Cancer patient care during different war times; is the response too slow?

War is a major action of provoked humanitarian destabilization, and the recent Russian invasion of Ukraine is no exception, leading to human disqualification and global uncertainty. All past conflicts have left vulnerable people in despair across involved countries and geopolitical areas of interest. These conflicts have taught many lessons concerning the routine management of chronic diseases, such as cancer. Have they been learned though?An abrupt decline in health sector financial funds has a predictable impact on prevention, immunization, health promotion, rehabilitation and cure of displaced populations. During war, environmental pollutants (i.e. dust and droplets in air and water), leukemogen, benzene and pyrophoric depleted uranium are induced, provoking unavoidable risk factors for hematologic malignancies and certain solid tumors.1Alwan N. Kerr D. Cancer control in war-torn Iraq.Lancet Oncol. 2018; 19: 291-292Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar,2Shahabi S. Fazlalizadeh H. Stedman J. Chuang L. Shariftabrizi A. Ram R. The impact of international economic sanctions on Iranian cancer healthcare.Health Policy. 2015; 119: 1309-1318Crossref PubMed Scopus (31) Google ScholarAs a result of bombing, hospitals and national grid are structurally and functionally damaged. Road blockage, limited supply of electricity and insufficient maintenance, lack of medical supplies and depletion of human resources make health care provision disrupted,3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar without undermining the emotional burden on the health care employees who only have the obligatory ‘choice’ to act as heroes. Deficits in routine imaging diagnostics lead to a more advanced or unknown disease stage. There is also a delay in pathological diagnosis (i.e. applying immunophenotyping and immunohistochemistry on analyzed specimens). Post-traumatic stress, depression, personal and social fear, lack of family or community support with loss of dignity and unavailability of public services impact patients’ care access and availability or viability of theragnostic care.1Alwan N. Kerr D. Cancer control in war-torn Iraq.Lancet Oncol. 2018; 19: 291-292Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar,4Mula-Hussein L, ed. Cancer Care in Iraq. Chisinau, Republic of Moldova: LAP Lambert Academic Publishing; 2012.Google Scholar, 5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 6Majid R.A. Mohammed H.A. Saeed H.M. et al.Breast cancer in Kurdish women of northern Iraq: incidence, clinical stage, and case control analysis of parity and family risk.BMC Womens Health. 2009; 9: 33Crossref PubMed Scopus (24) Google ScholarOncology units’ capacity decreases (i.e. single bedrooms occupied by double or triples)3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar mainly due to orthopedic and war surgery emergencies, as survival changes meaning. Limited treatment opportunities adversely affect cancer-specific survival rates.1Alwan N. Kerr D. Cancer control in war-torn Iraq.Lancet Oncol. 2018; 19: 291-292Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar,4Mula-Hussein L, ed. Cancer Care in Iraq. Chisinau, Republic of Moldova: LAP Lambert Academic Publishing; 2012.Google Scholar, 5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 6Majid R.A. Mohammed H.A. Saeed H.M. et al.Breast cancer in Kurdish women of northern Iraq: incidence, clinical stage, and case control analysis of parity and family risk.BMC Womens Health. 2009; 9: 33Crossref PubMed Scopus (24) Google Scholar Many patients seek care in neighboring cities or countries (conflict-induced cross-border travel). Less strict entry visa regulations (i.e. smaller fee) and/or a shorter-distance travel are the most important criteria in choosing a country as treatment destination, placing luck as the unique variable affecting the outcome. As the treatment cost exceeds patients’ incomes, they are obliged to even sell their properties.7Skelton M. Alameddine R. Saifi O. et al.High-cost cancer treatment across borders in conflict zones: experience of Iraqi patients in Lebanon.JCO Glob Oncol. 2020; 6: 59-66Crossref PubMed Scopus (5) Google ScholarEconomic and political punitive sanctions applied decrease imports and affect high-tech equipment needed for meticulous oncologic surgery (e.g. osseointegrated and modular tumor prosthesis used for treating limb sarcoma).2Shahabi S. Fazlalizadeh H. Stedman J. Chuang L. Shariftabrizi A. Ram R. The impact of international economic sanctions on Iranian cancer healthcare.Health Policy. 2015; 119: 1309-1318Crossref PubMed Scopus (31) Google Scholar,8Gorji A. Sanctions against Iran: the impact on health services.Iran J Public Health. 2014; 43: 381-382PubMed Google Scholar,9Hassani M. Impact of sanctions on cancer care in Iran.Arch Bone Jt Surg. 2018; 6: 248-249PubMed Google Scholar A substantial economic assistance through host countries and humanitarian agencies [i.e. Exceptional Care Committees (ECC) of the United Nations High Commissioner for Refugees (UNHCR)] is therefore warranted.8Gorji A. Sanctions against Iran: the impact on health services.Iran J Public Health. 2014; 43: 381-382PubMed Google Scholar,10Spiegel P.B. Cheaib J.G. Aziz S.A. et al.Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017.Lancet Oncol. 2020; 21: e280-e291Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar There is also a public insurance inability to cover expensive novel chemotherapy and biologic agents. Further, there is diversity in the operating procedures based on systemic therapy cost. Depending on the patient’s age, it does not cover patients in the terminal stage of the disease.10Spiegel P.B. Cheaib J.G. Aziz S.A. et al.Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017.Lancet Oncol. 2020; 21: e280-e291Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar A shortage of analgesics and a lack of infection control procedures influence cancer management.5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,9Hassani M. Impact of sanctions on cancer care in Iran.Arch Bone Jt Surg. 2018; 6: 248-249PubMed Google Scholar The import of some chemotherapeutic agents as well as devices that use radiation, such as scanners and radioisotopes, is prohibited because they are categorized as potential war weapons.1Alwan N. Kerr D. Cancer control in war-torn Iraq.Lancet Oncol. 2018; 19: 291-292Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar,5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,7Skelton M. Alameddine R. Saifi O. et al.High-cost cancer treatment across borders in conflict zones: experience of Iraqi patients in Lebanon.JCO Glob Oncol. 2020; 6: 59-66Crossref PubMed Scopus (5) Google Scholar Positron emission tomography scan is not feasible and, subsequently, the whole therapeutic management is affected. Pediatric and adolescent patients may die of curable malignancies (i.e. Ewing sarcoma) and survival rates are lower than in developed nonwar countries.5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google ScholarHospitals operate with a limited number of oncologists, with no involvement of primary care providers. The main delivered service is day acute care and there is inability to handle therapy toxicity, with no palliative care and end-of-life support. Difficult communication between damaged and separated hospital branches has a negative impact on organizing and coordinating hospital services (i.e. multidisciplinary teams and discussions). There is a need for continuous support from another oncology center, or collaboration with foreign university volunteers, through a telemedicine program. There are difficulties in data collection and processing before participating in clinical trials due to the unavailability of administrative assistance.3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar Real-world trials become real war trials, without any intention to literally exaggerate.Electricity is essential for the functioning of radiotherapy and brachytherapy equipment, and with its shortage even sophisticated devices such as these become useless.4Mula-Hussein L, ed. Cancer Care in Iraq. Chisinau, Republic of Moldova: LAP Lambert Academic Publishing; 2012.Google Scholar,5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar The lack of (i) functional machines, (ii) regular equipment maintenance, (iii) quality assurance measures and (iv) the presence of new equipment result in a long irradiation waiting list and demand prolonged times under the machine.5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,11Mula-Hussain L. Cancer in Iraq: the dilemma continues. 2014 Annual ASCO Daily Newspaper. Published online May 31, 2014.Google Scholar In Iraq, mean interval times between (i) referral and starting date of any palliative treatment was ∼19 days and (ii) simulation and radiotherapy starting date in the curative setting was postponed by ∼35 days.11Mula-Hussain L. Cancer in Iraq: the dilemma continues. 2014 Annual ASCO Daily Newspaper. Published online May 31, 2014.Google ScholarObtaining an ID registration number is important for patients with cancer. Changes in residency and phone numbers lead to the absence of medical history and regular follow-up.3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar,11Mula-Hussain L. Cancer in Iraq: the dilemma continues. 2014 Annual ASCO Daily Newspaper. Published online May 31, 2014.Google Scholar As for unregistered refugees, they receive a refugee status to be considered for UNHCR support. Protracted health care is referred to the UNHCR’s ECC, to provide full or partial therapies.10Spiegel P.B. Cheaib J.G. Aziz S.A. et al.Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017.Lancet Oncol. 2020; 21: e280-e291Abstract Full Text Full Text PDF PubMed Scopus (7) Google ScholarBrain drain occurs dramatically, because the most highly skilled and competent physicians and academics may leave the in-war state12Al-Khalisi N. The Iraqi medical brain drain: a cross-sectional study.Int J Health Serv. 2013; 43: 363-378Crossref PubMed Scopus (29) Google Scholar as scientific refugees. The need for continuing education, practicing professionals’ accreditation and certification, qualified board-certified trainers, clinical training institutions and complete students’ training3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar,9Hassani M. Impact of sanctions on cancer care in Iran.Arch Bone Jt Surg. 2018; 6: 248-249PubMed Google Scholar,12Al-Khalisi N. The Iraqi medical brain drain: a cross-sectional study.Int J Health Serv. 2013; 43: 363-378Crossref PubMed Scopus (29) Google Scholar,13Gendari A.H. Ameen H.A. Ramzi Z.S. et al.Geriatric radiotherapy in a war-torn country: experience from Iraq.J Geriatr Oncol. 2018; 9: 346-351Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar may influence decisions taken in the scientific capital of the threatened country.Most recent conflicts have not made a great impact on Western countries so far. However, with the ongoing Russian–Ukrainian war, Europe is most likely going to be affected and many countries are manifesting their support in this unprecedented European crisis.We should all act together to this A more and patients with cancer is There is also a need for a to patients cancer as well as an of medical In financial support of host countries is important to cover and treatment for refugee Cancer management has also been due to disease and that are for cancer treatment be with a provision of support for patients and their should not and become a to humanitarian of people in disease and war have some are by many that may be and great and as the of leading to is the of and and in this and The is that war, on geopolitical or and that human and for many vulnerable in war War is a major action of provoked humanitarian destabilization, and the recent Russian invasion of Ukraine is no exception, leading to human disqualification and global uncertainty. All past conflicts have left vulnerable people in despair across involved countries and geopolitical areas of interest. These conflicts have taught many lessons concerning the routine management of chronic diseases, such as cancer. Have they been learned abrupt decline in health sector financial funds has a predictable impact on prevention, immunization, health promotion, rehabilitation and cure of displaced populations. During war, environmental pollutants (i.e. dust and droplets in air and water), leukemogen, benzene and pyrophoric depleted uranium are induced, provoking unavoidable risk factors for hematologic malignancies and certain solid tumors.1Alwan N. Kerr D. Cancer control in war-torn Iraq.Lancet Oncol. 2018; 19: 291-292Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar,2Shahabi S. Fazlalizadeh H. Stedman J. Chuang L. Shariftabrizi A. Ram R. The impact of international economic sanctions on Iranian cancer healthcare.Health Policy. 2015; 119: 1309-1318Crossref PubMed Scopus (31) Google Scholar As a result of bombing, hospitals and national grid are structurally and functionally damaged. Road blockage, limited supply of electricity and insufficient maintenance, lack of medical supplies and depletion of human resources make health care provision disrupted,3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar without undermining the emotional burden on the health care employees who only have the obligatory ‘choice’ to act as heroes. Deficits in routine imaging diagnostics lead to a more advanced or unknown disease stage. There is also a delay in pathological diagnosis (i.e. applying immunophenotyping and immunohistochemistry on analyzed specimens). Post-traumatic stress, depression, personal and social fear, lack of family or community support with loss of dignity and unavailability of public services impact patients’ care access and availability or viability of theragnostic care.1Alwan N. Kerr D. Cancer control in war-torn Iraq.Lancet Oncol. 2018; 19: 291-292Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar,4Mula-Hussein L, ed. Cancer Care in Iraq. Chisinau, Republic of Moldova: LAP Lambert Academic Publishing; 2012.Google Scholar, 5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 6Majid R.A. Mohammed H.A. Saeed H.M. et al.Breast cancer in Kurdish women of northern Iraq: incidence, clinical stage, and case control analysis of parity and family risk.BMC Womens Health. 2009; 9: 33Crossref PubMed Scopus (24) Google Scholar units’ capacity decreases (i.e. single bedrooms occupied by double or triples)3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar mainly due to orthopedic and war surgery emergencies, as survival changes meaning. Limited treatment opportunities adversely affect cancer-specific survival rates.1Alwan N. Kerr D. Cancer control in war-torn Iraq.Lancet Oncol. 2018; 19: 291-292Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar,4Mula-Hussein L, ed. Cancer Care in Iraq. Chisinau, Republic of Moldova: LAP Lambert Academic Publishing; 2012.Google Scholar, 5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar, 6Majid R.A. Mohammed H.A. Saeed H.M. et al.Breast cancer in Kurdish women of northern Iraq: incidence, clinical stage, and case control analysis of parity and family risk.BMC Womens Health. 2009; 9: 33Crossref PubMed Scopus (24) Google Scholar Many patients seek care in neighboring cities or countries (conflict-induced cross-border travel). Less strict entry visa regulations (i.e. smaller fee) and/or a shorter-distance travel are the most important criteria in choosing a country as treatment destination, placing luck as the unique variable affecting the outcome. As the treatment cost exceeds patients’ incomes, they are obliged to even sell their properties.7Skelton M. Alameddine R. Saifi O. et al.High-cost cancer treatment across borders in conflict zones: experience of Iraqi patients in Lebanon.JCO Glob Oncol. 2020; 6: 59-66Crossref PubMed Scopus (5) Google Scholar and political punitive sanctions applied decrease imports and affect high-tech equipment needed for meticulous oncologic surgery (e.g. osseointegrated and modular tumor prosthesis used for treating limb sarcoma).2Shahabi S. Fazlalizadeh H. Stedman J. Chuang L. Shariftabrizi A. Ram R. The impact of international economic sanctions on Iranian cancer healthcare.Health Policy. 2015; 119: 1309-1318Crossref PubMed Scopus (31) Google Scholar,8Gorji A. Sanctions against Iran: the impact on health services.Iran J Public Health. 2014; 43: 381-382PubMed Google Scholar,9Hassani M. Impact of sanctions on cancer care in Iran.Arch Bone Jt Surg. 2018; 6: 248-249PubMed Google Scholar A substantial economic assistance through host countries and humanitarian agencies [i.e. Exceptional Care Committees (ECC) of the United Nations High Commissioner for Refugees (UNHCR)] is therefore warranted.8Gorji A. Sanctions against Iran: the impact on health services.Iran J Public Health. 2014; 43: 381-382PubMed Google Scholar,10Spiegel P.B. Cheaib J.G. Aziz S.A. et al.Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017.Lancet Oncol. 2020; 21: e280-e291Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar There is also a public insurance inability to cover expensive novel chemotherapy and biologic agents. Further, there is diversity in the operating procedures based on systemic therapy cost. Depending on the patient’s age, it does not cover patients in the terminal stage of the disease.10Spiegel P.B. Cheaib J.G. Aziz S.A. et al.Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017.Lancet Oncol. 2020; 21: e280-e291Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar A shortage of analgesics and a lack of infection control procedures influence cancer management.5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,9Hassani M. Impact of sanctions on cancer care in Iran.Arch Bone Jt Surg. 2018; 6: 248-249PubMed Google Scholar The import of some chemotherapeutic agents as well as devices that use radiation, such as scanners and radioisotopes, is prohibited because they are categorized as potential war weapons.1Alwan N. Kerr D. Cancer control in war-torn Iraq.Lancet Oncol. 2018; 19: 291-292Abstract Full Text Full Text PDF PubMed Scopus (16) Google Scholar,5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,7Skelton M. Alameddine R. Saifi O. et al.High-cost cancer treatment across borders in conflict zones: experience of Iraqi patients in Lebanon.JCO Glob Oncol. 2020; 6: 59-66Crossref PubMed Scopus (5) Google Scholar Positron emission tomography scan is not feasible and, subsequently, the whole therapeutic management is affected. Pediatric and adolescent patients may die of curable malignancies (i.e. Ewing sarcoma) and survival rates are lower than in developed nonwar countries.5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar operate with a limited number of oncologists, with no involvement of primary care providers. The main delivered service is day acute care and there is inability to handle therapy toxicity, with no palliative care and end-of-life support. Difficult communication between damaged and separated hospital branches has a negative impact on organizing and coordinating hospital services (i.e. multidisciplinary teams and discussions). There is a need for continuous support from another oncology center, or collaboration with foreign university volunteers, through a telemedicine program. There are difficulties in data collection and processing before participating in clinical trials due to the unavailability of administrative assistance.3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar Real-world trials become real war trials, without any intention to literally is essential for the functioning of radiotherapy and brachytherapy equipment, and with its shortage even sophisticated devices such as these become useless.4Mula-Hussein L, ed. Cancer Care in Iraq. Chisinau, Republic of Moldova: LAP Lambert Academic Publishing; 2012.Google Scholar,5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar The lack of (i) functional machines, (ii) regular equipment maintenance, (iii) quality assurance measures and (iv) the presence of new equipment result in a long irradiation waiting list and demand prolonged times under the machine.5Mula-Hussain L. Al-Ghazi M. Cancer care in times of war: radiation oncology in Iraq.Int J Radiat Oncol Biol Phys. 2020; 108: 523-529Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar,11Mula-Hussain L. Cancer in Iraq: the dilemma continues. 2014 Annual ASCO Daily Newspaper. Published online May 31, 2014.Google Scholar In Iraq, mean interval times between (i) referral and starting date of any palliative treatment was ∼19 days and (ii) simulation and radiotherapy starting date in the curative setting was postponed by ∼35 days.11Mula-Hussain L. Cancer in Iraq: the dilemma continues. 2014 Annual ASCO Daily Newspaper. Published online May 31, 2014.Google Scholar an ID registration number is important for patients with cancer. Changes in residency and phone numbers lead to the absence of medical history and regular follow-up.3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar,11Mula-Hussain L. Cancer in Iraq: the dilemma continues. 2014 Annual ASCO Daily Newspaper. Published online May 31, 2014.Google Scholar As for unregistered refugees, they receive a refugee status to be considered for UNHCR support. Protracted health care is referred to the UNHCR’s ECC, to provide full or partial therapies.10Spiegel P.B. Cheaib J.G. Aziz S.A. et al.Cancer in Syrian refugees in Jordan and Lebanon between 2015 and 2017.Lancet Oncol. 2020; 21: e280-e291Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar drain occurs dramatically, because the most highly skilled and competent physicians and academics may leave the in-war state12Al-Khalisi N. The Iraqi medical brain drain: a cross-sectional study.Int J Health Serv. 2013; 43: 363-378Crossref PubMed Scopus (29) Google Scholar as scientific refugees. The need for continuing education, practicing professionals’ accreditation and certification, qualified board-certified trainers, clinical training institutions and complete students’ training3Al-Hadad S. Al-Jadiry M.F. Future planning to upgrade the pediatric oncology service in the Baghdad children welfare teaching hospital.J Pediatr Hematol Oncol. 2012; 34: S19-S20Crossref PubMed Scopus (3) Google Scholar,9Hassani M. Impact of sanctions on cancer care in Iran.Arch Bone Jt Surg. 2018; 6: 248-249PubMed Google Scholar,12Al-Khalisi N. The Iraqi medical brain drain: a cross-sectional study.Int J Health Serv. 2013; 43: 363-378Crossref PubMed Scopus (29) Google Scholar,13Gendari A.H. Ameen H.A. Ramzi Z.S. et al.Geriatric radiotherapy in a war-torn country: experience from Iraq.J Geriatr Oncol. 2018; 9: 346-351Abstract Full Text Full Text PDF PubMed Scopus (1) Google Scholar may influence decisions taken in the scientific capital of the threatened recent conflicts have not made a great impact on Western countries so far. However, with the ongoing Russian–Ukrainian war, Europe is most likely going to be affected and many countries are manifesting their support in this unprecedented European should all act together to this A more and patients with cancer is There is also a need for a to patients cancer as well as an of medical In financial support of host countries is important to cover and treatment for refugee Cancer management has also been due to disease and that are for cancer treatment be with a provision of support for patients and their should not and become a to humanitarian of people in Cancer disease and war have some are by many that may be and great and as the of leading to is the of and and in this and The is that war, on geopolitical or and that human and for many vulnerable in war