The IAEA's technical cooperation programme is delivering support to the Syrian Arab Republic in several areas, from disaster response to assistance in addressing cancer.
Following the devastating earthquake in Syria in February 2023, the IAEA sent medical equipment in May, including portable and mobile X-ray machines, to strengthen the medical response system. The IAEA also organized a workshop from 21 to 25 May 2023 for local engineers and scientists, which provided them with knowledge and tools to assess earthquake damage accurately, thus facilitating recovery efforts. Over the course of the five days, 15 participants from Aleppo, Damascus and Latakia learned about non-destructive testing equipment and seismic analysis from a team of international experts. The workshop fostered collaboration to support the development of a comprehensive approach to rebuilding in the affected areas.
Additionally, Syria, like many other middle-income countries in the Arab world, is facing a significant increase in the occurrence of cancer cases among its population of 18 million, with the estimated 21 000 new cancer cases and 13 000 cancer deaths in 2020 predicted to almost double by 2030. Childhood cancers in particular constitute around five to 10 per cent of the cancer burden in the country, with approximately 1 500 new cases each year.
To support evidence-based planning and governance of cancer control, the country's Ministry of Health requested an imPACT Review of their national cancer control capacities, which was carried out in late 2022 by the IAEA together with the International Agency for Research on Cancer (IARC) and the World Health Organization (WHO). Following the Review, two new project proposals will be submitted for approval to the IAEA Board of Governors as part of the IAEA's 2024-2025 technical cooperation programme cycle. The proposed projects will support the national cancer control programme, and will improve national capabilities for radiopharmaceutical production.
"The challenges faced in the country relate to diagnostic imaging, radiotherapy and nuclear medicine for cancer control, and these are mainly related to heavy workloads, an inadequate workforce, shortages in equipment and technologies," said Dr Arwa Azmeh, Head of the Syrian National Cancer Control Committee. "This has led to limited coverage and accessibility for cancer patients in the country."
To improve the detection and treatment services available to Syrians, the Review provided for a number of milestones-to be organised into a national action plan and implemented with IAEA and WHO support-including the development of a cancer registry and surveillance tools, the establishment of a national radiotherapy programme and the implementation of accredited training programmes in diagnostic imaging and nuclear medicine.
In the area of cancer prevention, the imPACT Review concluded that reducing tobacco use and alcohol consumption, and introducing policies to promote good nutrition in children, are vital to restrain the growing incidence of cancer in Syria. The imPACT team also found that the late presentation of cancers, often at an advanced stage, to primary healthcare providers poses a challenge, which may in turn be alleviated by early detection schemes, particularly for breast and prostate cancer. One focus area of the assessment was the high burden of childhood cancer and limited access to specialized diagnostic and treatment centres in the country. Syria has two well-equipped paediatric oncology centres with multidisciplinary cancer care that treat more than 50 per cent of paediatric cancer patients in the country. However, many children do not complete the recommended treatment due to drug shortages and service disruptions.
The imPACT Review, which took place both virtually and through in-country meetings in 2022, examined Syria's cancer control capacity and needs in detail. Data was collected and technical meetings were held with key stakeholders from 13 facilities in Damascus and Latakia. These included specialised cancer centres and hospitals managed by the Ministries of Health and Higher Education, as well as the private sector and NGOs, including six civil society organizations involved in cancer control.
The imPACT Review is one of the broader IAEA and partner activities available to assist countries in tackling their cancer burdens. In this context, the Syrian National Cancer Control Committee (NCCC) organized round table discussions during the Review mission, bringing together key stakeholders to discuss and identify strategic areas of intervention and priority activities, aligned with the recommendations made by the international experts. Among other steps, the NCCC agreed to finalise the National Strategy for Cancer Control and a related Action Plan, strengthening technical working groups and engagement with civil society.
During the in-country mission to Syria, the imPACT Review team was able to identify how needs for radiation medicine, particularly in diagnostics and treatment, can be addressed through the ongoing and planned IAEA national technical cooperation (TC) programme. The experts were also able to validate the virtual Review findings through follow-up meetings with local hospital administrators, healthcare workers and national policy-makers, whose experiences highlighted the important role played by national health policies in the daily work of professionals on the ground.
"The imPACT review mission to Syria was an important opportunity to engage with the national health authorities, to make a comprehensive assessment, and provide recommendations to guide the national cancer control planning and investments based on a sustainable approach," said Dr Iman Shankiti, WHO Representative in Syria. "Together with our partners, WHO is working on strengthening the health system at the national level to help improve access to cancer treatments and enhance the implementation of interventions for the prevention, early diagnosis, and screening of patients with cancer."
The WHO Country Office and United Nations Population Fund (UNFPA) were also involved around possible support to Syria in implementing the imPACT Review recommendations.
