DUBAI: When Syrian writer and translator Dina Aboul Hosn received a letter from her local health authority in Germany three years ago asking her to visit for a routine breast examination, she thought nothing of it.

Hosn, who had just turned 50 and had sought asylum in Germany eight years ago, was mindful of the need for social distancing and self-quarantine amid the COVID-19 pandemic, so chose to put off her appointment.

When she finally went along for a comprehensive check-up two years later, she was not prepared for the findings. “I wouldn’t worry too much, but you have a lesion that needs to be checked,” her doctor told her after an ultrasound imaging session.

Although the lesion was not malignant or dangerous, Hosn’s name was moved from a list of people who receive biennial checkups to those who will have a yearly exam. The health scare has made her pay much closer attention since.

Hosn’s friend, a fellow Syrian who also has German residency, was not so lucky. She was diagnosed with early-stage breast cancer, undergoing a lumpectomy and a full course of radiation therapy.

Both women received full coverage from their health insurance, and quality care provided by the German healthcare system.

The outcome may have been different for these women if they had remained in their country of origin, where 12 years of bloody conflict have led to the displacement of half of the population and left essential services barely functioning.

“This is an awful thing. Even in sickness, you have that feeling of guilt, that I have access (to medical services here), but they don’t. It is an ugly feeling,” Hosn told Arab News.

Hospitals, clinics, laboratories, pharmaceutical factories and other infrastructure for oncology care have been damaged or destroyed across Syria by years of fighting, while those still standing have suffered under economic pressure and trade embargoes.

“Diagnostic imaging modalities and radiation therapy are not available in the majority of medical centers in Syria, making it very hard for the physicians to follow the universal guidelines in diagnosis and treatment,” according to a paper published in the American Society of Clinical Oncology Educational Book in 2018, titled “Cancer care for refugees and displaced populations: Middle East conflicts and global natural disasters.”

Many physicians and medical practitioners have either been killed or left the country. According to Physicians for Human Rights, some 15,000 doctors fled in 2015 alone.

Traf Al-Traf, a pharmacist and a program coordinator with the International Wars and Disasters Victims Protection Association in Syria’s opposition-held northwestern province of Idlib, has been working to raise awareness about self-examination and screening.

“We are trying to spread awareness and curb the spread of cancer cases with our very limited capabilities,” Al-Traf told Arab News. This includes mobile clinics, distributing leaflets and assigning a qualified female team to spread awareness among women.

Breast cancer is the most common kind of cancer in northwest Syria, said Al-Traf. Out of 373 new cancer cases reported in 2021, some 241 were breast cancer, followed by 61 cases of Hodgkin’s lymphoma.

When a woman is diagnosed with cancer, she will be referred to the main hospital in Idlib, which is supported by the Syrian American Medical Society. However, the hospital cannot offer treatments for all kinds of cancer, and only Syrians with enough money or connections are able to travel abroad for treatment.

The cost of cancer treatment, as well as specialized imaging, is very high. While the illness and its treatment are agonizing for all patients, the distress is twofold for the displaced. Many are diagnosed much later, funding for palliative care may be refused and many others die without proper diagnosis or treatment at all.

Often, the expenses of treating displaced cancer patients are not covered by international aid agencies and volunteer organizations, as cancer is “too poor of a prognosis and/or too financially costly to treat,” according to a paper titled “Burden of Cancer Among Syrian Refugees in Jordan,” published in the Journal of Global Oncology in 2018.

Health services tailored to refugees by humanitarian aid agencies tend to focus on issues like nutrition and infectious diseases, while neglecting most specialized maladies like cancer.

Arab News contacted four regional and international humanitarian organizations in Amman, Beirut, Cairo and Dubai to ask about any schemes they offer for raising breast cancer awareness or for providing early diagnosis or treatments in camps in Jordan, Lebanon, Sudan, Yemen and Palestine.

Two organizations said they had no such programs, while two others gave no specific answer, only stating that they were “very busy with the war in Gaza.”

Breast cancer is the most prevalent cancer among Palestinian women displaced to camps by the 1948 Arab-Israeli war, accounting for 32 percent of cancer diagnoses in the West Bank and Jerusalem, and 18 percent in the Gaza Strip.

Women in Gaza “were more likely than those living in the West Bank and Jerusalem to have good breast cancer risk factor awareness (42.0 percent and 35.2 percent, respectively), according to the 2022 report, “Awareness of Palestinian Women About Breast Cancer Risk Factors: A National Cross-Sectional Study,” published in the JCO Global Oncology journal.

“This difference might be compounded by the fact that the West Bank and Jerusalem have checkpoints and restrictions on internal mobility, even between cities, making it difficult to reach healthcare facilities,” the report said.

“Another explanation could be the number of women living in rural regions, where the West Bank and Jerusalem have a higher proportion, who might have limited access to healthcare facilities.”

Despite a good level of awareness among Gaza’s women, some treatment options, such as radiotherapy, remain out of reach in Gaza. Patients need to obtain permits from Israeli authorities to receive such treatments at hospitals in East Jerusalem. However, these permits are often impossible to obtain.

Studies show that in 2018, almost 40 percent of Israeli permit applications for Palestinian patients to exit the Gaza Strip to receive treatment in the West Bank or Jerusalem were rejected or delayed. About a quarter of these applications were for cancer care.