Adnkronos (Adnkronos) – "The numbers reveal a reality that's hard to ignore. In 2024, 123 million people were forced to flee their homes due to the 65 ongoing conflicts around the world. For those experiencing war, however, it doesn't just mean losing their homes and safety: it often also means losing access to healthcare, prevention, and treatment." This is how Rossana Berardi, president-elect of AIOM and director of the Oncology Clinic at the Polytechnic University of Marche-AOU delle Marche, spoke to Adnkronos Salute about the AIOM (Italian Association of Medical Oncology) Ethics Days, which conclude today in Erice, in the province of Trapani. This year, the Days are dedicated to "War, Global Health, and Oncology."
“These numbers speak for themselves,” explains Berardi, “because leaving one's home often means abandoning the opportunity to seek treatment, participate in prevention and screening programs, and receive diagnoses and treatments for oncological diseases.”
War can affect health directly, through the destruction of healthcare facilities, but also indirectly and over a longer period of time. In Ukraine, Berardi recalls, "nearly 3.000 healthcare facilities and infrastructures have been affected. In Syria, however, among approximately 5.000 patients with lung cancer, 70-80% were diagnosed at an advanced stage."
The issue is particularly relevant in oncology because the timing of a tumor's diagnosis can decisively influence the chances of treatment. "We don't yet have sufficient epidemiological data to establish with certainty the overall impact of the war on healthcare systems and people's lives," emphasizes the president-elect of AIOM, "but it is certain that the stage of the disease is one of the main prognostic factors.
Diagnosing cancer at a more advanced stage inevitably reduces the chances of recovery and significantly increases the risk of death.”
Not just the immediate consequences. The effects of war on health, according to Berardi, don't end with the emergencies and injuries caused by combat. They can linger for years, compromising prevention, diagnosis, and continuity of care. "These data have led us to reflect not only on the immediate impact of war and the devastation it causes," says the oncologist, "but also on its long-term consequences. Conflict inevitably leads to a lack of access to care, prevention, and the possibility of recovering from illnesses." Added to this are the environmental consequences. "If we look at the problem from a One Health perspective, it can have enormous repercussions on the pollution of air, soil, water, and groundwater," she adds.
The One Health concept considers human health closely linked to that of animals and the environment. "In this context, war can leave a mark that extends well beyond the duration of the fighting, through environmental contamination and the compromise of healthcare systems." And on the issue of "interrupted care," Berardi is clear: "The impact on health is already visible during conflict." He recalls the case of a Ukrainian cancer patient who arrived at his clinic in Ancona at the beginning of the war. "The problem was precisely access to care: the military hospital where he was being treated had been bombed, and it was possible to transport him to Ancona via a humanitarian corridor. This intervention allowed that patient to continue his treatment, but it cannot be a solution for everyone."
"This may have happened for some patients, but inevitably not for all," Berardi observes. "It is precisely this inequality in access to care that represents one of the ethical issues raised during the Ethics Days. And regarding the risk of a long-term health impact, Berardi emphasizes, "for now, it is not possible to precisely quantify the extent to which current conflicts will impact populations' health in the years to come. But some mechanisms are already known: when prevention, screening, diagnosis, and treatment are interrupted or delayed, the risk increases that diseases will be detected when they are most difficult to treat. We don't have the information to draw broader conclusions, but it certainly isn't just an impact on future health: it also affects current health."
The Ethics Days thus provide a reflection that concerns not only medicine, but also the human and social consequences of conflict. When a war destroys a hospital, not only is healthcare interrupted: prevention, diagnosis, and treatment programs built over years can be disrupted, with consequences that can persist long after the fighting ends. Among the reflections that emerged during the meeting, Berardi finally recalled a phrase related to the risk of nuclear escalation: "Don't push that button because, if you're the first to push the button, you'll be the second to die," he concluded.
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