Credit: Shutterstock/Mohammad Bash
The Feb. 6 earthquake that devastated southern Turkey and northern Syria has exacerbated Syria’s already-severe healthcare crisis.
Health care in the region of Syria afflicted by the earthquake was already stretched thin by a civil war that has raged for 12 years.
With the focus now on survival and recovery from a trembler that has killed more than 41,000 people, it is too early to determine the precise impact on cancer care. The American Society of Clinical Oncology said it’s “monitoring the situation in Turkey and Syria as a dire humanitarian crisis unfolds in the wake of the devastating earthquakes.
“We stand in solidarity with our members and colleagues as well as their patients whose lives have been tragically impacted by this natural disaster. ASCO is calling on the global cancer community to come together in support of both the patients whose lives have been impacted as well as the healthcare professionals selflessly providing assistance during this most difficult time.”
ASCO’s Conquer Cancer Foundation is collecting donations to help with relief efforts.
“More than 30,000 [people] lost their lives in Turkey, and more than 80,000 were injured. The number of casualties in Syria is around 2,000, and the number of injured is about 3,600. We can confidently say these figures will increase as debris removal work continues,” Vahit Ozmen, professor of surgery in the Department of Surgery at the Istanbul Medical Faculty of Istanbul University, said in a publicly-posted response to ASCO’s statement.
The estimated death toll in Syria has risen to 6,000, according to the United Nations, but it is not yet known for sure.
The earthquake couldn’t have hit Syria at a worse time—after a decade of civil war that killed and displaced millions, followed by an ongoing devastating era where the country has lost most of its resources, and people were living under the worst possible conditions.
Rami Manochakian
“Unfortunately, we saw that some hospitals were destroyed during these earthquakes. Therefore, this disaster reveals serious health problems in Turkey and Syria, which has been experiencing the war that has been going on for about 12 years. Moreover, it will negatively impact cancer patients in southeastern Turkey and Syria, where all cancers are detected as locally advanced or metastatic.”
Rami Manochakian, a native of Aleppo, Syria, who is now an associate professor of medicine and consultant of thoracic oncology at Mayo Clinic Florida, has lost friends in the earthquake and has family who still live there.
“The earthquake couldn’t have hit Syria at a worse time—after a decade of civil war that killed and displaced millions, followed by an ongoing devastating era where the country has lost most of its resources, and people were living under the worst possible conditions,” Manochakian said to The Cancer Letter. Manochakian is the program director of hematology/oncology fellowship and vice chair of education in the Division of Hematology/Oncology within the Department of Medicine at Mayo Clinic Florida.
“The first couple of days after the earthquake were the worst. With no- to very limited resources, it was painful and sickening to watch and hear about what they are going through. Young, inexperienced volunteers were digging in the rubble to look for survivors. Some could hear the voice of people under the ground, but could not help them,” Manochakian said.
“Food, supplies, and medications were missing. Homes and buildings, those which did not completely collapse, were shattered, forcing people to live and sleep in the streets out of fear. Also, unfortunately, the camps of refugees (due to the war) on the border between Syria and Turkey were severely affected,” Manochakian said.
“There are many local, national, and international communities and organizations that are accepting donations to provide needed supplies on the ground, find a shelter for the displaced people, and help the survivors survive. I am deeply thankful for all those who are helping. Despite the sorrow, I never lose faith in humanity. I am also grateful to see that sanctions that were imposed on the Syrian government were paused for six months to facilitate delivering supplies and money.”
Years of armed conflict have taken a toll on the medical system and cancer care in much of the affected region.
According to a paper published five years ago in JCO Global Oncology, only one oncologist remained in the large countryside of East Ghouta, which has a reported 500,000 inhabitants. This was before the earthquake.
“Functioning medical clinics have become rare and expensive. Patients with poor prognoses are turned away due to limited funding; those with better prognoses are turned away due to costly treatments. Since 2013, the majority of healthcare facilities have been destroyed, which leaves only 47% of Syria’s hospitals and health centers partially functional. The Global Health Observatory reported that in 2008, 31,000 physicians practiced in Syria, with approximately 15 physicians per 10,000 capita. Since then, >15,000 physicians have fled Syria,” the paper states.
Unfortunately, we saw that some hospitals were destroyed during these earthquakes. Therefore, this disaster reveals serious health problems in Turkey and Syria, which has been experiencing the war that has been going on for about 12 years.
Vahit Ozmen
An estimated 200,000 Syrians have died as a result of chronic diseases, including cancer because of a lack of access to treatment and qualified physicians. Specifically, cancer care has been so negatively affected due to delayed diagnosis, lack of screening programs or continuity of care, treatment interruptions due to displacement and costs, threats to medical personnel, and destruction of infrastructure, the paper states.
In Turkey, community-based screening can work, Ozmen said.
“The Breast Health Society, which I founded, is an NGO and PAG and has shown that a community-based screening program can be carried out in Turkey by carrying out the Bahçeşehir Community-Based Breast Cancer Screening Program, which lasted ten years (2009-2019) and includes 10,000 women, that the screening interval should be between the ages of 40-49, that screening provides early diagnosis and is cost-effective,” Ozmen said. “In addition, with the breast cancer registration program we created, the DCIS rate was 4%, and the stage 1 breast cancer rate was 29%. The above information shows that a non-governmental organization can do it in a country with low research support.”
Ozmen suggested that international organizations that are preparing to offer earthquake relief aid follow these guidelines:
- Society must cooperate with other scientific associations and patient associations First, a responsible cancer society (PAG, NGO) and its leader should be determined to provide this organization and carry out the project to be prepared. Then, the community should contact and cooperate with the central system (Ministry of Health), the cancer control department affiliated with this system, and the health directorates of the provinces affected by the earthquake.
- Society must cooperate with other scientific associations and patient associations dealing with cancer in these countries.
- The responsible society must cooperate with the relevant specialists of the Medical Faculties in the disaster-stricken provinces.
- A working group of cancer specialists to help cancer patients improve their cancer status should hold regular meetings in all these damaged provinces to investigate the number of patients and access to medication and treatments, conduct due diligence and identify suggestions for improvement. Representatives of patient associations and patients should also be invited to these meetings.
- An agreement should be reached with a professional agency that will organize the meetings, the people should be recorded, and improvement projects should be prepared and implemented.
