Childhood cancer among Syrian refugees: the need for new approach. Fouad M.Fouad MD World Cancer Congress Paris Oct.31-Nov.3, 2016

Transcription

1 Childhood cancer among Syrian refugees: the need for new approach Fouad M.Fouad MD World Cancer Congress Paris Oct.31-Nov.3, 2016

2 Syria Tragedy 10 p/ hour are killed since 5 years (mostly civilians) Half million death (direct violence) 2 million injuries 12 million displaced

3 Syria Tragedy 1. long term/protracted (almost 6 years) average length of major protracted refugee situations globally is now 26 years 23 of the 32 protracted refugee situations have lasted for more than 20 years. (UNHCR ) 2. massive influx (4.8 million Syrian refugees, 7 m IDPs) 10 million refugees/21.3m worldwide are Syrians and Palestinians (UNHCR/UNRWA) 1.1 m in Lebanon-209 refugees/1,000 inhabitants, one million have requested asylum to Europe 3. urban settlements; 85% of refugees are non-camps

4 4. middle income; NCDs are estimated to account for 77% of all deaths 5. multiple actors (state/ non-state) = multiple health systems life expectancy fell by 7.3 years (both sexes) 11.3 years (male) (Lancet 2015)

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6 The framework of humanitarian aid system Emergency OR Protracted crises

7 The framework of humanitarian aid system Built on the experiences of refugees living in camps in low-income, less developed countries where communicable, maternal, nutritional, and newborn diseases are prevalent Respond by straightforward interventions such as antibiotics vaccinations nutritional supplements. Cavallo 2016

8 % of total deaths caused by NCDs (both sexes, all ages) 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Percent of Total Deaths caused by NCDs in the Largest Source Countries of Refugees in % 37% 19% 34% 23% 59% 20% 62% 37% No data available Rabkin, Fouad 2016

9 Morbidity and Mortality before 2011 Mortality from CVD; coronary heart disease and stroke: over half of all-cause death in Aleppo (Maziak et al. 2007). Risk factors for CVD :two out of five were hypertensive, obese, or smokers (Maziak et al. 2007). overall rate of coronary heart disease morality rose by 64 % between the years 1996 and 2006, mostly due to increases in their risk factors (Rastam et al. 2012). The last two decades witnessed as well an increase in cancer morbidity and mortality in Syria perhaps due to a combination of increased risk factors and improved documentation (Deeb and Eid 2012). top three cancers (incidence rate) in men were bladder, leukemia and lung breast, uterus/cervix and leukemia in women (Mzayek et al. 2002).

10 per population Source: national cancer registry MoH

11 Childhood Cancer (0-14) -Syria Year # % Total 4750 Source: national cancer registry MoH

12 Childhood cancer top 5, age (0-14) Type # % Leukemias CNS Lymphomas Bones and soft tissues Urinary tract Total 4343 Source: national cancer registry MoH

13 NCDs among Syrian refugees in Lebanon ( )

14 Chronic Health Conditions: The presence of hypertension, cardiovascular disease, diabetes, chronic respiratory disease, or arthritis in one or more household members was reported by 50% of Syrian refugee households 70% had an out- of- pocket payment 76% of refugees were currently taking medicines; among those not taking medication, the primary barrier was cost.

15 Health service utilization for non-communicable diseases among Syrian refugees and host communities in Lebanon Age-specific chronic disease prevalence Hypertension CVD DM Ch.res dis. Syrian refugees (n = 1376) Host community (n = 686) 20.5 % 10.8 % 9.9 % 16.0 % 34 % 19.8 % 21.0 % 12.1 % Doocy 2016

16 Cancer among Syrian refugees in Lebanonestimate 1.5 m No data available on cancer Incidence rate per : (Syria before 2011, Jordan) = new cases/annually Childhood cancer Incidence rate per : = new case/an

17 Cost Treatment for every child with cancer costs (in Lebanon) between $100,000 and $200,000 (CCC-Leb) In 2015, CCC received $3.5 million from St. Jude and have enrolled 25 patients, 21 Syrians, and 4 Palestinians into the program (Saghir, 2016)

18 UNHCR- Leb: policy of health services support of Syrian refugees Refugees with serious medical conditions that require care costing more than the $1,000 to $2,000 allocated in the -UNHCR s budget for primary health-care services are referred to the ECC*, whose members include: a UNHCR medical doctor local doctors with varying specialties. The ECC decides whether to approve or reject treatment, based on the necessity of the suggested treatment, feasibility of the treatment plan, disease prognosis, cost of care, eligibility as a registered refugee. *Exceptional Care Committee

19 Examples from Jordan and Turkey Only 246/ 511 applications for cancer treatment most commonly for breast cancer were approved by ECC The main reason for denial, was poor prognosis or too expensive (UNHCR 2014) According to asylum law (April 2013); People who have registered as refugees, including children, have been provided with free medical treatment as Turkish citizens, including cancer treatment and care at tertiary Government and university hospitals. (Kebudi 2016)

20 Challenges complicated and expensive ongoing care mostly beyond the financial resources of relief organizations the delivery of continuity care (cancer) is especially difficult for persons who are mobile, unstably housed, psychologically stressed, lacking health coverage

21 New Approach Mobile and online information campaigns focusing on preventative health New financing models such as crowd-funding and potentially health insurance. Universal health coverage: structured pluralism - integrating the large humanitarian system into the hosting country health system (Frenk Blanchet & Fouad 2016) More research on cost-effective interventions New guidelines to address cancer care in conflict context and protracted displacement conditions

22 Thank you