Opinion: An 11-year-old who survived Uvalde says he and his friends will ‘never be the same’

(CNN) — On May 24, 2022, then-fourth-grader Daniel Ruiz managed to escape the Robb Elementary School shooting in Uvalde, Texas that claimed the lives of 19 of his classmates and two teachers.  Daniel climbed out of classroom 109 to safety through broken glass.

But Daniel, now 11, says the fun-loving kid he was, prior to that fateful day, did not survive the massacre. He doesn’t know anyone who is the same person after that experience.

“Sometimes, when my anxiety makes me zone out, I wish that I would just be back in the fourth grade and wake up and this would just be a bad, bad dream,” Daniel told me. “My friends, cousins and I will never be the same again … I miss how happy I used to be. I hate how I can’t stop my head from spinning or thinking of things that can go bad.”

Gun violence is the leading cause of death for children living in the United States, according to the US Centers for Disease Control and Prevention (CDC), and around 132 people succumb to gun-related injuries each day.  Yet these harrowing statistics do not fully or adequately encapsulate the true, ever-lasting harm caused by acts of gun violence.

The children left behind — kids with mental, physical and emotional scars, like Daniel — lose a piece of their former selves, too. And even when they have access to quality mental, physical and emotional support, they face numerous uphill battles that impact their quality of life. Sometimes, forever.

According to a recent study published in the journal Health Affairs, in the one-year period after a shooting, survivors’ health care costs increased by about $34,884, or a 17.1-fold increase.

The study, which only evaluated children who had associated health insurance claims, does not include those who do not have access to health insurance or who cannot afford any out-of-pocket costs for physical, mental and emotional care.

From the needs of children who were injured to those for whom the scars of gun violence are not visible, simply having access to health care coverage in the US — already inaccessible to far too many — does not guarantee that a child will fully recover from an act of gun violence.

“I’m a single parent doing it on my own, so any appointments he has or even my other children have, means I have to miss work and it makes it so hard,” Briana Ruiz, Daniel’s mom, told me. “It cost me so much and got to the point where I was afraid I was going to lose (our) home … When Daniel has bad days, I can’t always afford to keep him home and make sure he’s OK mentally, because if I do, I’ll fall behind on my bills and I can’t let that happen.”

Dr. Chethan Sathya, a pediatric trauma surgeon and director of the Center for Gun Violence Prevention at Northwell Health, told me that if US legislators lack the political will to pass common sense gun legislation that curbs the epidemic of gun violence, health care supports for children needs to change in order to adequately meet an increase in pediatric gun violence patients.

“So few resources have been poured into this issue,” Sathya told me. “A lot of the services we’re talking about are beyond surgical care… If someone comes in with a gunshot wound, our trauma team is activated and we care for them surgically.” Her team is not resourced to provide ongoing care for disability, PTSD, substance use or other behavior health issues that may present in the aftermath of a shooting.

As a result, Sathya says that when he has a patient with a gun injury and they survive, he does not know if that patient is “going to have everything they need for rehabilitation.”

“How am I going to know that they have adequate follow-up and social work and case management?” he asks. “A lot of patients who aren’t even able to come in for follow-up care for their wounds get secondary infections — complications that are totally preventable just from the surgeries that we do to repair the wounds.”

In addition, pediatric gunshot victims are often cared for by a burnt out and overworked hospital care system, where doctors, nurses and support staff are facing their own mental health issues, staffing shortages and inadequate workplace environments.

“There is intense trauma among healthcare workers themselves, normalizing — unfortunately — the fact that kids do come in with bullet wounds,” Sathya says. “(Gun violence) affects everybody.”

It is also impacting a crippling mental health care system that is already facing staffing issues, particularly among clinicians of color and at a time when Black children are five times more likely to be a victim of gun violence than their White peers, according to data from PEW Research Center.

“We need people to have more access to not only training programs but creating good training programs. We need to have more diversity and training of diverse groups of people providing (mental health) services,” Dr. Jill Emanuel, vice president of clinical training for the Child Mind Institute, told me.

In addition to a larger and more diverse clinician population, Emanuel says society at large needs to focus more on the mental and emotional needs of young people who manage to escape an act of gun violence with their life.

“Our job as adults and as caretakers of children is to provide as much support for them as possible and to restore their sense of psychological safety.” She notes that people may assume a child is fine if they have access to therapy, but their caretakers also need to be having ongoing conversations with them.

How clinicians are licensed, she adds, can also make a difference. “Right now, we are all licensed in our individual states and there are some initiatives to figure out licensing across state lines,” Emanuel says, noting that making telehealth more accessible and allowing for more reimbursement for health insurances will also eradicate some of the many barriers to long-term care for pediatric gun violence survivors.

For Briana Ruiz, she simply wishes more people understood that just because a child wasn’t struck with a bullet doesn’t mean they’re “perfectly fine and (can) get on with their lives.”

Perhaps then, she hopes, with some societal understanding, her son can start to become the boy he used to be.

“Nobody sees all the anger and uncertainty that these children have to live with for the rest of their lives now … Their worlds were turned completely upside down in a matter of seconds … My son to this day says he can still hear the bullets bouncing off things in his class,” Briana Ruiz says. “He recalls the noise the bullet made when striking a classmate and hearing her and his teacher in pain from being shot. These are the things that are not just going to go away.”

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Correction: The headline in an earlier version of this article gave the incorrect age for Daniel Ruiz.