By Andrew Wu
One of the greatest current humanitarian catastrophes is the worsening refugee crisis caused by the conflict in Syria, which has many unfortunate implications in public health, especially pediatric care. According to the United Nations High Commissioner for Refugees (UNHCR), there are around 554,288 displaced Syrians under the age of 18 in Lebanon (this is an underestimate due to a halt on refugee registration). Assuming the annual incidence of pediatric cancer is 17 in 100,000 children; there are 90 new cases each year. Lebanon, which borders Syria on the north and the east, is bearing some of the burdens of an increasing population of displaced peoples. All Lebanese citizens have some form of healthcare coverage, with almost two-thirds of its citizens relying on a national healthcare plan. However, these government plans do not offer optimal treatments to conditions that may require long-term care, such as cancer. Thus, an influx of displaced refugees can further exacerbate the country’s public health system. Besides the limited aid from various nongovernmental organizations, displaced patients with pediatric cancer lack sufficient finances for treatment and can expect little support from the government or other third-party entities. A research article published by Saab et al. explores these issues, analyzing the mounting challenge of untreated pediatric cancer and possible solutions.
In order to study the scope of the problem, the researchers collected a variety of data on patients enrolled in programs offered by the Children’s Cancer Institute (CCI) at the American University of Beirut Medical Center. Areas of interest included demographics, clinical information, treatments provided, initial responses, and outcomes (i.e. remission). Enrolled patients were entitled to function-preserving procedures (e.g. limb-salvage surgeries), radiation therapy, and medical examinations. Researchers also analyzed data regarding the types of treatment provided, with their respective costs, and the number of patients referred or declined to make future projections about budget allocation.
The data-crunching yielded the following statistics. From 2011 to 2017, 311 non-Lebanese patients received partial to full treatments with 264 patients only receiving consultations due to a lack of eligibility and sufficient funds. One important trend is that the percentage of non-Lebanese patients accepted for treatments increased from 18% to 55-60% in the span of the aforementioned 6 years, which corroborates the UNHCR’s report on the escalation of incoming refugees. A majority of those patients (86%) were treated within the last four years. There is, however, some discrepancy between the acceptance rates of the CCI based on country of origin. For example, a little more than half of the presenting non-Lebanese patients were given treatment overall, while almost three quarters of native citizens were accepted. Furthermore, 56% of Syrian patients and 52% of Palestinian patients were accepted, as opposed to the 62% of Iraqi patients who only received a consultation.
Patients that were not accepted for treatment could still be enrolled in disease-specific programs, which were an offshoot of the CCI and were additionally funded by St. Jude Children’s Research Hospital and the American Lebanese Syrian Associated Charities (ALSAC). Thus, those programs covered similar treatments as the CCI (e.g. diagnosis, local control surgery, and radiation therapy). On the other hand, chemotherapy was administered elsewhere at other Lebanon hospitals. Syrian and Palestinian patients requiring chemotherapy were supported by smaller NGOs besides CCI, but there were virtually no auxiliary funds available to Iraqi patients. While some of the costs were covered by the CCI, those families needed to pay out of pocket at the other hospitals. Nevertheless, patient nationality did not affect treatment planning or consultations. Overall, approximately half of the patients admitted had intermediate-risk diseases, with the remaining percentage split between 29% developing high-risk disease and 22% having low-risk disease. In a follow-up report, a majority of the patients were in remission (58%), 20% were continuing treatment, 13% were in relapse, 8% left before finishing treatment (most of these cases were patients relocating to continue treatment in another country), and 1% died of toxicity.
Such statistics demonstrate that the ongoing conflict in the Middle East will continue to exacerbate public health burdens. The UNHCR is currently unable to cover chronic conditions due to insufficient foreign aid. While the CCI does vital work, it is only able to treat 30% of new pediatric cancer cases in the country due to financial restraints. In addition, displaced families often live in communities without oncology specialists, and so patients end up concentrated in CCI under the care of already overburdened medical staff. Already a quarter of the population in Lebanon were refugees by the middle of 2014, and the fact that more than 2000 Syrian children are born annually will only put more pressure on the country’s resources. Partnerships between different charities such as St. Jude, the Children’s Cancer Center of Lebanon, and the ALSAC, have demonstrated the importance of an organized and committed approach from both public and private sectors to addressing this issue. There is no doubt that the United Nations has the moral responsibility of continuing to resolve the crisis. Hopefully, the CCI can raise ample funding in order to expand its outreach. Considering the power of modern medicine and the treatability of pediatric cancers, we ought to provide the best care for these children and build them a better future.
Image found on: http://thirdforcenews.org.uk/tfn-news/scots-charity-to-feed-refugees-in-lebanon