* Doctors choosing which refugees get treatment
* Some patients with costly chronic diseases denied care
* UNHCR's $1 billion appeal only 55 pct funded
By Stephanie Nebehay
GENEVA, April 26 (Reuters) - Doctors at Syrian refugee camps in Lebanon and Jordan are having to decide between treating acute cancer patients and helping deliver babies due to severe shortages of cash, the United Nations said on Friday.
More than 1.4 million Syrian refugees have now fled their shattered homeland for neighbouring countries whose health care systems are straining to meet the needs of their populations, in some cases suddenly swollen by 20 percent, it said.
But an appeal by U.N. High Commissioner for Refugees for $1 billion through mid-year is only 55 percent covered. This has meant that some of the costly medical care for chronic diseases is being denied, although emergency cases are treated, it said.
"We will prioritise paying for a woman's delivery instead of paying for treatment of a cancer patient with a poor prognosis. That is bad, but we have to do it. These are hard decisions," Dr. Paul Spiegel, UNHCR's chief medical expert, told Reuters.
Acute respiratory infections and diarrhoea are the most common ailments among Syrian refugees, three-quarters of whom are women and children, the UNHCR said in its first report based on medical consultations in Iraq, Jordan and Lebanon. No data was available from Turkey, it said.
Some refugees require treatment for hepatitis A infections, others for skin lesions due to leishmaniasis, it said.
Both diseases have broken out in Syria, whose health system and drug industry have collapsed due to the conflict between Syrian government forces and rebels, now in its third year.
"NOT THE HEALTHIEST POPULATION"
But many of the refugees are elderly, suffering from chronic diseases such as diabetes, lung disease, cancers or cardiovascular disease, who received free treatment under their country's socialised medical system, it said.
Spiegel, referring to treatment for diabetes, told a news briefing: "With renal dialysis you don't pay for a month and then stop, you pay forever.
"And then very hard decisions are made, and many are not funded, and therefore they either have to find other funding and in some cases, yes these patients may die."
Syrians are used to high-quality medical service, more comparable to that in Europe than in Africa, Spiegel said.
"This is not the healthiest population, there is smoking, a fair bit of obesity and not much exercise," he added.
In Iraq and Jordan, refugees have access to free health care at all levels.
But an "elective care committee" meets each month in Jordan to discuss refugee patients whose treatment exceeds a fixed financial ceiling, UNHCR said. In the first three months of the year, 158 Syrians were reviewed, with treatment approved for cardio cases, perinatal cases and acute renal failure, it said.
In Lebanon, which has a largely privatised health care system and cost sharing is the norm, refugees must pay for referrals to experts for specialised care. An elective care committee held its first meeting in late March to review cases.
Iraq is studying whether to set up such reviews, it said.
"People are spending more out of their pocket. Refugees are coming from a system where they are not used to paying. The longer they stay, the less they have," Spiegel said.
Antonio Guterres, U.N. refugee chief, warned in mid-March that the number of refugees outside Syria could triple by the end of the year from 1 million at that time.
"The challenges of providing access to affordable and quality health care for Syrian refugees will only increase in the months to come," the UNHCR said in its report on Friday.
(Reporting by Stephanie Nebehay; Editing by Michael Roddy)