Cancer care in times of conflict: cross border care in Pakistan of patients from Afghanistan

Abstract

Armed conflict in Afghanistan has continued for close to 40 years and has devastated its health infrastructure. The lack of a cancer care infrastructure has meant that many Afghans seek cancer care in neighbouring countries, like Pakistan. There remains a significant lack of empirical data on the new therapeutic geographies of cancer in contemporary conflicts.This retrospective single centre study explores the therapeutic and clinical geographies of Afghan cancer patients who were treated at the Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC) in Lahore, Pakistan over a 22-year-period (1995 to 2017) covering major periods of conflict and relative peace.Data was available for 3,489 Afghan patients who received treatment at SKMCH&RC. The mean age at presentation was 42.7 years, and 60% were men. 30.2% came from Kabul and Nangarhar districts of Afghanistan, which have relatively short travel times to Pakistan, but patients from all parts of Afghanistan migrated to SKMCH&RC for treatment. Overall, 34.1% were diagnosed with upper gastrointestinal malignancies and 55.7% presented with late stage III/IV cancer. A wide range of treatments were provided, with 25.4% of patients receiving a combination of chemotherapy and radiation treatment. 52.7% of all patients were lost to follow-up. Outcomes were more favourable for children with cancer, 42% of whom had a complete response to therapy.Complex migration patterns, mixed political economies (refugees, forced and unforced migrants) and models of care that must be adapted to the realities of the patients rather than notional international standards all reflect the new therapeutic geographies that long-term conflict creates. This requires significant new domestic and international (e.g., United Nations High Commissioner for Refugees) policy and practises for providing cancer care in today's contemporary conflict ecosystems that frequently cross national borders.

What Really Matters for Cancer Care – Health Systems Strengthening or Technological Innovation?

“…From a health services perspective, we still do not know how we should best organise care. Patients are increasingly moving across borders to seek care and multiple providers mean that most countries have complex and parallel pathways of care in private and public sectors [51]. Although some countries have a plurality of providers to support patient choice and hospital competition to drive quality improvement, other public sector systems are moving towards greater consolidation of cancer services to fewer high-volume centres, e.g.…”

Challenges Encountered in Cancer Care and Management During Covid-19 in South Asian Countries

“…Some countries including China also helped the Pakistan Government for coping the condition. At the end of March an increase was seen as most of the Pakistanis overseas from heavily infected countries travel back [31][32]. Initially the complete lockdown started since 13th of March.…”

“…Nowadays, country is in a state of partial lockdown and they are reluctant for a complete lockdown because of fear of economic havoc as 25% of the population are on daily wages. New facts and data of India also suggest this type of fear is most likely to be found in the developing Asian countries [32]. Stabilizing the economic loss in front of the COVID-19 is an inevitable task and Government like Pakistan which falls under low and middle income is already facing it.…”

Cancer Care During War and Conflict

“…Cancer care in this region has been long considered too costly and complex, with a lack of consensus on cost-effective interventions as well as an inability of host health systems to expand cancer services [23]. Patients already diagnosed or with a new possible diagnosis of cancer face deficiencies in healthcare facilities, resources, and treating specialists [24,25]. They are often forced to migrate seeking expensive cross-border therapy that occasionally proves to be unaffordable; given limited international aid available [26].…”