UN: Cancer care underfunded for refugees from Iraq, Syria conflicts

Among refugees from the recent conflicts in Iraq and Syria, there is a significant unmet need for costly cancer treatments, according to findings published in The Lancet Oncology.

These results have led study researcher Paul Spiegel, MD, chief medical expert for United Nations High Commissioner for Refugees (UNHCR), to call for new financing strategies to deliver necessary, affordable cancer care for refugees.

Spiegel and colleagues reviewed data from funding applications submitted to the UNHCR Exceptional Care Committee (ECC) from refugees in Jordan and Syria. In particular, the researchers focused on patients whose anticipated cancer treatment expenses totaled more than $2,000 per year.

In Jordan between 2010 and 2012, the ECC received 1,989 treatment funding applications, of which approximately 25% (n=511) were for cancer. The most prevalent cancers among these were breast (23.5%), colorectal (12%) and soft tissue (9.8%) cancers. Funding was approved and provided for only 48% of these requests. Denied funding applications were due to poor prognosis/palliative care only (for 43% of applications in 2011 and 31% in 2012) or too-expensive treatments (25% in 2011). On average, $11,540 was requested from the ECC for cancer therapies in 2011, and in 2012, an average of $5,151 was requested. Considerably lower amounts of money were actually approved, however: $4,626 was approved in 2011 and $3,501 in 2012.

According to Spiegel, much of the financial onus for these illnesses has inordinately fallen to the host countries that have extended hospitality, citing the Jordanian Ministry of Health’s payment of an estimated $53 million bill for refugee medical care within the first 4 months of 2013.

“The countries in the Middle East have welcomed millions of refugees, first from Iraq and then Syria. This massive influx has strained health systems at all levels,” Spiegel said in a press release. “Despite help from international organizations and donors to expand health facilities and pay for additional personnel and drugs, it has been insufficient. The burden has fallen disproportionately on the host countries to absorb the costs.”

The study researchers underscored the need for improved cancer prevention and treatment in the refugee population through novel funding approaches, more comprehensive cancer screening programs, and the implementation of Web-based cancer registries to avoid interruption of necessary treatment.

Spiegel said the current health care needs of refugees reflect a shift away from acute situations toward chronic diseases in refugee settings.

“Until now, the response to humanitarian crises have been primarily based on experiences from refugee camps in sub-Saharan Africa where infectious diseases and malnutrition have been the priority,” Spiegel said in the press release. “In the 21st century, refugee situations are substantially longer and increasingly occur in middle-income countries where the levels of chronic diseases, including cancer, are higher.”