Gaza: oncologists sound the alarm – asbestos found in 15 per cent of the rubble

The situation in Ukraine is very different: despite the damage, the shortage of healthcare staff and disruptions to supplies, access to essential cancer care in government-controlled areas had largely been restored within six months of the Russian invasion in February 2022. Today, most patients receive care at regional centres closest to their homes, whilst those requiring innovative medicines or treatments that are not available continue to travel abroad thanks to the European Commission’s temporary protection scheme, which guarantees Ukrainians access to healthcare on a par with that of European Union citizens.

“Ukraine’s rapid recovery highlights the value of structured cross-border mobility, centralised coordination and international collaboration – models that could also improve cancer care in other conflict zones,” says Francesco Perrone, President of the Aiom Foundation. Nevertheless, a number of long-term challenges threaten the post-war recovery of cancer care in the country. The Ukrainian healthcare system is currently entirely dependent on international grants and loans to sustain essential services, including cancer care, as domestic revenue is largely allocated to defence. Uncertainty over long-term funding could jeopardise cancer prevention, diagnosis and treatment programmes.”

‘In wartime, the immediate concern for survival takes precedence, so cancer screening and prevention take a back seat,’ continues Perrone. ‘This leads to a reduction in early diagnoses and, within a few years, an increase in preventable cancer deaths. Secondly, clinical trials and continuity of care are disrupted, partly due to difficulties in transporting patients, the reorganisation of hospitals to focus on emergency care, and the disruption of the supply chains for medicines. It is worrying that attacks on healthcare facilities are becoming increasingly frequent in conflicts worldwide, in open violation of the Geneva Conventions.’ In addition to the destruction of the Turkish-Palestinian hospital in Gaza, we must also recall the Russian attack in July 2024 on Ukraine’s largest paediatric oncology centre, the Okhmatdyt Hospital in Kyiv, in which 300 paediatric patients were injured and 600 were evacuated.

‘In addition to the deaths and injuries, and the enormous obstacles to the care of cancer patients, hostilities create a ‘biosphere of war’ in which the air and water are contaminated with heavy metals and carcinogens stemming from war debris and rubble,” emphasises Rossana Berardi, President-elect of AIOM. Environmental health and human health are closely linked within a One Health approach. In particular, asbestos represents a cancer risk factor present in numerous conflict zones. In Gaza, we are faced with a chemical trap, with rubble mixed with contaminated debris. In Ukraine, too, this material was used extensively in construction until very recently,” continues Rossana Berardi. In fact, it was only banned in Ukraine in 2017, whilst in Italia it was banned in 1992. The United Nations Office for Disaster Risk Reduction estimates that around 60 per cent of roofs in Ukraine are reinforced with asbestos. The massive destruction of buildings is creating millions of tonnes of hazardous debris. From the rubble and during collapses and fires following bombardments, asbestos fibres are released into the atmosphere, where they are inhaled by the population. The damage cannot be quantified in the short term, but will become apparent in decades’ time, because the latency period between exposure to asbestos and the development of related cancers is over 40 years. The overall impact of these wars on health will continue for generations.”