Since the launch of SAFER Ukraine, a global command center has been operating 24 hours a day by St Jude and ALSAC Global employees and with more than 400 international volunteers. The command center has supported evacuation logistics, provided translation services for medical documents, and facilitated communication between centers. Hospitals that volunteered to foster Ukrainian patients organize through a national coordinator, provide medical transport, and fund medical care and psychosocial services to patients and their families.1

“These children are at high risk of infection and for their disease progressing, especially since they’ve been off therapy for a long time,” Dr Agulnik stated. “Because of disruptions from the war, these children are really fragile. Many patients have spent a lot of time in bunkers, so they were unable to be isolated. They’re exposed to common and new infections as a result of those scenarios. We’re just dealing with a much more delicate patient population who is not at their ideal transport-ready medical state in addition to the challenges of being in the middle of a war where normal resources are not available.”

On February 27, 2022, just 3 days after the Russian invasion, the first 3 patients were evacuated via this program. In the subsequent 12 weeks, 1031 pediatric patients requested evacuation and the first convoy of 37 patients arrived in Poland on March 1, 2022. Since that time, 15 convoys comprising 6 to 73 patients have been evacuated and transported throughout Europe as well as North America for continuing medical care.1

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Although these patients are delicate, Dr Agulnik pointed out a silver lining: “These are kids, and they just want to be kids. They’re super resilient and want to be able to have a normal life and play. That’s what has been really amazing to see that when given the opportunity to exit the scenario in Ukraine, and be in a safe place, this program offers hope for a different outcome from their disease as well as physical safety.”

The success of the SAFER Ukraine program may become a blueprint going forward for how to rapidly and safety evacuate vulnerable populations from areas experiencing man-made or natural disasters.

However, Dr Agulnik cautioned, “There are also, I think, elements of race and other characteristics that unfairly harnessed more of a response from the world to the war in Ukraine and we shouldn’t be blind to that. The difference in the regional response to this disaster, not just for children with cancer, but just in general, to other refugee scenarios has been called out very clearly by others, including the World Health Organization. I think we should reflect on that and think how we can do better in other areas where there isn’t as much availability of financing and other types of support within the region.”


  1. Agulnik A, Kizyma R, Salek M, et al. Global effort to evacuate Ukrainian children with cancer and blood disorders who have been affected by war. Lancet Haematol. 2022;9(9):e645-e647. doi:10.1016/S2352-3026(22)00259-9
  2. SAFER Ukraine provides a blueprint for responding to global health crises. Memphis, TN: St. Jude Children’s Research Hospital; August 30, 2022. Accessed September 26, 2022.
  3. Ehrlich BS, Movsisyan N, Batmunkh T, et al. Barriers to the early integration of palliative care in pediatric oncology in 11 Eurasian countries. Cancer. 2020;126(22):4984-4993. doi:10.1002/cncr.33151
  4. Ehrlich BS, Movsisyan N, Batmunkh T, et al. A multicountry assessment in Eurasia: alignment of physician perspectives on palliative care integration in pediatric oncology with World Health Organization guidelines. Cancer. 2020;126(16):3777-3787. doi:10.1002/cncr.33001
  5. Ehrlich BS, Yakimokova T, Batmunkh T, et al. Translating research to action: the development of a pediatric palliative cancer care advocacy tool in Eurasia. JCO Glob Oncol. 2022;8:e2100270. doi:10.1200/GO.21.00270
  6. McNeil MJ, Ehrlich B, Yakimkova T, et al. Regional adaptation of the education in palliative and end-of-life care pediatrics (EPEC-Pediatrics) curriculum in Eurasia. Cancer Med. Published online September 2022. doi:10.1002/cam4.5213