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A new report published by the United Nations High Commissioner for Refugees (UNHCR) has revealed that refugees fleeing Syria and other Middle East war zones are being forced to return home to obtain treatment for diseases such as cancer and diabetes.

Host countries where refugees are living can apply to the UNHCR for funding for treatments, but budget constraints mean that the criteria for funding have been tightened up.

The UN says that in previous conflicts, the health needs of refugees was focused on infectious diseases which were a threat to public health – such as tuberculosis (TB), which may become antibiotic-resistant.

Refugees living in poor housing – or living outside or in camps without adequate shelter or facilities – can develop infectious diseases very quickly. Many refugees are exposed to potentially deadly bacteria such as cholera as a result of contaminated water supplies.

Health can soon deteriorate without adequate nutrition and clean drinking water –
living on open ground or in camps with contaminated water supplies can also expose refugees to bacteria such as Salmonella, E.coli and Campylobacter, which are often passed via the faecal-oral route in contaminated food and water. In refugees who have poor nutrition and an impaired immune system and no access to antibiotics, gastrointestinal infections can be fatal.

However, refugees fleeing the recent Middle East conflicts are presenting with a range of different health conditions such as renal disease, hypertension and hypercholesterolemia (high cholesterol levels in the blood).

These conditions can be more expensive to treat – and require lifelong treatment such as dialysis or blood pressure medication, as well as involving special dietary needs.

Lead author of the UN report, Dr Paul Spiegel – the UNHCR’s chief medical expert from Harvard School of Public Health and Johns Hopkins and Emory Schools of Public Health – said that the UNHCR was having to make “very difficult decisions” about who should receive funding for medical care in their host country.

“We are seeing many more humanitarian emergencies in middle-income countries, where non-communicable diseases are more prevalent," said Dr Spiegel. “Not just cancer, but diabetes, renal disease, hypertension and hypercholesterolemia.”

The incidence of cancer among refugees is also increasing – in 2010-2012, around one-quarter of applications for healthcare funding from Iraqi and Syrian refugees living in Jordan involved cancer care. Around half the applications were declined by the UNHCR because of the high cost of treatment or because of a poor prognosis for the patient.

Amnesty International has said that many refugees are having to go without vital cancer treatment as a result of the cost – or risk incurring heavy debts to pay for treatment.

A Syrian refugee who was refused funding for brain cancer treatment and related vertigo said:

“I have no hope that the hospital will afford me radiotherapy. I am asking if they can simply afford me the medicines.”

Dr Spiegel says that the emphasis needs to be placed on cancer prevention for refugees, as well as more cancer screening in host countries for refugees. He also suggested that health insurance for refugees had been successful in Iran and the Democratic Republic of Congo.

Dr Spiegel’s specialties in humanitarian emergencies include HIV, epidemiological methods and health information systems.

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