Tuesday, March 27, 2018

Yemen’s Cancer Patients: The Fight for Medication

8 September 2016

By Abdel-Nasser Al-Hilali
Sana’a, Yemen, June, 2016

(Al-Araby) – The health of Hassan Abdul-Rahman, 55, deteriorated drastically after he stopped receiving Gleevec medication for his leukaemia for three weeks in January of 2016.
Gleevec is a drug that works to disrupt the growth of cancer cells, and had been provided by the Ministry of Health in Sana’a at public health centres.
According to the Deputy Director of the National Oncology Centre Dr. Abdul-Wahab Al-Nahmi, a decision had been made to cut funds allocated for treating around 10,000 cancer patients in the country due to the ongoing civil war. Initially totalling $11.5 million in 2014, they were cut to $ 5.6 million in 2015. The cuts affected six clinics in Aden, Al Hudaydah , Al Mukalla, Ibb, Sanyyan and Taiz.
Abdul-Rahman, who subsists on a monthly income of $350, was unable to pay for the medicine from private pharmacies, where the drug sells for about Yemeni rials 107,000 ($500) for a month’s supply of 30 tablets.
Prior to the war, the drug had been selling for $250 in a country where the annual per capita income stands at $1260.
By February 2016, blood tests and pH measurements conducted by Abdul-Rahman’s doctor, Riad Qudsi, showed that his kidney functions had become imbalanced and that his tumour growths had complicated as a result of going off the medication.
His son Shadi detailed his father’s recent struggle with cancer, confirming that his father had been receiving free medicine from the National Oncology Centre since being diagnosed with the disease in August 2014 up until October 2015.
Starting in November however, the family was forced to buy medicine at a private pharmacy. He had to stop taking the medicine for three weeks as his family negotiated a $2,500 loan to provide him with Gleevec medication for five more months.
Dr. Jamil Ghazal, a haematologist who supervises Abdul-Rahman’s treatment along with Dr. Qudsi and Dr. Al-Nahm, warned that disrupting medical treatment could leave the patient at risk of death.
Abdul-Rahman was not the only patient suffering from interrupted medication, nor was he the only one unable to buy it at his own expense. By the end of April, this reporter discovered that 36% of the 50 patients he surveyed had stopped receiving the free treatment due to budget cuts. Of those, two thirds had been able to continue treatment in the private sector while the remainder had stopped treatment.
Parental Fears
In the city of Taiz, Ahmed Hassan al-Miqdad, 5, suffers from leukaemia. Assisted by the Centre for Hope in Taiz, 270 km off the capital Sana’a, his free treatments had ended in March 2015 as the civil war broke out. As a result his father has been unable to pay Yemeni rials 115,000 ($ 540) a month to buy the variety of drugs needed to keep his son alive.
The Centre’s Director Mukhtar Ahmed acknowledged that the last shipment of medicine had arrived in June 2015. Prior to the war their clinic had treated 1,418 patients suffering from various cancers but the resulting budget cuts had dropped the number down to 599 patients.
Ahmad had to discontinue treatment causing cancer to spread, according to his supervising doctor Ahmed Mikhlafi.
He explained that Ahmed “had been scheduled for intensive treatment every week for six months, but had underwent treatment for only four months before the treatments had been interrupted by the siege in Taiz and the outbreak of the war”.
Ahmed needed a new bout of intensive treatment to counter the cancer’s growth, he added.
Tasbeeh Abd Mohammad, 6, was feeling a little better. The interruption of her cancer treatment had caused tumour growth in her feet, leading to major swelling. The young girl was in danger of the cancer reaching her bone marrow, and required surgery and treatment outside the country that would cost her family $27,000, said Dr. Ali Hasber .
The World Health Organization (WHO) Representative in Yemen, Dr. Ahmed Chadol, said that all parties involved in the war have exhausted their resources and were unable to fully cover operating expenses of medical centers.
Around 80% of the 450 varieties of medicines and medical solutions provided by the centres have been exhausted since March 2015. This left the Ministry of Health last December with only the option of alerting both the Ministry of Finance as well as international NGOs.
Trying to Survive
Dr. Al-Nahmi is of the firm belief that interrupted treatments are the cause for the rise in cancer deaths over the last year, having climbed from 810 from 2014 to 893 over the course of 2015.
His linking of the two factors were supported by oncologist Dr. Abdullah Rabas. The latter noted that the initial two doses given to a patient are to agitate the tumours before the remainder begins to kill it. Consequently it is important to adhere to treatment schedules, as the drugs would take better effect if followed correctly.


Patient Name Medical Treatment Cancer Center-Obtained Treatment Patient-Paid Treatment Pricing
Hassan Abdul Rahman Monthly Leukemia None Gleevec $500 per month
Tasbeeh Abdo Mohammad Six Months Lymphoma None Could not afford any
Hamama Salah Eight Doses Every 21 Days Breast Cancer Chemicals Boosters and Immunotherapy pills $400 per dose
Hamidi Ahmed Saeed Eight doses every 26 days Intestinal Cancer Chemicals Immunotherapy pills $60 per dose
Inas Al Hammadi 12 doses every 12 days Intestinal Cancer Chemicals Immunotherapy pills $60 per dose
Ahmed Hassan al-Miqdad 6 months Lymphoma Chemicals Could not afford any
Mohammad Hazem Monthly Medication Bladder Cancer None Bicltanicl $200 a month

Fortunately for some patients, the WHO agreed in May 2016 to provide 4% of the 450 varieties of medicines and medical solutions that were available before the war, according to Dr. Haninah Mohammed Haninah, the Director of Medical Supply Management for the National Oncology Center. This was confirmed by WHO Representative in Yemen, Ahmed Chadol. But he warned that it would not be enough in light of the growing needs of the country’s medical services.
“We have cancer drugs and intravenous fluids that can be delivered quickly to the centers, but they require larger and more expensive support than we can provide alone. We are doing our best to help meet their urgent needs.”
Dr. Al-Nahmi affirmed that government funds would be available after a “significant delay” throughout 2015 that was only resolved in December.
This, he said, will lead to another delay because of the bidding process. Running from December 2015 to March 2016, the bidding would see pharmaceutical companies competing to provide the most medical supplies for the funds offered.
Still, he did not believe that the money allocated would provide for even half the supplies needed and blamed the Ministry of Finance for the failure to provide care for Yemeni citizens.
He understood how the civil war had affected Yemen, but insisted that no one but the patients and their physicians understood the problem.
Outlining the need for more funds, he stated clearly that Yemen’s medical services needed an annual budget of $ 25,000,000 dollars, estimating that a single patient’s cancer medications for a year could cost Yemeni rials 250,000($ 1,250).
The Government Response
According to an anonymous senior official in the Ministry of Finance, the Ministry itself had no problem supporting the full budget for the various Oncology Centers.
Rather, it was the civil war’s outbreak that drained the Central Bank’s liquidity and undercut the state’s resources.
Consequently revenues from customs, oil and gas and even taxes have not been collected, undercutting budgets and wages for all government agencies.
As a result of all this, cancer victims are suffering daily as resources necessary to keep them alive dwindle. With a shrinking budget and no change from the Ministry of Finance, the problem does not look to improve any time soon.
This investigation was completed with the support of Arab Reporters for Investigative Journalism (ARIJ ) and coached by Khaled Hrouji. The investigation was translated to English by Nicolas Awad.