As I write this piece at the beginning of May, two months have elapsed since the Russian Federation invaded Ukraine on February 24, 2022. Of the millions who have been displaced from their homes since the conflict started, the United Nations records that over 5.4 million Ukrainians have escaped to neighboring countries, largely to Poland, Romania, Russia, Hungary, and Moldova. The remaining 7.7 million individuals have been displaced within the Ukraine itself. Many of the displaced are children. However, due to the enormity of the chaos and disruption, it is difficult to know for sure exactly how many of the 12.65 million directly impacted by the war are minors (UNHCR Ukraine Situation Flash Update #10, 28 April 2022)
According to the regular United Nations updates on the refugee crisis, much of the current international humanitarian response has necessarily focused on ensuring that refugees have food, clothing, shelter, money, medical care, counseling, legal support, and protection from exploitation both within Ukraine and in the countries that have taken in refugees. Many children have escaped with mothers and female adult relatives, though some have fled as unaccompanied minors. These children have left fathers and other male adult relatives behind to fight and hide in dangerous and frightening circumstances. Many have seen family members killed or injured in the violence.
How do we try to understand the subjective experiences of children in these traumatic circumstances? Conceivably, these children will have to manage both the ongoing impact in the moment and the lasting trauma of war itself in addition to the disruptions of displacement and familial separation which will continue after the acute experience of the conflict ceases.
At the moment, there are limited personal accounts coming from children and families living through these catastrophic situations. One CNN story from April on the mental health needs of Ukrainian refugees in Poland featured an interview with an eight-year-old girl, Yana. In a video, she is shown practicing forward handsprings in a clear space in front of lines of cots and folding chairs at a refugee center in Warsaw. Before the war, Yana had been attending gymnastics classes six days per week near the Ukrainian coastal city of Odessa. When the interviewer queries Yana about the reasons her mother decided it was time for them to leave, Yana responds, “Well, because there were explosions there and stuff like that.”
The interviewer also spoke with the girl's mother, who describes a hard journey through Moldova, Romania, Hungary, and Slovenia before reaching Poland. The video shows Yana's school and play areas at the refugee center in Poland where she has access to donated school supplies and is surrounded by overflowing boxes of colored pencils. She has been attending Polish school on a smartphone remotely via video conference from the refugee shelter but has no access to in-person education. The play area has other children to play with and donated toys. When asked by her mother if she is OK, Yana states that, yes, she is OK. The evidence of the difficult journey and profound disruption to home are not easily seen in Yana's affect or demeanor. The mother speaks of her own hypervigilance when she hears the sounds of planes flying overhead.
In the next sequence, the camera pans from the women's circle group therapy session to the daycare area for children. The two areas are in the same large room separated only by a curtain, allowing sounds to travel back and forth between the two spaces. At one point, the voice-over states that the child playing in view is young enough “not to know too much” about the war. That seems doubtful, given that the mothers are just on the other side of the room speaking openly about their struggles, sometimes dabbing tears from their eyes with tissues. The Mayor of Warsaw, Rafal Trzaskowski, has devoted many mental health clinicians, including some who are refugees themselves, to help the refugees cope with the traumas that are, in his words, “beneath the surface.” Yet, with the call to provide material support for millions of refugees and the focus on adult mental health needs, it is possible that the unique emotional and psychological needs of children may get overlooked.
In his piece “Children in the War,” published for teachers in 1940 and likely broadcast by the BBC in 1939 (included in Oxford's The Collected Works of
DW Winnicott: Volume 2, 1939-1945), Winnicott writes about the differing impact of war on each age group. His observations of and writings on evacuee children were based largely on his experiences in outpatient clinics during World War II where he worked with children evacuated from cities in the UK. These children were sent to stay in private homes or placed in hostels in rural areas governed by the Hostels Committee with whom he consulted. His work highlighted the unique impact of war and displacement on children and provided a helpful guide for teachers, healthcare workers, aid workers, and mental health professionals during the current crisis.
Winnicott reminds us that whatever children may express outwardly, the situation of war will have an indelible impact on their development and intensify their pre-existing struggles. With parents and other adults under so much strain as a result of the crisis in Ukraine, it may be difficult for children of various ages to express fully what's in their hearts and minds to the adults around them. Therefore, their anxieties and grief may get pushed below the surface. They may exhibit more compliance on the surface, while the experience of the war continues to shape their experience. Thus, according to Winnicott's essay, “It is only possible to come to understand children's reactions to the giving of war news by first studying … the immensely rich inner world of each child which forms the background for whatever is painted in from today's external reality bulletin.”
Winnicott notes that very small children have less awareness of the actual circumstances of war but are more deeply impacted by disruptions to family and home life: “The worse effects come from separation from familiar sights and smells, and perhaps from loss of contact with father, things which often cannot be avoided. They may however come into contact with mothers' body more often than they would ordinarily do, and sometimes they have to know what mother feels like when she is scared.” Here, he highlights the trauma of various kinds of separation both from the environment of home and major attachment figures, including fathers, friends, extended family, neighbors, teachers, and clergy. They may also lose the possibility of an unstressed mother who would be more emotionally available to the child.
Winnicott reminds us that whatever children may express outwardly, the situation of war will have an indelible impact on their development and intensify their pre-existing struggles.
With regard to latency-age children between the ages of seven and eleven, Winnicott speculated that they are less apt to consider the real violence of war but instead will use aggression in fantasy and play. We can see that today in such games as “Ukrainians and Russians.” In the CNN video mentioned above, another eight-year-old girl interviewed on camera was asked why she and her family are in Poland; she stated that Putin “had something in his head” and agreed with the reporter that Putin didn't make good decisions. This eight-year-old's opinion of Putin is perhaps less bleak, minimizing the depth of Putin's aggression and wish to destroy Ukraine and the Ukrainian people.
Rather than emphasizing the ideological underpinnings of war and who is good and who is evil, Winnicott urges teachers of latency-age children to focus instead on war news within the context of geography lessons and on the facts and figures about the different countries involved. He expressed concern that a latency-age child could easily idealize what an autocratic regime promises to give to its people without appreciating the complexity of the abstract concepts driving the war on either side.
Unlike with younger age groups, adults may be able to more honestly share details about war with teenagers. Developmentally, adolescents are working to manage new drives and new ideas that arise in this stage. In this vein, Winnicott believes they may be able to make better use of real war news than younger children to understand their inner worlds and the adult world around them. Children who are “finding a new capacity for the enjoyment of personal responsibility, and who are beginning to cope with an increased potential for destruction and construction, may find some help in war and war news … In wartime we are all as bad and as good as the adolescent in his dreams, and this reassures him.” The tumultuous and chaotic world of war may serve as a mirror of the affects and drives within a child traversing adolescence.
In 1939 and again in 1940 and 1944, children from cities all across Great Britain were separated from their parents and evacuated due to the German bombing or blitzkrieg. Many children were placed in homes with families, but more troubled children were placed in hostels under the care of a warden and staff. While the psychological strain of separation from both parents and home for many of the British children who evacuated is arguably different than with many Ukrainian children who fled with their mothers or female relatives across national borders, it is worth highlighting the commonalities of experience.
Like the British children during World War II, Ukrainian refugee children might
be coping with fear, anxiety, and severe disruption to the many relationships and environment that comprise their sense of home. In Winnicott's paper “The Evacuated Child” (also included in volume 2 of The Collected Works), he describes a child's difficulty coming to accept his uncertain and profound separation from home. He highlights the fact that the child must struggle with whether to allow his temporary home to become his real home or treat his temporary home “as a place where he was to stay for rather too long a holiday.” He explains how very challenging it was for the evacuated children of World War II to attach to a new home and settle in. We can imagine that it is similar for children like Yana or for the children who are placed in the homes of other families:
It is so very natural for a child to feel that his own home is best, and that his own mothers' cooking is the only good cooking … He remained frankly anxious about his home and his parents, and indeed he had good cause to be anxious, since the danger to the home was real and well known, and as the stories of bombing began to go the rounds the justification for worry grew. Children from bombed areas did not go just go about looking exactly like the local children and joining in all the playing. They tended to keep apart and to live on the letters and parcels from home …
This passage depicts the experience of children who are evacuated and do not have the same ease of playing as the local children. They appear more isolated and preoccupied with their lost home. This would be a predictable reaction to the trauma of forced relocation. Winnicott expressed concern for children who settled into their foster homes too quickly and believed that it is more understandable when children express some level of distress and have periods of doubt and uncertainty and worries about their relatives from whom they are separated. For the children who adjust too quickly, their compliance and agreeability may reflect how children use the false self to contend with a multitude of stresses. In the case of the Ukrainian children, there would be uncertainties about male relatives who stayed behind to fight in the conflict or other family members who sought ways of escaping or resettled in other areas of Ukraine or other countries. We might expect a Ukrainian child to be hungry for news about family and to hold tightly to objects from home as important transitional objects.
While currently there are no exact figures of how many Ukrainian children and families have been resettled in other nations, it is clear that such resettlements are only temporary solutions. It is critical that longer-term solutions be found that prioritize and support security and stability for children and families, both physical and emotional.
Of course, such difficulties are not unique to Ukrainian children. They exist for children in war-torn countries around the world as well as for migrant unaccompanied minors and for any child who has faced violence and separation from family. However, the scale of the Ukrainian conflict and the sheer volume of children who are refugees are astonishing. Thinking about the emotional and psychological needs of these children—in addition to their basic needs for food, school, and shelter—is challenging and heartbreaking. In his report on the year 1943 to the Oxfordshire Hostels Committee, Winnicott summed up the enormity of the task of considering the needs of evacuee children:
In our work, therefore, we are not only providing something in between the child's own home and society itself, but we are also faced with the necessity of recognizing and trying to deal with the child's lack of belief. We therefore have a double task all of the time and it is this which makes the results disappointing to those who think that the problem is a simple one of providing a home to a stray (Winnicott Archives, Wellcome Collection, London).
For these children for whom the entire fabric of society and home has been torn apart, who have experienced this war as a profound failure of the environment, how can we as citizens of the world and as psychoanalysts consider their needs and in turn provide a response to these children that would be “good enough”?
Shirin Ali, M.D., is on the faculty of the Columbia Psychoanalytic Center for Training and Research and a Diversity Equity and Inclusion co-chair. She serves on the APsaA Board of Directors and the Institute Advisory and Consultation Service.