When a slow, devastating illness collides with the speed and chaos of disaster, the consequences can be dire. Cancer demands constancy—structured protocols, timed treatments, uninterrupted care. Disasters, on the other hand, dismantle. They disrupt and displace, often without warning. As floods rise and conflicts erupt, what becomes of the cancer patient whose chemotherapy is scheduled for tomorrow? Or the child awaiting biopsy results? These questions are no longer hypothetical—they are urgent. We live in a world in which climate-induced events, pandemics, and political instability are increasingly common, and yet cancer care systems remain woefully unprepared (Meara et al., 2015). More alarmingly, disaster preparedness plans globally tend to focus heavily on trauma and communicable diseases, leaving chronic illnesses like cancer out of the picture (Spiegel et al., 2018). This gap in planning and policy is not just an oversight—it is a failure that costs lives. Cancer does not wait. It does not decelerate in times of emergency, and thus our response systems must be re-engineered to reflect that urgency.
Throughout history, the story is tragically familiar. In West Africa during the 2014–2016 Ebola outbreak, already-strained healthcare systems collapsed under the weight of contagion. Oncology units shuttered. Diagnostics were suspended. It is estimated that cancer diagnoses dropped by more than half—not because the disease disappeared, but because access to care did (Lal et al., 2020). During the COVID-19 pandemic, the narrative repeated. Nearly 1.5 million cancer surgeries were postponed or canceled globally in the first phase alone, creating a backlog that continues to impact patients today (COVIDSurg Collaborative, 2020). The disruptions extended beyond surgical delays: patients missed chemotherapy cycles, radiotherapy sessions were halted, and research trials were suspended. Even long after the initial waves subsided, patients continued to face delays due to workforce shortages, overwhelmed hospitals, and financial strain. In low-income countries, the effects were particularly acute—many patients never returned to care at all (Hanna et al., 2020). For diseases where timing can determine survival, such delays are nothing short of devastating.
Not all disasters make global headlines. In Haiti, the slow erosion of healthcare capacity due to political instability has silently decimated oncology care. The country has only one radiotherapy machine, often out of service due to power outages or mechanical failure (IAEA, 2021). Few outside the region know that patients are sometimes forced to travel to the Dominican Republic—an international journey that requires money, paperwork, and time most do not have. In Ukraine, following the 2022 invasion, radiation oncology centers were damaged by shelling, not as deliberate attacks on health services, but as collateral in broader infrastructure strikes. Linear accelerators were damaged, and hospitals had to triage power between radiotherapy equipment and ventilators. These cascading failures don’t just interrupt care—they erase it.
Why is cancer care so fragile in the face of crisis? Unlike many medical disciplines, oncology depends on a convoluted web of components: technology, personnel, pharmaceuticals, and precise timing. Sophisticated machines like PET, MRI, and CT scanners are fixed and highly location-bound. Radiation therapy requires specialized shielding and uninterrupted electricity. Chemotherapy drugs often demand cold-chain logistics and exact calibration. When disasters strike—whether they be cyclones or armed conflict—these systems do not adapt; they fracture (Beddoe, 2019). Health workers are reassigned to trauma units. Oncology wings are converted into ICUs. Supply chains buckle under logistical bottlenecks. Medications expire in warm storage rooms. The loss of a single link can compromise the entire therapeutic chain.
Additionally, health information systems often crash, wiping out records, imaging histories, and continuity plans. Paper records, still common in many parts of the world, are destroyed by flooding or lost in evacuation. Digital systems, where they exist, may lack redundancy or cloud backup (Chan et al., 2022). In such fragile architectures, resilience isn’t just a buzzword—it is a literal matter of life and death.
The price for this failure is rarely paid by the wealthy or politically protected. Rather, the toll is borne by those already standing at society’s margins. It is the refugee with no address, no insurance, and no voting rights. The woman in a remote village with cervical cancer whose screening was never completed. The child born into the shadow of war, whose swollen lymph nodes go ignored until too late. In Syria, Sudan, Gaza, and beyond, cancer becomes the silent casualty of humanitarian disaster (El Saghir et al., 2018). These patients are not just neglected; they are erased from the narrative.
In Lebanon, where millions of Syrian refugees reside, a cancer diagnosis for a non-citizen can be a de facto death sentence due to high costs and lack of access to specialized care (Saab et al., 2019). In Yemen, where humanitarian funding has been slashed, cancer patients are reportedly turning to unproven herbal remedies in desperation. These lives are marginalized not only by disaster but by the systems built to respond to disaster. The harm is not accidental—it is structural.
Less discussed are the internal migrants—those displaced not across borders, but within their own country. After floods in Pakistan displaced over 30 million people in 2022, many oncology patients were unable to access urban hospitals.
Temporary shelters set up for the displaced did not include oncology services. In the United States, Hurricane Maria’s destruction of Puerto Rico’s infrastructure led to cancer patients being airlifted to mainland hospitals—but only those with Medicaid portability or private insurance could access care. Disaster response often assumes temporary needs. But cancer care is not temporary. It cannot be paused and resumed without consequence.
Can we truly plan for the unpredictable? Can we outpace disaster with foresight? The answer, increasingly, is yes. The key lies in data-driven prediction. Artificial intelligence and climate modeling can forecast hotspots of disaster exposure, layered with population health maps to anticipate where cancer care will likely be disrupted. Rwanda, for example, has implemented a national telemedicine network that connects rural health centers with oncology specialists, ensuring continuity of consultation even when physical access is compromised. These are not theoretical innovations—they are operational strategies that can be scaled globally. Predictive algorithms can also identify patients most at risk of losing care continuity, enabling pre-disaster outreach and medication stockpiling. This is anticipatory medicine—a shift from treating the aftermath to engineering the future.
Decentralization is another pillar of resilience. Cancer care must move beyond capital cities and elite hospitals. In India, the expansion of mobile cancer screening and treatment units has proven effective for reaching underserved populations (Pramesh et al., 2014). In Kenya, Project ECHO connects rural clinicians with top oncology experts in real time, democratizing expertise and shrinking the urban-rural divide (Strother et al., 2021). In the Philippines, emergency response plans now incorporate considerations for cancer patients, including medication supply reserves. These models not only deliver care—they redefine what care infrastructure looks like.
Technology can serve as a lifeboat when all else fails. In Rwanda, Zipline drones ferry medical supplies including cancer medications across impassable terrain. In Bangladesh, solar-powered healthcare facilities ensure that diagnostics and treatments can continue even after grid failures during cyclones. Electronic health records with cloud backups ensure that a displaced patient’s oncology file can travel with them, digitally intact, across regions (Guleria & Dua, 2021). These innovations aren’t luxuries; they are future standards. Health systems must invest not just in gadgets but in technology ecosystems that are climate-resilient, secure, and scalable.
For all this progress, the most urgent questions are moral. Who is accountable when patients fall through the cracks? When pharmaceutical embargoes block cancer treatments in war-torn nations, who intervenes? When governments prioritize military spending over oncology units, who is held responsible? (UNDRR, 2015). These are not just questions of policy—they are tests of our ethical architecture. Global health law must evolve to classify cancer care as a protected service during crisis, much like food and shelter. This includes safeguarding cancer infrastructure under international humanitarian law and establishing international corridors for drug delivery in conflict zones (Lancet Commission on Global Access to Pain Control and Palliative Care, 2018; Singh et al., 2020).
The WHO’s Global Initiative for Childhood Cancer shows what coordinated international action can achieve. But such initiatives must expand in both scope and binding authority. Cancer must be built into every emergency preparedness and response framework. Countries must be incentivized—perhaps even mandated—through funding structures and international law to protect cancer services during disaster. Civil society must demand this from their leaders. Humanitarian response teams must include oncologists and palliative care specialists. Cancer cannot be an afterthought.
This is not just about survival—it is about justice. Continuity of cancer care in the face of disaster is a barometer of our civilization. It is a reflection of how we value life, dignity, and equity. The crises ahead—climate displacement, antimicrobial resistance, economic collapse—will test us even more deeply. If we are not ready, we will repeat the same pattern of delay, death, and denial. But if we choose to be ready—if we design for disruption, plan for pain, and invest in resilient care—we can ensure that no diagnosis becomes a death sentence simply because the ground shook, the skies opened, or the sirens wailed. The next disaster is coming. The question is not if—but whether we will meet it with courage or complacency.
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