Cancer Patients Facing the Trinity of War, Displacement and Destitution on the River Nile

Sudan Events – Agencies

Zainab had no choice but to travel to the city of Shendi, in the River Nile State, to continue treatment in a special oncology center after the war that had been raging for months between the army and the Rapid Support Forces (RSF) prevented her from continuing her doses with which she was trying to defeat cancer. Zainab, who lives in Omdurman, did not have relatives in Shendi. However, she packed up her mind and headed there. She met one of the families by chance, so they decided to cover her treatment expenses and transport her to the center. The young woman shows childish joy as she tells “Journal” her story, then says with evident happiness, “Ummah (Nation) of Mohammad.” Okay, thank God”.
As for “Halima,” she began her treatment journey in Khartoum, from where she moved to Medani, and then arrived at Shendi Center recently. However, in her interview with “Journal,” she complained of her inability to afford the costs of the doses, amounting to 200 thousand pounds, of which her son’s friend succeeded in providing part of it.
In turn, Iman, who suffers from breast cancer, speaks to Journal about the great suffering she faces in receiving doses that are not available at the center and which her family arranges amid great difficulties in reaching the center due to her residence in an area located on the outskirts of Shendi.
The tragic stories of cancer patients whose lives and treatment stages were complicated by the war that broke out in Khartoum and moved to Wad Medani do not end, as the largest oncology treatment centers in Sudan are concentratedl in the two cities.p
Official statistics obtained by Journal reveal a significant increase in cancer rates in the River Nile State by up to 70% compared to the past five years, accompanied by a rise in death rates from the disease, which is knocking strongly on the doors of the northern states.
The River Nile, which has become the most preferred haven for cancer patients – after the RSF invasion of Gezira State – is surrounded by accumulated problems in the health sector, the details of which are affected by cancer patients.
These problems are most evident in those imposed by historical circumstances related to the poor public health situation in the country, in addition to the situation inside the state, which is currently receiving large numbers of war-displaced people.
The case of “Siddiq,” who has been suffering from cancer for 15 years, which he told “Journal,” embodies the miserable situation of patients who struggle to afford the cost of treatment and obtain housing to wait for the next doses. During his long treatment journey, Siddiq faced complications that worsened with the outbreak of fighting in Khartoum. Then he entered a journey of double suffering after the invasion of Medani by RSF which he resorted to to continue his treatment, which was interrupted.
Siddiq is now seeking to complete his treatment at the Shendi Center.
Increasing cases:
Official statistics issued by the Statistics Unit at the Oncology Center in Shendi (governmental) and obtained by Journal show that 1,405 cancer cases were recorded after the war that broke out in mid-April.
The statistics show that 325 cases were recorded in 2019, and 312 in 2020, jumping to 484 in 2021, and 521 in 2022, but medical explanations from workers at the center believe that the increase is due to the arrival of cases from Khartoum after the war.
Statistics from the Statistics Department also showed a catastrophic increase in death rates by 153 cases during the past year alone, while about 70 cases were recorded annually in the state until 2022.
There has been a clear increase in the number of infections received since the outbreak of the war, according to the analysis of the Statistics Department, but its main reason is the movement of patients from Khartoum and other cities to the center.

Medical sources and specialists that Journell spoke to attribute the rise in cancer death rates recently, specifically during the past year, to the lack of a number of doses and their high costs, in addition to the lack of specialists.

Patients and their families are often forced to obtain doses from commercial pharmacies at very high prices, as they are not available at the Shendi Oncology Center.
Pharmacist Dr. confirms: Nihal Al-Tayeb, in an interview with Journal: Cancer treatment centers, medicines, and doses are shrinking due to the expansion of the war to larger areas.
The Director of the Oncology Center, Dr. Awad Al-Tayeb, revealed in a limited statement, according to the Journal, that 721 cases had been recorded until the month of May 2023, confirming that 266 cases had been recorded during the month of May alone, to reach 1,380 by the end of the year 2023.
The only center in Shendi includes departments of chemotherapy, oncology pharmacy, and radiation pharmacy with a capacity of 70 beds, and an isolation room consisting of 4 beds for thyroid cancer patients.
Breast cancer cases are the largest among cancer cases in the state, with 450 cases recorded during the year 2023, while the other types were 37 colon cancer cases, 88 ovarian cancer cases, 83 uterine cancer cases, 25 lung cancer cases, 23 pharyngeal cancer cases, and 68 with leukemia.
Awad noted that work at the center continues despite the increase in cases of hesitation due to the breakdown of the radiation machine in the city, and the massive influx of patients to the city of Shendi.
High costs:
The director of the oncology center talks about the high cost of chemotherapy, as some patients are forced to buy it through intermediaries who bring it illegally at great costs.
He stressed that the center needs to accommodate more cadres and improve working conditions and financial management, and that the center is under pressure due to the increase in hesitation after the war.
The director points out the disruption of the Nuclear Medicine Department, which is specialized in providing treatment for thyroid patients, which led to a shortage of doses of radioactive iodine that were stopped due to not being imported from abroad because they must be shipped in safe operations via specific airline companies that are currently suspended from operating in Sudan due to the war.
The center faces problems due to the lack of specialists and its lack of consultants, as only five specialists work who are not permanently present, in addition to that, the center faces a problem in the ability to provide doses.
A glimmer of hope:
Despite the harsh conditions faced by patients and the center, its visitors live in hope of catching up with those who have recovered, as their number has exceeded eighty cases who were able to challenge and defeat the dangerous disease despite the weak logistical capabilities of the center.
The head of the medical physics department at the center, Dr. Al-Sadiq Azraq, told “Journal” that the frequency of visits to the radioactive iodine department reaches 200 patients on the waiting list, which represents pressure on the center, which treats 4 patients every two weeks. Azraq reveals that negotiations are currently taking place to exclude some airline companies from carrying out flights to import iodine from abroad.
Danger of mining and fertilizers:
Dr. Al-Sadiq Al-Jilani Mohammad Abdul-Qadir, a consultant in oncology, hematology and bone marrow transplantation and head of the Research Committee of the Sudanese Medical Specialties Council, believes that it is difficult to have accurate statistics for diseases in the state at the present time with the arrival of expatriates there.
In an interview with Journal, Al-Jilani takes into account a group of causes that may be the cause of cancer, including waste from mining factories, especially traditional mining, as a result of the use of high-risk chemicals, which quickly cause diseases such as heart attacks and allergies, which develop carcinogenic over time.
He continued his speech by stressing that the irrational use of fertilizers throughout the country, and in particular in the River Nile State, can cause diseases, while he pointed out that the method of agriculture has changed from the previous method regarding the use of fertilizer and existing techniques, even if they are legitimate, saying: “The test comes in In the way they are used in an unguided manner, while the process of accelerating the production of some crops, tomatoes and watermelons, has an impact on humans as a result of excessive use of fertilizers.”
The specialist Al-Jilani called for other factors related to the environment, lack of exercise to stimulate a person’s internal energy, and people’s dependence in recent years on necessities or comfortable things that cause obesity, weight gain, and insulin deficiency, which are factors that lead to cancers.
Al-Jilani confirmed that the high rates of diabetes will increase the incidence of cancer in the future.
Al-Jilani noted that another factor linked to cancer is lack of awareness, considering that this is a very big problem.
He said that the incidence of breast cancer in Sudan is higher than international rates despite the different causes of infection, noting the lack of a culture of periodic examination, which must be taught to students in schools and universities to learn how to conduct periodic and self-examination.
He warned that 4-5 patients always attend treatment, three of whom are in a late condition, while 10 percent of breast diseases are hereditary, warning that the use of tobacco and hookah, especially among women, leads to infections.
He concluded: “In addition to the unsafe use of cosmetics of unknown origin.”
Dr. Al-Jilani revealed that the city of Atbara faces a problem related to the detection devices, which are located in Merowe and Shendi, as the city does not have a government center or detection devices, which also places additional burdens on people in the cities of Berber and Al-Damar to move between the latter two cities.
He continued: “There are some doses available in Shendi, but people in Atbara and elsewhere are forced to go there, in addition to the high costs of MRI and radiation, which cost about 4 million pounds.”
Psychological effect:
Cancer has a strong psychological impact on the patient, according to psychologist Fatima Al-Sir. She confirmed to Journal that women are more affected by the disease than men due to the nature of women.
Dr. Fatima supports setting psychological guidelines for the patient before the examination in order to alleviate psychological disorders.
Fatima revealed the psychological effects of cancer patients, which include psychological pressure, depression, hysterical attacks, convulsions, fainting, panic attacks, and psychological shock.
Mining is the first accused
A study prepared by master’s students at Nile Valley University in 2018 showed indications that the blood of people in areas adjacent to mining areas contains large quantities of mercury, as confirmed by the official of the Supreme Council for the Environment in the state, who specializes in chemistry, Dr. Essam Mohamed Zein.
Zein, who also cooperates with the Ministry of Health in the River Nile State, said in an interview with “Journal” that the council is concerned with the early detection of diseases and injuries caused by mining pollutants through analysis of the miners and the future of the areas around it.
There is another aspect that he pointed out, related to the study, which is the search for comprehensive treatment methods and treatments to reduce this risk.
Zein stressed that mining diseases are mainly caused by hazardous materials used such as mercury and sulfur, pointing out that the Supreme Council for the Environment is taking diligent steps to investigate the direct and indirect causes of mining industry waste, which causes dangerous diseases such as cancer, kidney failure, and other diseases that have a direct impact on humans.
Zein predicted the occurrence of environmental disasters due to what he described as the expansion of “dirty” industries such as mining and cement and the large, dangerous wastes they throw into the environment, such as gases and polluting dust.
Environmental activists in the state, who requested that their names not to be disclosed, confirmed in a statement to “Journal” that the central and state authorities concealed dangerous studies related to mining in the state and its effects on human health, soil, and animals.
There is a deficiency in restricting patients or those who are hesitant for examination to the official offices of the relevant authorities within the Ministry, according to what was shown by “Journal” follow-ups.
A study reviewed by Journal conducted at the Faculty of Medicine at Atbara University under the title (The Most Used Chemical Drugs to Treat Cancerous Tumors) at the Nuclear Treatment Center in Shendi locality, prepared by six students, indicated that Sudan ranks sixth in terms of cancer deaths in Africa.
According to a study by Dr. Malath Bakri, at the University of Khartoum, entitled “Assessing the subjective quality of life among patients with colorectal cancer” in 2023, it was stated that a study conducted in 2016 on the spread of cancer among the states of Sudan had the northern state with the highest prevalence rate, while the River Nile state had the highest prevalence rate. It ranked second, and Khartoum State ranked third.
In her research, she pointed out several studies conducted in the River Nile State that showed an increase in the number of people with cancer, due to an increase in the rate of air and soil pollution.