5,000 support calls in 40 days: keeping childhood cancer care running in Iran

One night this spring, the walls of the paediatric cancer hospital of MAHAK, the Mahak Society to Support Children with Cancer, in northern Tehran shook as bombing struck close to the site. Children and their parents were on the wards. Most of the families who travel to Tehran for treatment from elsewhere in the country could not reach the city at all.

For organisations providing cancer care, conflict and instability create challenges that extend well beyond the hospital itself. Medicines must remain available, families must be able to travel for treatment, and specialist teams must find ways to maintain care when normal services are disrupted.

MAHAK, the Mahak Society to Support Children with Cancer is a non-governmental and non-profit organisation in Tehran and UICC member organisation dedicated to helping Iranian children with cancer. It employs around 800 people across 31 departments, and runs both a treatment hospital and a research centre. Mahak already had to manage the consequences of the previous conflict the year before. That experience shaped how it handled the latest one.

“We believe that nothing should be stopped, even under a war situation,” says Dr Hadieh Eslampanah, Director of PR, International Development and Communications at MAHAK. “It is our mission and commitment to childhood cancer and cancer control.”

A committee met daily to work through what the hospital would do if the systems it depends on stopped working. “When the country's electricity and fuel infrastructure was publicly threatened, MAHAK’s CEO, Dr Arasb Ahmadian, told managers to assume the loss of all power within 72 hours,” says Dr Eslampanah. “An alternative electricity supply had already been installed, but it would run for ten days at most.”

The committee also worked through what would happen if internet and telephone lines were cut, and how transport would be arranged if roads became unusable.

“We should be ready. Maybe the next 72 hours we lose all of our electricity, and at that time, how do we want to manage our young patients on chemotherapy in the hospital? We planned for all of those events,” says Eslampanah, recalling the instruction.

The most consequential decision was to stop bringing children to Tehran. MAHAK maintains working relationships with hospitals in 25 provinces, and used them to move care closer to where families already were. 

“We told families to continue their treatment in their own city, because their city in the north of Iran was safe at that time," says Dr Eslampanah. “We sent all the medical documents to healthcare professionals there. Everyone was still supported by MAHAK, but in a different way.

Over the same 40 days, MAHAK's supportive services department delivered more than 5,000 online psychosocial support sessions to families who could not travel. Eslampanah notes that the psychological effects extended well beyond the children in treatment.

“We had to address a lot of psychosocial problems and challenges, not only for our young patients, for their families and even for the personnel,” she says. “When it comes to the worst situation, it definitely influences the good and effective procedure of treatment.”

Sanctions, inflation, and the price of medicines

Dr Eslampanah is clear that the persistent constraint on childhood cancer care in Iran is not clinical. “On treatment protocols, my country is in a good situation, because there is enough knowledge and a great deal of practical experience," she says, pointing to hospitals and research centres equipped with diagnostic instruments and test kits. "There is no significant gap between detection and delivering the treatment protocols and services.”

Iran has achieved a high rate of childhood cancer survival nationwide analysis of Iran’s cancer registry published in BMC Pediatrics found overall five-year survival for childhood cancers of 81% for the period 2010 to 2014, up from 70% in the preceding five years, and now comparable to most high-income countries. 

“We have achieved a high rate of survival despite the challenges we face in the Middle East. These challenges have taught us how to build effective pathways in complex circumstances, overcome barriers, and turn challenges into opportunities for growth and greater impact,” Dr Eslampanah explains. 

“Sanctions restrict what MAHAK can buy and what it can receive,” she continues. “Hospital pharmacists and clinicians have had to reorder their protocols, substituting originator products with medicines manufactured by approved companies elsewhere in the region, which are also less expensive. Where those routes close, we look for alternative supply through neighbouring countries.”

Donations of medicines are no simpler. “Of course I would prefer to have the best original, high-quality medicines that are available on the market in the US and Europe," says Eslampanah. "But because of sanctions, we cannot access many of them. A lot of our supporters want to send them to us, but there is no way for them to get past the borders.”

Cost compounds the problem. “Because of the high inflation in Iran, the price of medicine is increasing fast," she says. “That puts a lot of pressure on families and on the young patients, and on us, because we are trying to cover all of this cost.”

For six months, a member of Dr Eslampanah’s team has been preparing an application to the Global Platform for Access to Childhood Cancer Medicines, the WHO and St Jude Children’s Research Hospital initiative that supplies quality-assured childhood cancer medicines at no cost. MAHAK considers itself eligible, but the platform currently works with 12 participating countries and demand exceeds what it can absorb. At a Childhood Cancer International Asia conference in Mongolia, Eslampanah found that several countries with more acute shortages were further ahead in the process.

Continuing to build international partnerships and advanced treatment options

Alongside efforts to secure access to medicines, MAHAK has continued work it began before the conflicts to expand specialist treatment options for children with cancer.

Around 18 months ago, MAHAK's transplantation department began building an international twinning programme focused on stem cell transplantation, cell therapies and immunotherapy, with the aim of strengthening clinical expertise and expanding treatment options available in Iran.

“We have very distinguished specialists in this field, but at the same time we want to benefit from international knowledge and experience sharing,” says Dr Eslampanah. “Personalised medicine, gene therapy, cell therapy, and immunotherapy are developing very quickly, and we want our teams to remain connected to those advances.”

While conventional treatments such as chemotherapy and radiotherapy remain the backbone of paediatric cancer care, Dr Eslampanah explains, stem cell transplantation and immunotherapy can offer additional options for some children with difficult-to-treat cancers or disease that has returned after initial treatment. 

The programme brings together clinicians and researchers working across treatment, research and hospital management. MAHAK is already collaborating with institutions in the United Kingdom, Sweden, and France, and is exploring similar partnerships elsewhere in Asia. 

“The emphasis is less on importing technology and more on building the expertise, protocols, and clinical infrastructure needed to support increasingly specialised care,” Dr Eslampanah says. “Our goal is not only to develop new facilities, but also to strengthen the knowledge behind them – the protocols, the training, and the systems required to deliver these treatments safely and effectively.”

The organisation is also preparing awareness campaigns for Childhood Cancer Awareness Month this September, on the basis that earlier diagnosis depends on what families recognise. “In many cases we have found that parents ignore the signs of cancer, and that will certainly affect survival rates and cancer control,” she says. Air pollution in Tehran, particularly in winter, is a further concern, both as a risk factor and as a complication during and after treatment.

These campaigns are part of a wider effort to ensure that the ongoing crisis and uncertainty do not undermine the progress they are making in childhood cancer care.

“We don't know whether the war will happen again or not," she says. "But we are ready for it. We have been thinking about how we would manage our young patients and their families if something happens again.”