Strengthening capacity for cancer research in conflict settings: key informant insights from the Middle East

Abstract

Background Management of cancer in the Middle East and North Africa (MENA) region is accompanied by multiple challenges including heterogeneous access to early detection and treatment options and limited implementation of national cancer control plans. Furthermore, protracted armed conflicts across the region have had dramatic effects, including disruption of healthcare systems and the migration of healthcare professionals. Strengthening capacity for cancer research has been identified as a key intervention to correct data poverty, inform policy, manage limited resources and improve health outcomes. Objective The main objective of this study is to gain insights into the landscape, barriers and enablers of cancer training, research and care in the MENA region. Method We utilised purposive sampling to interview 16 key informants from a diverse academic, medical and research background originating from countries affected by conflicts, such as Lebanon, and from active conflict zones including Iraq and Syria. Results The themes that emerged from the interviews focused on the barriers to cancer care, barriers to cancer research and training, strengths and importance of cancer research and training recommendations. The detrimental effect of conflict on cancer provision and research was a cross-cutting sub-theme disrupting cancer care provision and research due to unsafe environments, fragmented facilities, absence of drugs and migration of personnel. When asked about perceived optimal training format for cancer research, most informants recommended a post-graduate, face-to-face training focusing on cancer research methods and concepts. Conclusion This study offers a unique insight into the barriers affecting cancer research and capacity-strengthening priorities from oncologists and researchers working in conflict-affected areas of the MENA region. These data will form the base for future capacity-strengthening initiatives addressing specific regional challenges.

Burden of female breast cancer in the Middle East and North Africa region, 1990–2019

“…The effects of conflict and turbulence in the region must also be taken into consideration. There have been a number of conflicts in the region, including in Lebanon, Syria, Iraq and Yemen, which have imposed cultural, logistical and financial barriers for cancer care and research [ 19 ]. Moreover, the consequences of these conflicts, such as acute injuries, the displacement of sections of the population and the destruction of infrastructure could also affect the provision of medical care and preventive measures, which may also lead to variations in the morbidity and mortality of cancers in MENA [ 20 , 21 ].…”

The Armed Conflict and the Impact on Patients With Cancer in Ukraine: Urgent Considerations

“…Cancer research has been negatively affected because of armed conflicts in different low-and middle-income countries. 28…”

“…Cancer research has been negatively affected because of armed conflicts in different low- and middle-income countries. 28 Lack of safe conditions and environment; lack of personnel; alteration in the chain of supplies for devices, drugs, and others; and improper conditions for meetings, suboptimal communication systems, and networks are few examples that limit the options to develop research. Unexpectedly, only 1 month ago, similar situations because of this war are affecting cancer research in both Ukraine and Russia.…”

Access to advanced cancer care services in the West Bank-occupied Palestinian territory

“…The findings reveal that cancer patients encounter multiple barriers in accessing oncology services throughout their treatment journey, underlining difficulties Palestinians in general face in accessing health care ( 16 – 18 ). Some of these challenges are shared with other conflict-affected areas ( 5 , 7 ), while others are specifically related to prolonged Israeli military occupation and its effects on the capacity of the Palestinian health system to deliver comprehensive cancer care.…”

“…Moreover, cancer treatment is constrained by a lack of advanced diagnostic services, a dearth of oncology health providers, shortage of radiation therapy services, and the fragmentation of cancer services ( 2 , 3 ). In areas affected by armed conflict, as in some MENA countries, cancer care is much more difficult to obtain ( 5 , 6 ). Physicians’ departure “brain drain”, is an additional challenge ( 7 , 8 ).…”