BEIRUT: Iman Moussa is a quiet child, but has a bright smile that masks the fact that the 3-year-old with rich black hair and olive skin has spent the last year undergoing chemotherapy for cancer that once rendered her immobile. However, neither her mother nor her doctor are smiling, as the money for Moussa’s treatment is running out and with it her options.
Moussa is under the care of Dr. Peter Noun at the Lebanese Hospital in Beirut’s Geitawi, where Moussa’s family – and many other Syrian refugee families like them – have been receiving cancer treatment.
At the start of the year, Dr. Noun began struggling to finance his patients’ treatment due to a funding crisis caused by a drop in donations.
“I have 45 Syrian [children] now with cancer,” he told The Daily Star. “Most of them now have their treatment interrupted due to these financial problems.” In the event that he has to halt treatment for the children under his care, Noun said all would be at risk of relapse.
Cancer treatment is difficult to access in Lebanon even at the best of times, he said. Families who are not Lebanese nationals do not have recourse to government funding and for many, like Moussa’s mother Maryam Ramadan, private health insurance is unaffordable.
“I have to work on a farm from morning to evening to earn LL8,000 ($5.28) a day to afford a ride from Tyre to Beirut,” she told The Daily Star. “I have eight children living in a tent that doesn’t block the rain.”
Noun estimates that a course of cancer treatment can cost around $50,000, and many children suffering from the disease rely on funding from third-party donors and NGOs to pay for it.
Most health care for Syrian refugees is provided through Lebanese medical centers or through services run by large international NGOs and humanitarian bodies such as UNHCR. The U.N. refugee agency will cover between 75-90 percent of the cost of hospital care, although this is largely limited to obstetric and life-threatening conditions and treatment is contingent on funding. However, UNCHR does not have the funding to cover tertiary care like cancer treatment.
“Complex cases, while also urgent, such as organ transplantation, cancers requiring chemo, radiotherapy and chronic renal failure, are unfortunately beyond UNHCR’s ability to provide coverage,” UNHCR spokesperson, Lisa Abou Khaled, told The Daily Star via email. “When these instances arise, UNHCR actively engages with a number of pre-identified NGOs or private sponsors who might be able to cover hospital fees and help the affected refugees.”
One of the NGOs providing tertiary care is Karma, a Lebanese organization set up to provide care, including cancer treatment, for refugee and underprivileged children in the country. Alaa Najjar, one of the founding members of Karma and its secretary, told The Daily Star that on average the funding they are now able to secure for each case is two-thirds less than previous years.
While the huge number of Syrian refugees registered in Lebanon is officially decreasing – the number of registered refugees dropped below 1 million last December – both Noun and Najjar said that the burden on existing infrastructure is the funding, not the lack of capacity.
“It’s getting harder and harder to cover these cases,” Najjar said. “Unfortunately, we are declining many cases coming to us asking ... because we cannot afford it.”
He said that Karma is already in debt to some of the hospitals where they have referred cases and says that one of their main issues is the phenomenon of donor fatigue, which is exacerbated by the high price of cancer therapy.
From the donor’s perspective, those with cancer have “little chance of life, little chance of success, and you’re investing too much money on one case,” Najjar said, adding that this has caused many to choose to fund humanitarian projects instead.
“They consider it a case. We consider it a kid,” he said. “It’s a child. They deserve a chance and whatever the chances of life or recovery they deserve to get treatment for free.”
On top of this, Najjar said he believes that there is a perception among the organization’s donors, who are mainly based in Lebanon and Germany, that the war in Syria is winding down. “Donors are saying that the kids might have a chance to go back to Syria where they can get their [state-funded] treatment,” he said. This leaves families with the unenviable choice of returning to Syria to try to secure treatment for their children or find funding in difficult circumstances in Lebanon.
Abou Khaled said that refugees with the correct documents do sometimes return to Syria in order to access health care. Many, however, are unwilling to make the journey. Ramadan, Moussa’s mother, is among them. “I have family members who went to the border between Turkey and Syria. There is no treatment there,” she said.
“In Syria, in Aleppo, there is no treatment [and] no clinics.”
For the moment, Moussa continues to rely on Noun for her treatment, but how long she will be able to do so is in question. Since the funding crisis started in early January, Noun has been treating patients in his own clinic, so as “not to stop the chemo,” he said.
“But I cannot go on any more.”