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The number of refugees with cancer is overwhelming health systems in Jordan and Syria, the UN Refugee Agency's top medical expert has warned, forcing UNHCR offices and partners to make agonising decisions over who does and doesn't receive care.
In a new study published today (Sunday 25 May) in The Lancet Oncology, Dr Paul Spiegel documented hundreds of refugees in Jordan and Syria denied cancer treatment due to limited funds, and called for urgent new steps to tackle cancer in humanitarian crises.
"We can treat everyone with measles, but we can't treat everyone with cancer," says Dr Spiegel. "We have to turn away cancer patients with poor prognoses because caring for them is too expensive. After losing everything at home, cancer patients face even greater suffering abroad - often at a huge emotional and financial cost to their families."
The Lancet Oncology study - which looked at refugees in Jordan and Syria from 2009-2012 - says the number of documented refugee cancer cases in the region have risen because there are more refugees overall, and because more people are fleeing middle income countries like Syria. Cancer is also a growing issue amongst refugees from low-income countries, where the focus had traditionally been on infectious diseases and malnutrition.
The most common form of cancer amongst refugees is breast cancer, accounting for almost a quarter of all applications in Jordan to UNHCR's 'Exceptional Care Committee', or ECC, which decides whether to fund expensive treatments.
In Jordan for example, the ECC could only approve 246 out of 511 (or 48 percent of) refugee applications for cancer treatment between 2010 and 2012. The main reason for denial was poor prognosis, meaning a patient had little chance of recovery, and the committee decided the limited amount of money was better spent on other patients.
In rare cases, the ECC has to reject even patients with good prognoses, because their treatment is too expensive. Dr Adam Musa Khalifa, a UNHCR doctor who sits on the ECC in Syria, tells of an Iraqi mother of two with a rare form of breast cancer. She had to end her treatment in Iraq due to insecurity, but her therapy was too expensive to continue in Syria.
The cost of cancer treatment can be as high as $21,000 in some cases.
"We face a terrible decision over who to help," says Dr Khalifa. "Some patients have a good prognosis, but the cost of treating them is too high. These decisions affect all of us psychologically.'
Government health systems in Syrian and Jordan have been overwhelmed, and private facilities are proving insufficient. International organizations have helped to expand facilities and pay for personnel and drugs, but it has not been enough, the paper warns.
Refugees with cancer often have their treatments interrupted due to insecurity in their home country. In Syria, for example, many hospitals have been destroyed or closed, and physicians have fled.
"The Lancet paper leaves no doubt that cancer is an important health problem amongst refugees," says Dr Spiegel. "We must find better ways, with host countries, to fund prevention and treatment."
New approaches could include mobile and online information campaigns focusing on preventative health, and new financing models such as crowd-funding and potentially health insurance. Any measures will need to include health-care systems in the asylum countries as a whole, to avoid inequality between host communities and refugees.
An embargoed copy of the full article can be found at
Photos and videos available here: http://www.unhcr.org/cancer
For further information, please contact:In Geneva, Dr Paul Spiegel, mobile +41 79 217 3112 In Geneva, Ariane Rummery, mobile +41 79 200 76 17