Letter to Editor

Authors

• Danial Fazilatpanah ¹
• Ali Shabestani Monfared ²
• GholamReza Ataee ¹
• Seyed Alireza Javadinia ³

¹ Assistanat Professor, Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

² Professor ، Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran

³ Assistant Professor, Non-Communicable Diseases Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.

Abstract

Dear Editor,
 
Armed conflicts represent a profound public health emergency, extending beyond immediate casualties to systematically dismantle healthcare infrastructure and disrupt care continuity for patients with chronic diseases. The 12-day military offense against Iran, commencing on June 13, 2025 (23 Khordad, 1404), precipitated a severe crisis within the nation's health system. Among the most vulnerable populations are cancer patients, whose survival is contingent upon uninterrupted access to advanced, time-sensitive therapies.
 
Local reports and human rights organizations documented direct and indirect targeting of medical facilities, including Shahid Motahari Burn Hospital and Labbafinezhad Hospital in Tehran, Iran. The attacks affected over 80 cities and 90 counties, triggering massive internal displacement, crippling patient referral systems, and creating dangerous concentrations of patient populations in specific provinces. Consequently, countless cancer patients experienced critical delays, interruptions, or complete cessation of life-saving treatments, a known factor for increasing cancer-specific mortality across numerous malignancies (1).
This situation mirrors findings from other conflict zones. In Ukraine, the destruction of oncology centers and disruption of supply chains for chemotherapeutic agents and radionuclides led to a dire deterioration in cancer outcomes (2). Similarly, conflicts in Iraq and Afghanistan resulted in the collapse of screening programs and a significant decline in early-stage cancer diagnosis, severely impacting survival rates (3).
 
Pre-existing economic sanctions have also severely constrained Iran's access to essential chemotherapeutic drugs, radiopharmaceuticals, and spare parts for radiotherapy equipment. The recent conflict compounded this by introducing cyber-attacks that disabled electronic health records (EHR) and e-prescribing systems, further paralyzing clinical operations. Furthermore, the psychological trauma of war, including post-traumatic stress disorder (PTSD), anxiety, and depression, poses a significant barrier to treatment adherence and efficacy in cancer patients (4).
 
Despite these challenges, Iranian healthcare workers demonstrated remarkable resilience in sustaining service delivery. However, this crisis underscores the urgent need for robust, pre-emptive measures to fortify healthcare systems against future shocks. We propose the following essential actions:

Establishment of strategic stockpiles of essential oncology drugs (chemotherapy, supportive care agents, and vaccines) in secure, geographically dispersed locations.
Investment in building hardened, conflict-resistant oncology and radiotherapy centers.
Decentralization and redistribution of cancer care resources based on population density and projected internal migration patterns.
Implementation of fail-safe, low-technology backup systems (e.g., paper-based records and prescriptions) for continuity of care during digital outages.
Formalization of inter-provincial mutual aid agreements for emergency patient transfer and support.
Integration of crisis-oriented psychiatric teams into oncology care pathways to address conflict-induced PTSD and anxiety.

 
The 12-day war exposed a critical vulnerability in Iran's cancer care continuum. We call upon the international scientific community, humanitarian organizations, and global health leaders to advocate for the protection of healthcare infrastructure and the defenseless patients it serves. The targeting of medical facilities constitutes a gross violation of medical ethics and international humanitarian 

Keywords

• War
• cancer
• chemotherapy
• radiotherapy

Main Subjects

• Health System