Could you tell us about your work with emergency and conflict settings?
We see about 22 countries in our region, the Eastern Mediterranean, across these 22 countries currently we have half of them, 13 countries, categorised as either on grade 1, 2 or 3 emergency or hosting a displaced and refugee population or countries of protracted emergency. Non-communicable disease, the four diseases including cancer, are now becoming a great issue and a critical issue in cases of emergency. You know that emergency previously looked at most of the work, the response for emergency looked into the area of maternal and child health, communicable infections. The area of non-communicable disease has not been on the radar for a long time and currently because of the rising number of populations displaced and refugee population we have to look into this area.
The WHO response usually is a response including all the sectors in terms of health and non-communicable diseases are chronic diseases, one of the issues the WHO is currently looking at as the main area to address during emergency.
Cancer has not been focussed on for many reasons. Although we looked into the area of what is the treatment for displaced diabetic, cardiovascular, hypertensive cases, cancer specifically has been left behind because of many issues of uniqueness of cancer care. First is the medicine – medicine for cancer is very specific and it is very high cost medicine usually. Second, the treatment has to be done not in primary healthcare, it has to be done in a special institution and a special administration of chemotherapy and radiotherapy and also it needs special staff. But unfortunately there is a huge number, or you could say reasonable number, of people who are affected by cancer who are currently displaced or in a country which is under crisis, like we could say Syria, Yemen in our region, Libya, Iraq and, to a certain extent, people who are displaced in Jordan and in Lebanon, these hosting countries, and Egypt. So we are addressing the issue, currently we are addressing the issue of what to do with these cancer patients in terms of accessibility for care, how do they take this care, and in terms of ethical issues, in terms of prioritising the care for these cancer patients considering, as I said, cancer care is very expensive and also special cancers need a special situation.
As a WHO challenge with this issue, the first thing to address these things we have to do an assessment of the situation. Assessment is helping on two angles – first to know what is the size of the problem, the size of people displaced who are affected by cancer. What is the situation in terms of destruction of the health system and what are the gaps currently available in that country which suffered destruction and what is needed in terms of supply, medicine, chemotherapy, staff, other resources needed. So assessment help and there is a process of doing a rapid assessment situation for the affected country as well as for the people displaced, refugees. The other issue is to try to enhance accessibility of these people. Unfortunately if you give an example like in Syria the UNHCR is also having a special committee who decided who are the people, what are the criteria for the people who can take treatment or people who cannot take treatment. This is also an ethical issue which needs to be addressed because there are many people who are not able to afford the treatment and for cancer treatment it will be ending with a huge burden on the patient. It will be much larger and expanding the out of pocket expenditure.
The issue of what is needed in terms of human resources and capacity building for the people serving the people for cancer. That gives me the lead to talk about the role of developing standard protocols for management of cancer cases in emergency situations. Now already the WHO have developed a sort of emergency kit for non-communicable disease. This emergency kit will talk about the treatment needed for cases who are suffering from other chronic diseases, not cancer, like cardiovascular, hypertension, diabetes. But cancer has to also be included at a certain stage, this is what we are working on. One of the important issues for the cancer cases also is the surveillance. Surveillance to put in place like knowing how many people are displaced with cancer, how many people are affected by cancer in areas of conflict and emergency.
How can people be a part of this initiative?
The way forward, there is a funding gap issue. Donation and funding for the area is highly needed. We are just trying to project the picture. These people, cancer people, sometimes they strive for limited access of treatment because of the resources issue so funding is a very, very key issue and critical. We are working with all partners to support and enhance the funding for treatment and accessibility of the treatment. Area of research is also a very critical element because we need to know what is going on. We know what is the situation of cancer normally in the region, cancer is one of the top four causes of death in the region, this is also expected to increase. But currently with the existing emergency situation and refugees we are also expecting this issue will be even more evident and more will appear so we need more research, more data to assess the situation of affected countries and hosting countries as well. So there is an element of people, cancer support and research, and support and funding and also support in a technical capacity. This is also very important, and training and providing technical support.
