UNHCR calls for more to be done for Syrian refugees with cancer

News Stories, 26 May 2014

© UNHCR/L.Addario
Four-year-old Syrian refugee Zacharia lies dying of a brain tumour as his mother gives him water and his siblings look on with love and concern. He had been receiving treatment in Syria, but in Lebanon his health deteriorated dramatically.

LONDON, United Kingdom, May 26 (UNHCR) The UN refugee agency's top medical expert warned, in a study just published by a leading British medical journal, that the number of refugees with cancer is overwhelming health systems in Jordan and Syria.

Paul Spiegel, in the latest edition Sunday of The Lancet Oncology, added that this was forcing UNHCR offices and partners to make agonizing decisions over who does and doesn't receive care. He 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," said Spiegel, a doctor, who documented hundreds of refugees in Jordan and Syria denied cancer treatment due to limited funds.

"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," he noted.

The Lancet Oncology study which looked at refugees in Jordan and Syria from 2009-2012 said the number of documented refugee cancer cases in the region had risen because there were more refugees overall, and because more people were fleeing middle-income countries like Syria.

Cancer is also a growing issue among refugees from low-income countries, where the focus had traditionally been on infectious diseases and malnutrition.

The most common form of cancer among 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 per cent) 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. 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 US$21,000 in some cases.

"We face a terrible decision over who to help," said Dr. Khalifa, a co-author of the article. "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 Syria 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 Lancet Oncology article 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," said 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.

To read the report, go to http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(14)70067-1/abstract




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Advocacy is a key element in UNHCR activities to protect people of concern.

Syrian Refugees in Lebanon

As world concern grows over the plight of hundreds of thousands of displaced Syrians, including more than 200,000 refugees, UNHCR staff are working around the clock to provide vital assistance in neighbouring countries. At the political level, UN High Commissioner for Refugees António Guterres was due on Thursday (August 30) to address a closed UN Security Council session on Syria.

Large numbers have crossed into Lebanon to escape the violence in Syria. By the end of August, more than 53,000 Syrians across Lebanon had registered or received appointments to be registered. UNHCR's operations for Syrian refugees in Tripoli and the Bekaa Valley resumed on August 28 after being briefly suspended due to insecurity.

Many of the refugees are staying with host families in some of the poorest areas of Lebanon or in public buildings, including schools. This is a concern as the school year starts soon. UNHCR is urgently looking for alternative shelter. The majority of the people looking for safety in Lebanon are from Homs, Aleppo and Daraa and more than half are aged under 18. As the conflict in Syria continues, the situation of the displaced Syrians in Lebanon remains precarious.

Syrian Refugees in Lebanon

Turkish Camps Provide Shelter to 90,000 Syrian Refugees

By mid-September, more than 200,000 Syrian refugees had crossed the border into Turkey. UNHCR estimates that half of them are children, and many have seen their homes destroyed in the conflict before fleeing to the border and safety.

The Turkish authorities have responded by building well-organized refugee camps along southern Turkey's border with Syria. These have assisted 120,000 refugees since the crisis conflict erupted in Syria. There are currently 12 camps hosting 90,000 refugees, while four more are under construction. The government has spent approximately US$300 million to date, and it continues to manage the camps and provide food and medical services.

The UN refugee agency has provided the Turkish government with tents, blankets and kitchen sets for distribution to the refugees. UNHCR also provides advice and guidelines, while staff from the organization monitor voluntary repatriation of refugees.

Most of the refugees crossing into Turkey come from areas of northern Syria, including the city of Aleppo. Some initially stayed in schools or other public buildings, but they have since been moved into the camps, where families live in tents or container homes and all basic services are available.

Turkish Camps Provide Shelter to 90,000 Syrian Refugees

Displaced inside Syria: UNHCR and its Dedicated Staff help the Needy

The violence inside Syria continues to drive people from their homes, with some seeking shelter elsewhere in their country and others risking the crossing into neighbouring countries. The United Nations estimates that up to 4 million people are in need of help, including some 2 million believed to be internally displaced.

The UN refugee agency has 350 staff working inside Syria. Despite the insecurity, they continue to distribute vital assistance in the cities of Damascus, Aleppo, Al Hassakeh and Homs. Thanks to their work and dedication, more than 350,000 people have received non-food items such as blankets, kitchen sets and mattresses. These are essential items for people who often flee their homes with no more than the clothes on their backs. Cash assistance has been given to more than 10,600 vulnerable Syrian families.

Displaced inside Syria: UNHCR and its Dedicated Staff help the Needy

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