In one of the countries hardest hit by the pandemic, thousands of Italian minors lost a parent or caregiver to COVID. However, unlike other places, Italy has yet to set out a clear plan to support them, leaving them more vulnerable to mental health issues, and even abuse.
ROME — Julia was 13 years old when her father was hospitalized for COVID. It was March 2020 and very little was known about the virus. When they loaded him into the ambulance, the girl had no idea that she would never see him again.
The following days at home were rough: her mother was very agitated because she could not get any information, while her little sister did not understand what was going on. And then came the news: Julia’s father had died, but no one knew if and when it would be possible to see him and conduct his funeral. Julia did not allow herself to cry. Instead, she told the psychologist who was seeing her: "Now I have to be strong, dad would have wanted it that way."
Her mother fell into depression, she had no job, and the entire family was left without financial support. "Can I get a job to help mom?," Julia asked the psychologist. For a moment she even thought of quitting school, but then changed her mind and got a part-time job as a babysitter.
After a few weeks, however, she broke down: she no longer felt like leaving her room, quit volleyball, and no longer wanted to go to school.
Julia started to experience regular flashbacks to the last time she had seen her father, and slowly felt an anger growing inside her.
How can young people cope with losing a parent to COVID?
Julia's story (the name is fictional) is like that of many boys and girls who lost a parent during the pandemic. "These young people have experienced grief and have not had a chance to process it," explains Giovanna Bonvini, a psychologist at Mandorlo, a family counseling center in the province of Lodi in northern Italy, which has followed many families affected by the death of a loved one in the first wave of COVID in 2020.
"At that time the key steps that help people accept the loss of a person were missing: saying goodbye one last time, attending their funeral or sharing their grief with family and friends. All the protective factors for the physiological processing of grief have been skipped: children and adolescents have been suspended in suffering, which has been prolonged, creating greater damage."
The family climate was severely compromised, and the children felt it
According to research conducted in 21 countries and published in the medical journal The Lancet, in Italy 3,201 minors lost a parent to COVID during the first year of the pandemic: 671 were motherless, 2,529 fatherless, and one child lost both parents. Added to this are the 366 children or adolescents who lost a grandparent serving as their foster parent, and another 2,214 who lost grandparents or relatives who lived in their same household.
Despite these numbers, Italy still lacks a specific plan of psychological, social and economic support for orphans of COVID victims. A bill providing support in favor of these minors was presented in March 2021, but it is currently blocked in parliament. In the meantime, each local community has responded by activating its own resources: associations, family counseling centers or the child neuropsychiatry departments of hospitals. Services that, however, differ from region to region.
"In our area, although the impact of the pandemic has been devastating, solidarity has been very strong and a very efficient social network has been mobilized," says Enrica Bianchi, manager of Il Mandorlo counseling center. "Children lost their daily routines overnight: they could no longer go to school, see friends or other attachment figures. Families were isolated at home, with no news of hospitalized relatives, waiting for a phone call. The family climate was severely compromised, and the children felt it."
This is what happened to 12-year-old Adriano (fictitious name), who lost his maternal grandfather to COVID. After he was hospitalized, Adriano and his mother did not get any information about his condition until two weeks later, when they were informed that he had died.
"Adriano’s grandfather was a guide for him, since he had lost his father two years before the pandemic due to a car accident," says psychologist Lucia Guasconi of Il Mandorlo, who accompanied the family. "This also brought back up the grief of his father's death, which had not been fully processed." Adriano began to suffer from very severe separation anxiety from his mother: he feared that she too would get sick, he never left her. And then he stopped playing soccer and going to school. Home was the only safe place for him, he repeated, "Only bad things happen out there."
Even at night, Adriano wanted to sleep with his mother. He had nightmares about what he imagined was the death of his grandfather and his father. He stopped eating. He would always stay in his room playing video games, because "at least there you can control things" and if you die you have the right to another life. Then came the insomnia, irritability, and aggression, especially toward his mother.
"On the one hand he protected her, on the other he took his anger out on her," Guasconi says. "We treated them in parallel, with some sessions together, to help them process the pain." Today Adriano is better, he is attending seventh grade and has resumed playing soccer, although sometimes when he scores goals he still turns toward the stands to look for his cheering grandfather.
Each child requires individual care
Communicating bad news to children
The emotional and psychological consequences of bereavement can be different depending on age: "Children of primary school age often develop symptoms of separation anxiety from parents, due to the fear that they may lose them at any moment, and regressive behaviors, such as wetting the bed or no longer wanting to sleep alone," Lucia Guasconi explains.
"Children often have nightmares or intrusive thoughts, such as the sound of an ambulance. In older children, symptoms such as depression, anxiety, episodes of self-harm, eating disorders, tendency to social withdrawal, internet addiction, and sleep-wake rhythm reversal are more common."
Even before COVID, several hospitals and associations had started projects to give psychological support to children and families coping with a relative’s illness. In 2015, for example, the Pope John XXIII Hospital in Bergamo had begun an experiment, called the Lego project, aimed at accompanying children whose parents have cancer.
There are no things that cannot be said, the important thing is to find the right words.
"In critical moments, such as those of illness, children suffer a lot from not being involved and not understanding," explains Dr. Maria Simonetta Spada, director of the hospital's clinical psychology unit. "Considering that death is a taboo, it is essential to take the time to explain to children what is happening, without hiding one’s emotions, without wanting to seem like superheroes."
The same applies to the victims of the pandemic. "In order to protect their children, some parents preferred to omit information or tell lies," says Spada. "But that's not the right approach: the children feel a climate of suffering anyway; there's no point in denying it to them." From the very first lockdown, the clinical psychology unit has been active with remote support for families to help them communicate the course of the disease to their youngest children.
"It is crucial to strengthen trust in adults and to build an alliance, starting with telling the truth," Spada continues. "There are no things that cannot be said, the important thing is to find the right words."
Protecting the vulnerable
As of April 2020, Save the Children has also started a remote support service for families and a Facebook group for parents to share their concerns. "As always, those who suffered most were the most vulnerable, that is, the children and families with fewer economic, social and cultural resources," explains Erika Russo, head of psycho-social and case management department at Save the Children Italy.
"The issue of children orphaned in pandemics has not yet been addressed structurally in Italy. In other countries, such as India and Peru, the debate is open. We as an organization have made important efforts in order to prevent these children from being put in orphanages or ending up in illicit exploitation, and have called on governments to provide aid for foster families."
The issue of mistreatment of children orphaned by COVID is also a urgent one in Italy: in its Regional Index on Child Maltreatment 2022, the humanitarian organization Cesvi notes that during the pandemic, situations of particular stress within the family, combined with increasing economic hardship, have resulted in the deterioration of the risk factors leading to child abuse.
"This does not mean that more girls and boys have actually been abused, but that these conditions make the phenomenon of family abuse more likely," explains Valeria Emmi, editor of the report. "Domestic violence remains a submerged phenomenon, even more so in a time of public health crisis and isolation, with schools closed and pediatricians not visiting in person: we were lacking those local facilities that normally play a key role in intercepting new cases of maltreatment. According to the World Health Organization, for every case of child abuse, there are nine others that do not emerge."