Refugees With Cancer Have Less Than 50% Chance of Therapy

More than half the requests for cancer treatment by refugees fleeing wars in Iraq and Syria were rejected by the United Nations as limited funds forced decisions about which patients had the best chance of survival.

In Jordan from 2010 to 2012, the UN High Commissioner for Refugees turned aside the applications because of the patients’ poor prognosis or because of the cost of the medicines involved, according to a study published today in The Lancet Oncology.

The findings highlight the wrenching decisions facing humanitarian agencies. While many previous refugee crises have occurred in low-income countries where infectious diseases and malnutrition can be managed relatively cheaply, conflicts in middle-income nations such as Syria, where chronic diseases such as cancer are more common, pose a more complex and costly challenge, said Paul Spiegel, the commissioner’s chief medical officer and the study’s lead author.

“It’s horrible, it’s like playing God,” Spiegel said in a telephone interview. “It’s very sad, but it’s just basic public health that you want to, with your limited amount of funds, help the largest number of people that you can.”

The UN agency has appealed for $4.26 billion this year to help support 2.8 million refugees from Syria’s three-year civil war, of which it has received $1 billion so far.

The UN high commissioner, in partnership with other charities, provides medical care to refugees of as much as $2,000 per patient per year. Requests for treatment above that level are referred to exceptional care committees, which approve or reject the requests based on criteria such as the necessity of treatment, disease prognosis and cost.

Treatment Cost

Among 1,989 requests for treatment from 2010 to 2012, 26 percent were for cancer, according to the study. Many of the rest were for war wounds, cardiovascular disease or kidney disease, Spiegel said. Among the cancer cases, 48 percent were approved for treatment. The average amount approved per application was $4,626 in 2011 and $3,501 in 2012.

Of the cancer applications that were rejected, 43 percent were because the patient had a poor prognosis, and 25 percent because the treatment was too expensive.

“Something that is very, very expensive we will not pay for, because even with a good prognosis, maybe we could help 10 other people,” Spiegel said.

Jordan’s health ministry spent about $53 million on care for refugees just in the first four months of last year, Spiegel and colleagues wrote.

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