We are going to discuss the cancer care in emergency situations. The reason behind it, we are surrounded by crises, not only the wars but the earthquakes, natural crises, economic and financial crises and natural disasters. So people are affected by these crises after having acute problems; if the crises continued then people started to face suffering from chronic problems like cancer, diabetes, dialysis. These kinds of emergency situations need improvement at the global level. The session has a focus on this – cancer care in emergency situations.
How does conflict impact healthcare, especially cancer care?
First of all, let me tell you that more than one billion people globally are living in a zone affected by conflict, fragility, political instability, whatever you name it. So at the moment there are more than 100 million people who are forcibly displaced from their home country. When they left their home country after having safety issues, lodging issues, accommodation, then the food supplies, the crisis is not a short-term crisis anymore. They are long-term crises, we are faced with long-term crises.
When the crisis continued the people started to face with the diagnosis, new treatment or the continuation of ongoing treatment or to follow-up their situation, so to give them the best chance to survive. What is happening, we have seen during the last ten years, personally I had observed the Syrian crisis in the country where I am living, Turkey. The crisis started in 2011, now how many years? 13 years we still have three million plus refugees; some babies were born in Turkey. Some people when they immigrate, when they are forcibly displaced suddenly they left their treatment behind, they have no documentation. When they come, the host country was not ready to take care of those who had cancer diagnoses. While we are dealing with the issues with Syrian refugees then another crisis occurred, the Russian Ukrainian crisis. Many Ukrainian people left their country while they are on treatment or they got diagnoses or delayed diagnoses during the immigration itself or right after the immigration. Then recently the Israel Gaza conflict caused a lot of disruption on the treatment and diagnosis, screening of the cancer care, in people living in Gaza.
This is something we need to invest more. Involuntary migration for many years is better described but the crisis in emergency situations is less described. There is not that much research and the world does not have capacity to invest a lot in those people who are affected by those crises. So, together with other colleagues during the session, two days later during the World Cancer Congress, we will be discussing the solutions, how we can improve the situation for those people forcible displaced from their home country.
What can be done to improve cancer care in conflict zones?
The crisis in emergency situations is something unexpected. So even the countries where people are living and the host country where people are supposed to arrive are not ready to manage those crises. So what is needed, first, the knowledge of how to manage the situation. The managers, decision-makers, politicians, investors, the people who decide to spend the money should know how to manage these kinds of health conditions, how to manage it. Preparedness, I would name it.
When I look at the world, more than 160 countries have already national cancer control plans but very few of them have cancer control in emergency situations. After having this awareness during the last few years, I hope to see more on cancer control during the crisis situation in the national cancer control plans. So infrastructure in the host country should be right after the crisis, after providing the lodging, food, security, infectious disease control, vaccination, the host country should organise how to take care of the patients immigrated, forcibly displaced, to the country who already have cancer diagnoses or how to manage the screening of those people, mobilising the existing healthcare capacity or establishing the new rules, organisations. For example, in my country, Turkey, right after the crisis, after a few years, established immigration centres, getting some financial support from the European Union, trying to establish partnerships with other stakeholders to manage the situation. But also it’s important, it’s not only the money issue, it’s also an issue of how to mobilise your healthcare workforce. Because the healthcare people, healthcare professionals, are not trained to take care of the people who immigrated to their own country. They should act very quickly, establish the teams, quick training, those kinds of things.
So if I classify the actions to manage the situation, there are responsibilities to the home country, there are responsibilities to the host country, there are responsibilities for immigrants themselves. So, for example, there are different types of barriers – cultural barriers, language barriers, legal barriers. When you go to a country if there are not laws, or laws are not implemented to protect the immigrants, you are in trouble. It’s a full spectrum of measures.
Last February the WHO in Copenhagen invited all the experts and they discussed how to manage the NCDs, non-communicable diseases including cancer, in crisis situations. Then they will come with a plan at the global level. So it’s not easy, it’s a complicated issue.
We haven’t made that much progress yet but I am happy to see much interest and much awareness are coming from the global community, not only from the WHO, United Nations, but the oncology community is also trying to discuss how can we manage the situation in a better way.
Are there any success stories?
There are good initiatives in which I see hope and I support. For example the UICC. Right after the Ukrainian crisis the UICC established a fund to support cancer organisations in the neighbouring countries and within Ukraine to support the people with cancer immigrating to other neighbouring countries. The UICC was able to collect one million euros and distribute that money to support the people. That did not solve everything but it was a good move.
The other thing is the story from Turkey. Turkey was able to get some financial support from the European Union, on the top of that from its own sources also they put money. However, does this action change the life of the people? We are not there yet because I did some research on cancer in Syrian patients in Turkey. Still when I look at the survival rate for the Syrian refugees in Turkey it is still low compared with the current survival rate. But I am glad to see the WHO, United Nations, all decision-makers, some funders, are investing a lot recently on cancer care in emergency situations.
The whole issue is not solved yet because the crisis is not over yet. We are disappointed to see how crises affected the life of the people. I’m not talking only about the war and cancer but I’m also talking about earthquakes, natural disasters, and the violence in some sub-Saharan African countries. There are different types of crisis. I think we should continue on the work that we are doing now.
