The Global Coalition for Radiotherapy (GCR), a member of the European Cancer Organisation Emergencies and Crises Network, hosted an important Radiotherapy Task Force webinar, “Emergency Response to Crises”. Speakers at the event discussed the urgent, real-time challenges of accessing radiotherapy in Palestine and Lebanon, as well as the impact of natural disasters such as the Florida hurricanes, on cancer care services.
ISRAEL-PALESTINE
GCR Executive Director, Darien Laird gave an update on the Israel-Palestine conflict, one year since the start of the war.
“The Rafah border closed for medical evacuations in June 2024, and this is one of the large reasons that our radiotherapy task force members came and said there's more that we need to be doing. There's more that we need to be discussing and sharing.”- Darien Laird
Laird shared information from the World Health Organization (WHO) from September 2024. WHO Emergency Situation Report: Occupied Palestinian Territories:
Over 41,000 fatalities
Over 96,000 injuries
More than 10,000 are reported missing
> 2,000 people will be diagnosed with cancer each year, including 122 children.
We were honored to hear from Dr. Fadi Mizyed, who is the CEO for Augusta Victoria Hospital, and Head of the Radiation Unit there. He also currently serves as the President of the Palestinian Oncology Society.
Dr. Mizyed’s message was important and clear:
“The situation is very catastrophic. I can't find any other words. And any advocacy, any support, any call that might help will be appreciated by anyone. Any, medication, any equipment that can be sent, simple equipment to Gaza, will definitely help easing the pain of some patients or even saving lives of some patients there.”- Dr. Fadi Miyzed
He provided details about the history of Augusta Victoria Hospital and the timeline of cancer care treatment at the centre. Over the years, there has been an increase in the number of patients treated in their radiation department, until October 2023.
“Since October [2023], until today, we didn't receive any cancer patients from Gaza. On our list, we had almost 82 patients who were ready for treatment after simulation and planning. And they were supposed to come in October, November and December to start their treatment, but they were not allowed to come.”
Dr. Miyzed said that the current health system is totally destroyed. Many patients, including those with cancer, are not getting the essential treatment they need. The main cancer center in Gaza was the Turkish–Palestinian Friendship Hospital that was supposed to be the location for radiation therapy in the future, but is now occupied by the Israeli army.
“There is no infrastructure in Gaza now for any cancer treatment except [a] few locations where you might be able to prepare some chemotherapy. The drugs are not available. The people who [have] the expertise are not available. Part of the medical staff were killed. Part of them were displaced to other places.”
He described the challenges of diagnosing new cases and ensuring they have access to medical care. He believes that the current evacuation process is insufficient, and even if they were to permit more patients to be evacuated, it would require a significant increase in support to effectively receive medical treatment in the nearest hospitals.
LEBANON
Dr. Caroline Samaha Jabbour is a practicing radiation oncologist at Mount Lebanon Hospital and CMC Medical Center, and the former Chair of the Radiation Oncology Department at Mount Lebanon Hospital. She provided information on the current situation in Lebanon, along with background and context for radiotherapy in the country.
In Lebanon, out of the 6 million people, almost half are refugees. Among them, almost 1 million are Palestinians and 2 million are Syrian refugees. Dr. Caroline Samaha Jabbour’s work to evaluate access to radiation therapy in Lebanon, began in 2020 and has spanned a number of crises: the COVID pandemic, the Beirut port explosion, an economic crisis, and now, war.
She outlined the challenges in her country, including endangered infrastructure, displacement of the population, displacement of medical professionals, financial constraints, patient access mobility, and delays in maintenance due to the country's classification as a high-danger area.
“Two weeks ago, there was one center here in Nabatieh, of radiation therapy. It was bombarded, so they had 70 patients per day on treatment and maybe another 30 on the waiting list. They all were shifted to the centers in Beirut. So we had to accommodate almost 100 patients in one week. And they were divided on only two centers. So two centers of radiation therapy had to accommodate almost 100 patients.”-Dr. Caroline Samaha Jabbour
One million Lebanese citizens have been displaced, and distributed throughout the country, increasing demand for oncology care, especially for radiation therapy services. This also includes displaced medical professionals. Jabbour also described the plight of technicians, living under attack on a daily basis. To alleviate some of these concerns, they were given rooms at the hospital, a space to stay and sleep in safety. Patients are also dealing with the same terrors as they attempt to travel to and from the hospitals for treatment.
Financial security for radiotherapy treatment is also a large burden:
“We have financial constraints because now the funds that were allocated to cover some of the treatments by the Ministry of Health, some of the radiation therapy treatments are now diverted and they are shifted to the more important and more urgent matters. Like you have heard about the pager incident. Well, in the pager incidents, I will give you an example. In one hour, the ER department in my hospital has received more than 200 injured in one hour. And they're all severe injuries. So there wasn't a discrepancy between injuries. So the low, the very mild injury to severe injury, they were all severe injuries like loss of eyes, loss of limbs, etcetera. And the hospitals had the duty to take care of these patients and to do their surgeries for free. And now the Ministry of Health will shift the money that was allocated for radiation therapy or for oncology care to cover these surgeries and these long term treatments.”
After experiencing improved radiation access following previous crises, they are now confronted with uncertainty. It has been nearly a month, with a high likelihood of escalation, and she said they simply do not know what to expect.
Florida
“The challenges that we are dealing with here in Florida are nothing compared to what others are presenting” Mr Stuart Wasserman, Director of Clinical Physics, Moffit Cancer Center said, following the other presentations, but these interventions for understanding preparation and reaction during climate crises are equally valuable.
Stuart Wasserman is a medical physicist, serves as a Director of Clinical Physics at the Moffitt Cancer Center, as well as a Division Administrator for Radiation Oncology. Our GCR Resident Partners Chair, John Peterson is also a resident at this center.
He shared some lessons on preparation, following the two Hurricanes that impacted Florida, USA. Unlike the other events, with hurricanes there is advance notice, and understanding that it will be a temporary event.
“When you think of preparing for a storm like this to take into account the needs of your staff. Most of the staff is worried about their own family and home, and many of them were in evacuation zones. And so, in fact, we closed operations. And I think all the other centers that I spoke to in the area shut down operations the day prior to the storm to give patients and their staff opportunities to prepare their homes. And a percentage of them had to evacuate their homes because they were living in evacuation zones.”
He described some of the practical preparations which included: shutting down the equipment in case of flooding, preparing communication groups, and checking in on staff, especially those with lost power.
They were hit with two hurricanes, Helene and Milton, which each brought different challenges. Helene was more of a flooding event and Milton resulted in more power outages. His advice was that whatever plan you come up with, you need to have some flexibility.
Ukraine
Dr. Oleksandr Ogorodniitchouk is the Co-Director Cancer Care Programs at the Blue Heron Foundation. His colleague at Blue Heron is Dr. Horia Vulpe who has been part of the GCR Radiotherapy Task Force since the beginning and has been working to provide access to radiotherapy treatment for Ukrainians.
“So we noticed that with the war, a lot of Ukrainian patients had to travel to other countries to treat them. I see, like in the other countries now, unfortunately. And we also noticed that in Ukraine, a lot of cancer centers used cobalts and now they transfer the technology to accelerators and they are not so used to Hypofractionation and SBRT and SRS. So we imagined that maybe if we just can help them to gain efficiency on the machine, on the centers. Maybe it can be a first step before going to SBRT and SRS, but we can first speak about hypofractionation.”
The group is teaming up with experts from Paris, UK, Australia, and others to present at their upcoming webinar. He said they are trying to make a simple and effective workshop that will be useful to medical physics and doctors.
DISCUSSION FORUM
GCR Co-Founder and Radiotherapy UK Chair, Professor Pat Price facilitated the Q&A discussion. The panelists shared ideas about retaining RTT’s, using free resources, training, and utilizing expats. There was discussion about ways Industry can support them through remote data, spare parts, maintenance and compliance.
“We felt there was something we could do for radiotherapy. It's a very specialist subject, and we have a lot of solutions that can be remote and can be very technical. And we felt by sharing the problems, sharing around the world, there can be some solutions.” -Professor Price
Sharing these problems and potential solutions is encouraging; however, the key takeaway was advocacy. Dr. Mizyed stated:
“The advocacy on our behalf because we are not there on the ground in Gaza, to do anything. So the advocacy and highlighting the issue as much as we can is the most important thing.”
Next Steps
We encourage our community to take advantage of the upcoming free events and spread the word about these areas of impact:
Hypofractionated Radiotherapy in Practice: Mon, Oct 28 @ 14:30 GMT & Mon, 4 Nov @ 14:30 GMT
London Global Cancer Week: Mon, Nov 11 @ 14:00 UK "Cancer and conflict in Africa: a spotlight on The Sahel"
MESTRO 2024 Congress: Nov 27-29, Alfaisal University, Riyadh, Saudi Arabia
GCR will continue supporting Richard Sullivan and the WHO Emergency Committee as they work to rebuild the cancer continuum needs in Ukraine, including understanding on-the-ground intel for radiotherapy needs, technology & personnel.
REVIEW THE RECORDING
You can watch a recording of the GCR Emergency Response to Crises webinar here:
REVIEW THE NOTES AND MEETING CHAT
You can download the notes and chat from the 22 October meeting here:
REVIEW THE SLIDE DECKS FROM THE PRESENTATIONS
This slide deck includes presentations from the meeting, and can be downloaded here:
GET INVOLVED
We invite you to join our Radiotherapy Task Force by signing up on our Contact page and indicating your interest in participating.
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