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.
Highlights
Armed conflicts cause massive disruption including loss of life, injuries, the destruction of vital infrastructure and forced migration, with all the resulting short and long term socioeconomic, political and health consequences
A total of 4,039 patients were identified as Afghan nationals, i.e., having provided an Afghan address at the time of initial registration between 1995 and 2017. This represents 4.84% of all new patients (n = 83,477) seen at SKMCH&RC [8]. 550 of these patients did not receive any further care at SKMCH&RC for various reasons including the diagnosis of benign disease and not returning for follow-up after being requested to obtain further diagnostic investigations
SKMCH&RC is currently engaged in discussions with the Government of Afghanistan to help to establish a national cancer centre in Kabul
Summary
Armed conflicts cause massive disruption including loss of life, injuries, the destruction of vital infrastructure and forced migration, with all the resulting short and long term socioeconomic, political and health consequences. The international community has managed multiple refugee crises, mostly through United Nations (UN) agencies and non-governmental organisations providing acute medical care as well as controlling public health issues such as malnutrition and infectious disease outbreaks. Non-communicable diseases (NCDs) affecting refugee and migrant populations, especially cancer, have received little attention both politically, and within the ecosystem of humanitarian medicine [2]
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