My presentation is part of a panel on cancer care in time of uncertainty, war and conflict. My talk was about cancer care in Syria and Lebanon, the two settings that face protracted long-term crises.
How does conflict and war impact cancer care in crisis affected areas?
Cancer usually is a long-term disease that needs a long-term management. The whole issue of a humanitarian response in times of war, of displacement, of uncertainty, is quite a short-term response, so focussing on infectious diseases and basic needs whereas in cancer we need this sort of continuity of care. If there is no plan from the beginning, or programme, to address this long term, usually the management, the care for cancer will be shortened in a way that is having a severe impact on the prognosis of the patient.
I would also want to address another point here which is about that cancer, like many other chronic diseases, is a costly health problem. This is an issue that needs more resources, whereas the humanitarian response in times of conflict or times of crisis focuses on the issues that don’t need a lot of funds or the funds usually go to these sorts of basic needs. That’s why more money goes to infectious, family planning, children and maternal health and less on chronic diseases and, on the top, cancer. So that’s there. So very few patients can get the cancer care and very rare in numbers that can afford paying for their own.
What is the current situation of cancer care in the crisis affected areas of the Middle East?
There’s a dire situation now in the Middle East. I focus on countries that face crises – Iraq, Syria, Lebanon; to some extent countries that receive also refugees, including Jordan. So the whole issue of cancer care is quite critical because of lack of funds, because of a lack of enough human resources, including specialised physicians on this, a lack of equipment. Cancer needs sophisticated equipment – radiotherapy, diagnosis with advanced technology machines. With this issue of needs, very little is available to serve those patients.
The other issue is there is not enough data to know exactly the situation, which is quite weird because collecting data is not any costly or expensive issue. Collecting data needs policy, willing and political willing, and the experience in doing so. But even though there is no cancer registry, there is no data available, and that’s why we don’t know exactly the size of the problem. We have bits and pieces from here and there and we don’t know exactly what could be the main issue to address.
So asking about what’s achieved up until now, the main issue is that finally we have programmes on NCDs within the humanitarian response plan. That could be a first step, hopefully, next time to have programmes for cancer in such a sort of response. Second is that we already started such a sort of debate about the need to include refugees’ health in the national health system. That could bring cancer as one of these needs to be responded to.
What does the future look like for the Middle East?
I don’t want to be very pessimistic but the future is not very shiny. It’s still more protracted crises in the region and more drying in funds, more massive movement from physicians, doctors, health workers, nurses, leaving the dire situation. That will put a high burden on the health system. A lot of political tension also. So what can be done is that we need to bring this topic as a major topic for discussion, for conversation in the region. Also to integrate the different population groups in search of not just the national system but also in the regional system.