Mohsin Kouther, Mula-Hussain Layth, Gilson Richard
Institute for Global Health, University College London, London, UK.
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
BMJ Oncol. 2024 Mar 1;3(1):e000252. doi: 10.1136/bmjonc-2023-000252. eCollection 2024.
The Iraqi population has lived under four decades of conflicts, warfare and political instability. The health consequences of the protracted conflict continue to persist. This work critically analyses Iraq's barriers to delivering and accessing cancer care during the conflicts that Iraq passed through from 1980 to 2017. To identify the barriers to accessing and delivering cancer care services, we used the HealthCare Access Barriers framework, which categorises the barriers into three groups: financial, structural and cognitive. Moreover, a structured search was performed in multidisciplinary databases. To produce a comprehensive body of literature, further materials were retrieved using alternative methods, such as hand-searching and snowballing. The key findings and themes identified in the literature were issues related to funding and affordability (within the financial), destruction and inaccessibility of facilities, therapeutic and diagnostic shortages, workforce and human resources and lack of national guidelines and awareness programmes (within the structural), awareness and knowledge and finally attitudes and beliefs (within the cognitive). These results demonstrated that the barriers to cancer care delivery are complex and inter-related. The financial and structural barriers were particularly intertwined with the protracted conflict, but this relationship was not demonstrable within the findings of the cognitive barriers. We concluded that the barriers facing the delivery and access to cancer care in Iraq are intertwined mainly with its protracted conflict. To ensure that future generations do not continue to pay the price of war, improved reconstructive efforts and further research are necessary.
伊拉克民众在长达四十年的冲突、战争和政治动荡中生活。长期冲突对健康造成的影响依然存在。这项研究批判性地分析了伊拉克在1980年至2017年冲突期间提供和获得癌症护理的障碍。为了确定获得和提供癌症护理服务的障碍，我们使用了医疗保健获取障碍框架，该框架将障碍分为三类：财务、结构和认知。此外，还在多学科数据库中进行了结构化搜索。为了形成全面的文献资料，还使用了其他方法，如手工检索和滚雪球法，获取了更多材料。文献中确定的主要发现和主题包括与资金和可承受性相关的问题（在财务方面）、设施的破坏和无法使用、治疗和诊断方面的短缺、劳动力和人力资源以及缺乏国家指南和意识项目（在结构方面）、意识和知识，最后是态度和信念（在认知方面）。这些结果表明，提供癌症护理的障碍是复杂且相互关联的。财务和结构障碍与长期冲突尤其交织在一起，但在认知障碍的研究结果中，这种关系并不明显。我们得出结论，伊拉克在提供和获得癌症护理方面面临的障碍主要与其长期冲突交织在一起。为确保子孙后代不必继续为战争付出代价，必须加强重建努力并开展进一步研究。
