How refugees and IDPs in the Middle East could benefit from early breast cancer diagnosis and treatment

How refugees and IDPs in the Middle East could benefit from early breast cancer diagnosis and treatment
Hospitals, clinics, laboratories, pharmaceutical factories and other infrastructure for oncology care have been damaged or destroyed across Syria by years of fighting. Above, displaced Syrian women carry babies at Washukanni camp in 2019. (AFP file photo)
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Updated 31 October 2023
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How refugees and IDPs in the Middle East could benefit from early breast cancer diagnosis and treatment

How refugees and IDPs in the Middle East could benefit from early breast cancer diagnosis and treatment
  • Thousands of medical professionals have fled conflicts in the Middle East, depriving women of care
  • Syrians and Palestinians often unable to access treatment abroad due to travel restrictions and lack of means

DUBAI: When Syrian writer and translator Dina Aboul Hosn received a letter from her local health authority in Germany three years ago asking her to visit for a routine breast examination, she thought nothing of it.

Hosn, who had just turned 50 and had sought asylum in Germany eight years ago, was mindful of the need for social distancing and self-quarantine amid the COVID-19 pandemic, so chose to put off her appointment.

When she finally went along for a comprehensive check-up two years later, she was not prepared for the findings. “I wouldn’t worry too much, but you have a lesion that needs to be checked,” her doctor told her after an ultrasound imaging session.

Although the lesion was not malignant or dangerous, Hosn’s name was moved from a list of people who receive biennial checkups to those who will have a yearly exam. The health scare has made her pay much closer attention since.




Breast cancer is the most common kind of cancer in northwest Syria. Above, volunteers provide sessions about the risks and symptoms of the disease, methods of self-examination and the importance of examination in prevention and recovery. (X: The White Helmets)

Hosn’s friend, a fellow Syrian who also has German residency, was not so lucky. She was diagnosed with early-stage breast cancer, undergoing a lumpectomy and a full course of radiation therapy.

Both women received full coverage from their health insurance, and quality care provided by the German healthcare system.

The outcome may have been different for these women if they had remained in their country of origin, where 12 years of bloody conflict have led to the displacement of half of the population and left essential services barely functioning.

“This is an awful thing. Even in sickness, you have that feeling of guilt, that I have access (to medical services here), but they don’t. It is an ugly feeling,” Hosn told Arab News.

Hospitals, clinics, laboratories, pharmaceutical factories and other infrastructure for oncology care have been damaged or destroyed across Syria by years of fighting, while those still standing have suffered under economic pressure and trade embargoes.




Breast cancer is the most common kind of cancer in northwest Syria. Above, volunteers provide sessions about the risks and symptoms of the disease, methods of self-examination and the importance of examination in prevention and recovery. (X: The White Helmets)

“Diagnostic imaging modalities and radiation therapy are not available in the majority of medical centers in Syria, making it very hard for the physicians to follow the universal guidelines in diagnosis and treatment,” according to a paper published in the American Society of Clinical Oncology Educational Book in 2018, titled “Cancer care for refugees and displaced populations: Middle East conflicts and global natural disasters.”

Many physicians and medical practitioners have either been killed or left the country. According to Physicians for Human Rights, some 15,000 doctors fled in 2015 alone.

Traf Al-Traf, a pharmacist and a program coordinator with the International Wars and Disasters Victims Protection Association in Syria’s opposition-held northwestern province of Idlib, has been working to raise awareness about self-examination and screening.

“We are trying to spread awareness and curb the spread of cancer cases with our very limited capabilities,” Al-Traf told Arab News. This includes mobile clinics, distributing leaflets and assigning a qualified female team to spread awareness among women.

Breast cancer is the most common kind of cancer in northwest Syria, said Al-Traf. Out of 373 new cancer cases reported in 2021, some 241 were breast cancer, followed by 61 cases of Hodgkin’s lymphoma.




Breast cancer is the most common kind of cancer in northwest Syria. Above, volunteers provide sessions about the risks and symptoms of the disease, methods of self-examination and the importance of examination in prevention and recovery. (X: The White Helmets)

When a woman is diagnosed with cancer, she will be referred to the main hospital in Idlib, which is supported by the Syrian American Medical Society. However, the hospital cannot offer treatments for all kinds of cancer, and only Syrians with enough money or connections are able to travel abroad for treatment.

The cost of cancer treatment, as well as specialized imaging, is very high. While the illness and its treatment are agonizing for all patients, the distress is twofold for the displaced. Many are diagnosed much later, funding for palliative care may be refused and many others die without proper diagnosis or treatment at all.

Often, the expenses of treating displaced cancer patients are not covered by international aid agencies and volunteer organizations, as cancer is “too poor of a prognosis and/or too financially costly to treat,” according to a paper titled “Burden of Cancer Among Syrian Refugees in Jordan,” published in the Journal of Global Oncology in 2018.

Health services tailored to refugees by humanitarian aid agencies tend to focus on issues like nutrition and infectious diseases, while neglecting most specialized maladies like cancer.

Arab News contacted four regional and international humanitarian organizations in Amman, Beirut, Cairo and Dubai to ask about any schemes they offer for raising breast cancer awareness or for providing early diagnosis or treatments in camps in Jordan, Lebanon, Sudan, Yemen and Palestine.

Two organizations said they had no such programs, while two others gave no specific answer, only stating that they were “very busy with the war in Gaza.”

Breast cancer is the most prevalent cancer among Palestinian women displaced to camps by the 1948 Arab-Israeli war, accounting for 32 percent of cancer diagnoses in the West Bank and Jerusalem, and 18 percent in the Gaza Strip.




Breast cancer is the most prevalent cancer among Palestinian women displaced to camps by the 1948 Arab-Israeli war. (AFP file photo)

Women in Gaza “were more likely than those living in the West Bank and Jerusalem to have good breast cancer risk factor awareness (42.0 percent and 35.2 percent, respectively), according to the 2022 report, “Awareness of Palestinian Women About Breast Cancer Risk Factors: A National Cross-Sectional Study,” published in the JCO Global Oncology journal.

“This difference might be compounded by the fact that the West Bank and Jerusalem have checkpoints and restrictions on internal mobility, even between cities, making it difficult to reach healthcare facilities,” the report said.

“Another explanation could be the number of women living in rural regions, where the West Bank and Jerusalem have a higher proportion, who might have limited access to healthcare facilities.”

Despite a good level of awareness among Gaza’s women, some treatment options, such as radiotherapy, remain out of reach in Gaza. Patients need to obtain permits from Israeli authorities to receive such treatments at hospitals in East Jerusalem. However, these permits are often impossible to obtain.

Studies show that in 2018, almost 40 percent of Israeli permit applications for Palestinian patients to exit the Gaza Strip to receive treatment in the West Bank or Jerusalem were rejected or delayed. About a quarter of these applications were for cancer care.


Jordan’s civil aviation authority ‘temporarily’ closes Jordanian airspace

Jordan’s civil aviation authority ‘temporarily’ closes Jordanian airspace
Updated 3 min 39 sec ago
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Jordan’s civil aviation authority ‘temporarily’ closes Jordanian airspace

Jordan’s civil aviation authority ‘temporarily’ closes Jordanian airspace
  • Commission said Jordanian airspace would be closed to all incoming, departing, and transiting flights

AMMAN: The Jordanian Civil Aviation Regulatory Commission on Saturday announced that Jordanian airspace will be closed “temporarily” for inbound and outbound flights in light of rising regional risks. 

The commission said in a statement that the decision has been taken to ensure the safety and security of Jordanian aerospace in light of the rising escalation and after assessment of the potential regional risks. 

Stopping short from giving further details on the source of these risks, the commission said that Jordanian airspace would be closed to all incoming, departing, and transiting flights temporarily starting from 20:00 UTC, 11:00pm local time, for several hours. 

It added that this measure would be continuously updated and reviewed according to developments. 

The commission said that this measure is taken "to ensure the safety and security of civil aviation in the Jordanian airspace.”


Hamas says submitted response to Gaza truce mediators

Hamas says submitted response to Gaza truce mediators
Updated 38 min 34 sec ago
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Hamas says submitted response to Gaza truce mediators

Hamas says submitted response to Gaza truce mediators
  • Truce talks started on April 7 in Cairo but have so far brought no breakthrough on a plan presented by US, Qatari and Egyptian mediators
  • Hamas said it was also ready “to conclude a serious and real prisoner exchange deal between the two parties“

GAZA STRIP, Palestinian Territories: Hamas said Saturday it had submitted its response to Egyptian and Qatari mediators on a proposed truce with Israel in the Gaza Strip, insisting on a “permanent ceasefire.”
Truce talks started on April 7 in Cairo but have so far brought no breakthrough on a plan presented by US, Qatari and Egyptian mediators.
In a statement, the Palestinian militant group said it “reaffirms adherence to its demands” including “a permanent ceasefire, the withdrawal of the occupation army from the entire Gaza Strip, the return of the displaced to their areas and places of residence, intensification of the entry of relief and aid, and the start of reconstruction.”
Hamas said it was also ready “to conclude a serious and real prisoner exchange deal between the two parties.”
Israeli Prime Minister Benjamin Netanyahu has opposed a permanent ceasefire and vowed to send ground troops into Rafah, ignoring an international outcry against it, including from the United States.
Netanyahu’s office said Saturday “the only obstacle to obtaining the release of the abductees is Hamas and not any factor on the Israeli side.”
“Among other things, Hamas demands an end to the war and a complete withdrawal of the IDF from the Gaza Strip.
“The cabinet and the security forces are united in their opposition to these unfounded demands.”
“Hamas to this day has refused any deal and any compromise proposal,” it said.


Israelis rally against government amid deadlock on Gaza hostages

Israelis rally against government amid deadlock on Gaza hostages
Updated 59 min 5 sec ago
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Israelis rally against government amid deadlock on Gaza hostages

Israelis rally against government amid deadlock on Gaza hostages
  • As concern mounts in Israel for the wellbeing of the 129 remaining hostages their families and friends have organized increasingly vocal demonstrations
  • They have dovetailed with activists who have long called for Netanyahu’s ouster given his trial on graft charges

TEL AVIV: Thousands of Israelis rallied against their government on Saturday, with some demanding Prime Minister Benjamin Netanyahu call off the half-year-old war in Gaza amid a deadlock in diplomatic efforts to retrieve hostages held there by Hamas.
Hamas-led gunmen seized 253 people during an Oct. 7 attack on Israel that killed 1,200 others, according to officials. Some hostages were freed in a November truce but Egyptian- and Qatari-mediated efforts to secure another deal appear to have stalled.
As concern mounts in Israel for the wellbeing of the 129 remaining hostages, who cannot be contacted, their families and friends have organized increasingly vocal demonstrations against Prime Minister Benjamin Netanyahu’s rightist government.
They have dovetailed with activists who have long called for Netanyahu’s ouster given his trial on graft charges — which he denies — and his attempts to overhaul the judiciary last year.
“Our country’s near the abyss. We’ve already started to drive down and we must stop it. I’m here to gather the force to tell the people that they need to come out and they need to tell our government that it’s time to stop,” said Marva Erez, 45, who was among demonstrators in Tel Aviv.
Netanyahu said he will continue with the war to dismantle Hamas, despite alarm in Washington and other Western capitals at the civilian toll in Gaza, where medical officials say more than 33,000 Palestinians have been killed.
Hamas has said any new hostage deal must bring about an end to the Gaza war and withdrawal of all Israeli forces.
“There will be a (hostage) deal,” Culture Minister Miki Zohar, a senior member of Netanyahu’s Likud party, told Channel 12 TV. “But not at any price.”
The anti-government protest in Tel Aviv was held separately to a smaller vigil for the hostages. Many of those taking part in the latter event soon merged with the bigger demonstration.
Michael Levy, whose brother Or is among the hostages, said he was protesting because “we have no time for the talks.”
“We need actions. We need to get them home,” he said.


Iraqi prime minister heads to Washington as regional tensions flare

Iraqi prime minister heads to Washington as regional tensions flare
Updated 13 April 2024
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Iraqi prime minister heads to Washington as regional tensions flare

Iraqi prime minister heads to Washington as regional tensions flare
  • “This official visit occurs at a delicate and sensitive time in the relations with the US, as well as in the context of regional conditions and the ongoing crimes against innocents in the Palestinian territories,” a statement from Al-Sudani’s office said

BAGHDAD: Iraq’s Prime Minister Mohamed Shia Al-Sudani left Baghdad on Saturday for the US, his office said, where he will meet with the US president as regional tensions flare.
US President Joe Biden is due to receive the Iraqi leader on Monday to “coordinate on common priorities” and discuss the “evolution of the military mission” of the US-led anti-terror coalition in Iraq and Syria, according to the White House.
The trip comes after Iran threatened to retaliate for deadly strikes, blamed on Israel, on its consulate in the Syrian capital, Damascus.
Biden has said he expects Tehran to take action “sooner rather than later.”

BACKGROUND

President Joe Biden is due to receive the Iraqi leader on Monday to ‘coordinate on common priorities’ and discuss the ‘evolution of the military mission’ of the US-led anti-terror coalition in Iraq and Syria, according to the White House.

“This official visit occurs at a delicate and sensitive time in the relations with the United States, as well as in the context of regional conditions and the ongoing crimes against innocents in the Palestinian territories,” a statement from Al-Sudani’s office said.
The surging tensions come against the backdrop of the six-month war waged by Israel against Iran-backed Palestinian Hamas militants in Gaza.
The conflict has since drawn in regional actors, including Iran-backed groups in Yemen, Lebanon, Syria, and Iraq.
Al-Sudani’s office added that the “meeting with President Biden will discuss the regional issues and the current escalations, focusing on the joint efforts to promote calm and prevent the conflict from widening, which could impact global stability.”
After the war in Gaza erupted, armed groups linked to Iran carried out a slew of attacks across the region on US soldiers deployed to the Middle East with the anti-Daesh coalition in support of Palestinians.
Washington has responded by striking several factions.
But calm has largely returned, and tensions have subsided between the US and Iraq, which have resumed talks on the future of the anti-Daesh coalition.
Iraqi authorities have voiced hope for drawing up a timeline to reduce the presence of US forces.
The talks aim to establish “a timeline to end the coalition’s mission and transition to bilateral relations with the coalition member states,” Al-Sudani’s office added on Saturday.
A State Department official, quoted on their website, said the US hopes the talks will also “focus on energy, water, business investment — US businesses investing in Iraq — and we want to talk about the private sector and the banking reforms that we have been working on.”

 


Israel closes schools over security concerns: army

Israel closes schools over security concerns: army
Updated 13 April 2024
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Israel closes schools over security concerns: army

Israel closes schools over security concerns: army
  • There will be “no educational activities” when the school week begins on Sunday
  • The measure is set to last two days, according to online army guidelines

JERUSALEM: Israel is closing schools nationwide over security concerns, military spokesman Daniel Hagari said on Saturday, after Iran threated to retaliate for a deadly air strike on its Damascus consulate.
There will be “no educational activities” when the school week begins on Sunday “in light of the security situation,” he said in a televised statement.
The measure is set to last two days, according to online army guidelines.
Iran has vowed retaliation after the presumed Israeli strike on April 1 which levelled its consulate in Damascus, killing seven members of the Revolutionary Guards including two generals.
US President Joe Biden said on Friday that he expected Iran to retaliate “sooner (rather) than later.”
Earlier on Saturday Iran’s Revolutionary Guards seized a container ship “related to the Zionist regime (Israel)” near the Strait of Hormuz, state media reported.
Israeli Foreign Minister Israel Katz postponed a planned visit to Hungary and Austria which had been scheduled to begin on Sunday “due to the security situation,” his spokesman said.