an anesthesiologist, a psychologist. One car was a complete intensive care unit.

The Besidovska family settled into a car lined with low cots for the five-hour ride. A clown twisted Yevheniia a pink-and-green balloon flower. Back east, her father fretted about the slow progress.

“I’m so worried about Zhenia,” he texted.

“Everything is fine,” Besidovska replied. She sent a picture with the balloon.

“I know you are next to her. That makes me feel calmer,” he said.

It was dark and raining when the train pulled into Kielce station, greeted by dozens of uniformed police officers, Red Cross volunteers and medics with bright headlamps. Some of the families looked startled as they were all whisked onto another bus and driven to the outskirts of town.

It was close to midnight when Besidovska and Yevheniia finally sat at one of the three tables in the Unicorn Clinic’s noisy lobby. A triage team of five people crowded around. A nurse checked Yevheniia’s pulse and temperature. They pored over her medical records, which had already been translated into English by a network of Ukrainian- and Russian-speaking doctors in the United States.

Katarzyna Kononczuk, a volunteer physician from Bialystok, Poland, asked about the girl’s first tumor, the remission, the MRI scan that showed a recurrence.

“How is she feeling now?”

“The same. But her eyesight is getting worse,” Besidovska said.

Clinic officials say the flow of patients has slowed in recent days, with so many having already made it out of Ukraine. But these latest arrivals are some of the most challenging cases, because they have been denied treatment for so long or they are newly diagnosed. An ambulance waits outside just in case.

“Now we’re seeing children who are more sick and more likely to get sick,” said Marta Salek, a fellow in pediatric oncology at St. Jude in Memphis who happened to be visiting her ailing grandfather in Poland when war broke out. She has been running this clinic ever since.

The Besidovskas were given a room, and plates of spaghetti. They were out of the war zone. But the matter of Yevheniia’s treatment was still unsettled.

The Unicorn Clinic is set up as only a temporary stopping place. For each group of arriving refugees, a clinic team crunches all the medical information and sorts through a list of facilities able to take patients for treatment. They hold nightly conferences with doctors in Lviv, Warsaw and around the world, matching cases to hospitals.

The process used to take a day, sometimes two, but it has become more efficient. Soon after dinner, the Besidovskas were told the psychologist was ready to see them.

“I don’t care where it is, as long as there is no shelling,” Yevheniia said as they waited.

The psychologist, Inna Alanbousi, turned out to be Ukrainian and asked about Besidovska’s family and their village. Besidovska told her how it had been surrounded by Russian troops, how she told Yevheniia that the explosions were thunder until she couldn’t lie anymore, how their only hope was to get away from the war, away from the Russian doctor who could no longer help them, to get to someplace else.

It would be Rome. You are going to Rome, Alanbousi said, to the famed Bambino Gesù Pediatric Hospital. The bus to the Warsaw airport would leave at 7 a.m.

Besidovska nodded. Rome was fine.

And, because war is both tragic and absurd, there was more. Alanbousi told them their trip to Rome — the family’s first flight — would be on the plane of Polish President Andrzej Duda, who was visiting Italy. They would meet Pope Francis.

Besidovska nodded again, more tired than excited. She didn’t follow politics and was Ukrainian Orthodox rather than Catholic. But any sign that God had an eye on Yevheniia was welcome.

“It is like God heard our prayers,” she said. “Maybe we have been traveling under his blessing.”

Oksana Parafeniuk contributed to this report.