In high-income countries, at least 75–80% of children with cancer, particularly acute lymphoblastic leukaemia (ALL), can be cured with intensive chemotherapy, administered by fully trained inter-disciplinary teams in specialized hospital units. Cooperation and collaboration at both national and international levels has helped to achieve this success. The costs of such intensive therapy have been calculated at between 100,000–200,000 USD in high income countries (HICs) where health services are free at the point of care, paid by the public sector and /or insurance schemes which cover most but not necessarily all of such costs. In sharp contrast, survival in countries impacted by conflict ranges between 10 and 30%. Delays in diagnosis due to migration (refugees), internal displacement, the destruction of facilities, high levels of treatment refusal/abandonment by family’s due to impoverishment, or denial of access by conflict actors, all contribute to this decreased survival. Each of these factors and the reasons for them need to be researched and strategies developed to overcome them to drastically improve survival rates of children with cancer. Building on the international work of NGOs the WHO recently (29-30th Sept 2018) brought together organisations, such as St. Jude’s, World Child Cancer, SIOP and R4HC, to create a worldwide initiative to improve outcomes in childhood cancer in the most vulnerable countries. A number of R4HC and MENA regional leaders attended this meeting – Richard Sullivan (Global childhood cancer policy), Tezer Kutluk (childhood cancer lead for R4HC and former President of UICC), Raya Saab (American University of Beirut), Iyad Sultan (King Hussein Cancer Centre), Khaled Ghanem (BASMA Paediatric Unit, Damascus) and plans were developed to help build both care and research capacity. Crucially in childhood cancers building research capacity has been shown to be directly linked to better outcomes. R4HC is working with WHO and regional partners to build a needs assessment around both curative and palliative research for children with cancer building on our previous global analysis published in the Lancet Oncology and a new Commission on global childhood cancers which will be published in 2019.

Professor Richard Sullivan