Cancer and palliative care in crisis-affected populations in the Middle East

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Published: 22 Nov 2022
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Dr Deborah Mukherji - American University of Beirut, Beirut, Lebanon

Dr Deborah Mukherji speaks to ecancer about cancer and palliative care in crisis-affected populations in the Middle East.

She describes how conflict and war have impacted cancer and palliative care in crisis-affected areas.

She also discusses the actions that have been taken so far to improve cancer care in these areas.

Dr Mukherji concludes by highlighting the future plans for the conflict-affected areas.

I was very privileged to be talking this morning on two panels, co-ordinating a discussion about cancer and palliative care in conflict and crisis-affected populations. The first panel involved our speakers from Turkey, from Afghanistan, Pakistan, Palestine, Lebanon, Syria and also from Latin America. We also were very fortunate to have one of the WHO representatives from Ukraine talking about the acute conflict in Ukraine and how this is affecting populations with cancer on a very global scale in very different conflict and fragile settings.

How has conflict and war impacted cancer and palliative care in crisis-affected areas?

As we’ve learnt this morning, the issue of cancer and palliative care in crisis-affected populations is a very complex one. It’s very complex because the situations are changing rapidly and it’s very context specific. We have a lot of issues with multiple stakeholders, lack of funding and especially lack of data. So one of the main challenges globally is data poverty, looking at how many cancer cases are in different population settings when we’re dealing with forced migrants, both internally and externally. When we’re dealing with different populations in very difficult conflict and humanitarian settings often cancer is not top of the policy agenda. So as we are dealing with a very complex disease and unfortunately treatment can often be very expensive, many humanitarian agencies are not willing to even contemplate most non-communicable diseases when they’re thinking about healthcare coverage.

So what we learned today is that healthcare financing that’s very innovative and flexible, involving partnerships with NGOs, looking at individual cases, the individual context, is going to be really, really important in moving the agenda forward.

What is the current situation of palliative cancer care in the crisis-affected areas of the Middle East?

In the Middle East specifically we’ve had unfortunately lots of protracted conflict zones and again we’ve heard data this morning about refugees from Syria in Turkey and in Lebanon. We’ve heard data about patients having difficulties in cancer care access in Palestine. One of the major issues is the complexity and chronicity of conflict in the region. So as populations are aging, as populations are displaced internally and externally for numbers of years, the health needs of those populations change. There are very different ways in different areas of how governments, NGOs and other financing initiatives have dealt with populations with really complex needs.

So in the Middle East specifically unfortunately palliative care and access to cancer treatment is really very location dependent. So we have some data that this often means that patients present with later stages of disease, with limited access to palliative care services and this is one of the very vital issues that we’re shedding light on. As a community we really need to help these very vulnerable populations, we need to invest in cancer control strategies that are looking at populations in very different stages of migration.

What has been done so far to improve cancer care in these areas?

There are many, many initiatives, as you can imagine. I think one of the most important ones is actually the advocacy work and we’ve seen a lot of that here today. We’ve seen a lot of emphasis on looking at methods to look at cancer care funding and also the issue of value-based care. So really choosing wisely is one of the movements that has proven to be very informative about how to focus on low-cost interventions rather than the moonshot, very expensive, cancer care interventions that can affect a very small minority of the population.

What does the future look like for the Middle East?

For the research community that we’ve been involved in led by Professor Richard Sullivan, the R4HC research group, we’ve been looking specifically at cancer and medicine in conflict zones in the Middle East and Turkey. The future really is moving forward with how to use our data and using that to influence policy because without that, without reaching out to the multiple stakeholders, things will not change. So we have a lot of work to do, we’d like to call on the global community, the global oncology community, to be supporting this work because we really are looking at some of the most vulnerable patients that we serve in the region.