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"Before he got hit, Sasha was like a proper child. Now he seems like a grown up. He can tell from the sounds what type of weapon is firing." - 12-year-old Sasha's guardian talking about the changes in him since he was shot in the ankle by a stray bullet. After nearly five years of conflict in eastern Ukraine, 3.4 million people are in need of humanitarian assistance – 60 per cent of them are women and children. Approximately 1.6 million people have been forced from their homes and tens of thousands of civilians have been killed or wounded. The situation is particularly grave for girls and boys living in areas with the fiercest fighting: Donetsk and Luhansk oblasts – within 15 kilometres of the ‘contact line’ – a line that divides government- from non-government-controlled areas. Children face the immediate threats posed by the conflict, and the long-term impact of lost education and trauma. Children living in these areas face grave threats from shelling, landmines and unexploded ordnance. Their lives are also threatened by destruction of vital civilian infrastructure – health centres, schools and water supplies – as a result of the fighting. Millions of people depend on water infrastructure that is in the line of fire. Aleksey washes his face and his missing fingers are highlighted. Aleksey, 14, lost two fingers and a thumb when a discarded shell exploded in his hand. Education – so crucial for a child’s sense of ‘normalcy’ – has been shattered, with more than one in five schools in eastern Ukraine damaged or destroyed. Teachers and psychologists report signs of severe psychosocial distress among children, including nightmares, social withdrawal and panic attacks triggered by loud noises. More than one in four children in Donetsk and Luhansk are thought to need psychosocial support. Few, however, get that support, as the available services are over-stretched and under-funded. “It is extremely painful to recall how we almost died twice. It is hard for us to talk about how we had to leave behind everything we had – a home, a job and friends – so we could stay alive.” - Amina, aged 12, from the village of Mykolaivka in Donestk, now living in Kiev. Immunization coverage has been undermined by a combination of conflict, lack of vaccines and vaccine hesitancy (a reluctance among parents to have their children immunized). The country experienced polio outbreaks in 2015 and is at high risk for polio transmission, according to the Polio Regional Certification Committee.

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Conflict in Ukraine