Cancer and Syria in conflict: a systematic review

Abstract

Background: Armed conflict can disrupt oncology care profoundly, resulting in worsened health outcomes for cancer patients. Syria has endured armed conflict for over a decade, resulting in a severe breakdown of its healthcare services. The aim of this systematic review was to assess the available evidence on the burden of cancer and oncology services in Syria and how they have been affected during the conflict.

Methods: Eight academic and six grey literature databases were searched for English- and Arabic-language studies published from March 2011 until February 2024. Studies reporting any outcomes relating to the burden of cancer or the state of oncology services in wartime Syria were considered for inclusion, although case reports and scoping reviews were excluded. A narrative synthesis of findings was performed.

Results: Of 5,801 studies identified, 28 studies from academic (23) and grey literature (5) were eligible. Papers which reported on the burden of cancer showed an overall increase in cancer incidence and mortality between 2012 and 2022 (most recent data available). Most services were noted to be concentrated in Syria's capital, Damascus. The main identified themes related to the challenges of providing oncology services with staff shortages, chemotherapeutic drug shortages, insufficient radiotherapy services, and a lack of screening and palliative care noted.

Conclusion: There is insufficient high-quality exploration of the burden of cancer and the state of oncology services across Syria in academic and grey literature. Syria's health system is divided, creating disparities in access to oncology services, most of which are concentrated in Damascus, exacerbating pre-existing inequalities. The sparsity of robust data reinforces the need for high-quality data, including the use of national or other cancer registries with data from all regions of Syria, including those under opposition control. As the country rebuilds its healthcare systems, policymakers should focus on addressing inequities in oncology service availability to support equity of services.

Keywords: Cancer; Health services; Military conflict; Oncology; Syria; Systematic review.

Fig. 1

A diagram showing the study selection process to identify eligible studies

Fig. 2

This map from WHO shows the main cancer centres across Syria. It is from 2016 but the main cancer centres in areas under government control remain the same; there are still no cancer centres in northeast Syria and only one cancer centre (Idlib Oncology Centre) in northwest Syria [23]