Children with cancer latest victims of Lebanon’s economic crisis

Parents and doctors say they are forced to travel to find medicine

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  Three-year-old Quin with Blu-Blu the bear, on the pediatric oncology ward at St Georges Hospital in Beirut. All photos: Elizabeth Fitt / The National

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  Quin is receiving chemotherapy for a rare, aggressive sarcoma.

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  She is dependent on NGO, Kids First, both to pay for and find medication that is often in short supply due to Lebanon's economic crisis. Her 85 per cent recovery prognosis has dropped to 45 per cent as medicine shortages delay her treatment.

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  Marwa Younis, left, Quin's mother, is struggling to shoulder the human cost of Lebanon's economic crisis.

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  Thirteen-year-old Charbel Fahed on the oncology ward at St Georges Hospital. Charbel suffers from leukimia and is reliant on donations to complete his treatment cycles as currency depreciation puts imported medicines ever further out of reach of those who need them.

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  Charbel Fahed, 13, and his parents chat with Head Pediatric Oncologist Dr Peter Noun. Charbel suffers from leukemia and is reliant on donations to complete his treatment cycles.

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  With none of the usual procurement options available, this fridge is full of medication that staff on the pediatric oncology ward at St Georges Hospital have received as donations or sourced from abroad themselves.

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  Dr Noun is determined to keep his practice's 84% recovery rate. So far he has managed to ensure not a single patient has missed a medication cycle, despite dire economic conditions in Lebanon causing medicine shortages and making families of many children in his care unable to pay for treatment.

Quinn Alma Antar sits patiently in a hospital chair, playing with her stuffed pony, galloping it around the IV drip attached to her arm.

At only three years old and with an aggressive form of rare tissue sarcoma, Quinn has become accustomed to chemotherapy treatments and long hospital stays. But she is still too young to understand Lebanon’s relentless economic crisis and the consequences it could have on her life – instead, that burden lies with Quinn’s parents and doctors.

Her parents spend sleepless nights worrying about how to source their daughter’s monthly chemotherapy round in a country suffering from an acute medicine shortage – and, once it’s found, how to afford it.

“We are too busy trying to scavenge for Quinn’s treatment right now,” her mother, Maria Younes, says. “We don’t even have the capacity to think about the future, about how we will get the next round of treatment.”

Since 2019, Lebanon has weathered a severe economic meltdown rated by the World Bank as one of the worst in the world’s modern history. The Lebanese currency has plummeted in value, and a recent UN report said over 80 per cent of the country’s population has since plunged into poverty.

Unemployment is at an all-time high; many in the once middle-income country now struggle to make ends meet. Meanwhile, Lebanon’s power-holders – accused of the same corruption and mismanagement that ultimately brought the country to its knees – have done little to bring in the reforms needed to receive an international bailout.

Failing public services and acute shortages have come to dominate the small Mediterranean country’s economic disintegration. Necessities such as drugs, diesel and electricity are in extremely short supply, harsh symptoms of a prolonged collapse.

Drug delays affect outcomes

Ms Younes said her daughter was given an 80 per cent chance of making a full recovery when her cancer was diagnosed 18 months ago. Now, because of difficulties and delays involved in sourcing treatment, as well as chemo-related medical complications, she says Quinn’s recovery rate has dropped drastically to below 45 per cent.

Quinn’s case is emblematic of those of hundreds of young cancer patients struggling to receive treatment as Lebanon’s healthcare system flounders. Healthcare workers have been sounding the alarm there since signs of severe medical shortages began to show last summer.

In December, Health Minister Firass Abiad has said that Lebanon’s healthcare system – once considered one of the best in the region – is on the brink of collapse. Some hospitals struggle to keep the lights on, and a mass departure of healthcare professionals for better opportunities elsewhere is causing staff shortages.

Dr Abiad told The National by phone that the government is attempting to address the shortages in subsidised cancer medications, but denied shortages are impacting childrens' care.

“Really the major player is BDL,” he said, referring to Lebanon’s destitute Central Bank. “If there are delays in transferring any sums abroad…if there is a small delay or any delay in delivery, you end up with shortages.”

“There are [medical] shortages in Lebanon,” he admitted. “But that does not apply to cancer medications in children and children.”

Dr Peter Noun, head of the pediatric oncology department at St Georges Hospital Beirut is determined to keep his practice's 84% recovery rate. Elizabeth Fitt for The National

Dr Peter Noun is head of paediatric haematology and oncology at Saint George Hospital University Medical Centre, where Quinn is a patient.

He registered his surprise at Dr Abiad’s comment denying shortages of children’s cancer medications. “I’m really surprised. So is every oncologist and parent in the country,” he said.

He said his department is struggling to maintain its reputation as one of the best places for paediatric oncology in the region.

In addition to the difficulty in sourcing cancer medicines, the national drain of resources and staff has jeopardised its patients’ survival rate, which is currently above 80 per cent.

“The main challenge now is the shortage of medication,” he told The National. “Because we’re all trying – as hospitals, as NGOs, or as the parents – to get the drugs from abroad.”

The medicine for Quinn’s previous round of chemotherapy was impossible to find in Lebanon. Eventually, her parents secured ampoules of Oncovin through friends who holidayed in France and Switzerland. They brought the drug back in a fridge lined with dripping ice.

Dr Noun said acquiring chemotherapy drugs from abroad is a double-edged sword: they are both expensive and difficult to find.

We cannot lose these children because of the economic situation

Dr Peter Noun

Government subsidies on some life-saving medicines began to disappear last year, causing their prices to increase exponentially. Although the majority of cancer treatments remain subsidised by the Lebanese government, import shortages mean they are difficult to find.

Back in 2005, Dr Noun co-founded Kids First, a donation-based association created for children in Lebanon with cancer. The NGO, which operates in three hospitals in the country, initially helped those without health insurance or adequate financial means.

“But in the last two years, everything has changed,” he says.

Dr Abiad said Lebanon is relying on large international donations to ensure the shortages in children’s cancer medications are mitigated.

“We received some donations of children's cancer medicines during the past two weeks and there are large quantities coming in the coming weeks as well.” He did not elaborate on how many patients the delivery would serve, or how long it would relieve shortages, if at all.

Dr Noun says the number of patients needing financial assistance has risen drastically in the past two years, to more than 80 per cent, putting increased pressure on the association’s finances. It currently helps about 170 patients.

Going above and beyond to secure treatment

Dr Noun helps parents like Quinn’s navigate a web of financial and medical challenges in Lebanon’s post-collapse landscape. When need dictates, he tells parents or staff at his NGO where to travel to find the treatments needed. Sometimes he goes himself.

“Last week I was in France and brought drugs for cancer treatment back with me … But it’s not enough – and we can’t count on these small quantities.”

He maintains a constant line of communication with pharmaceutical manufacturers in Europe, import agents and local medical warehouses.

“It’s not the description of a doctor to do this,” he laments. “Now we are helping in everything – specifically, how to get the money and the drugs for their treatment.”

Dr Noun says that so far, none of his patients has had to skip a chemotherapy cycle, but depending on international donations and trips outside the country is not sustainable.

In the meantime, he stresses, there’s not much choice.

“We cannot lose these children because of the economic situation.”