By the end of last year, nearly 120 million people around the world had been forced to flee their homes because of conflict and insecurity. According to the UNHCR, this figure includes 15.6 million people in the Middle East and North Africa. These people, displaced in their own countries or across national boundaries are only the tip of the iceberg – according to the World Bank about a quarter of the world’s two billion people now live in fragile, insecure and conflict-hit states. In addition, more than a third of the men, women and children who become refugees will develop or be at risk from cancer.
In August, the recognition that cancer is now a serious issue for refugees and host countries led to an unprecedented manifesto being published in The Lancet medical journal. Led by Dr Tedros Adhanom Ghebreyesus, the head of the World Health Organisation, it called on the international community to integrate cancer care into its wider humanitarian efforts.
This call was the culmination of a long campaign of advocacy and research that began in 2017 with the creation of the Research for Health in Conflict Partnership across the Mena region co-led by the King Hussein Cancer Centre in Jordan, Hacettepe University in Turkey, the American University of Beirut and King’s College London.
The complexity of cancer care for refugees and those in conflict settings means many of our standard models simply do not work. As Dr Mac Skelton and Dr Omar Dewachi from the American University of Iraq – Sulaimani have described, cancer patients affected by conflict have unique therapeutic geographies. They move within and across countries in search of care, something that makes delivering the essentials of treatment – surgery, radiotherapy and chemotherapy – very challenging.
The challenges of gender are even greater. Dr Debbie Mukherji from the Clemenceau Medical Centre in Dubai and her colleagues have shown how female refugees with breast cancer are particularly vulnerable to delays in diagnosis and treatment. Such delays are lethal. A meta-analysis published in the British Medical Journal four years ago showed that delaying breast cancer surgery for four weeks meant an additional 10 women out of 1,000 would die of their disease. This number rises to 31 additional women when surgery is delayed by three months. To give some context, most women who are refugees will experience surgery delays of between three and 12 months.
The reality at present is that many refugees will present with advanced disease, requiring good palliative care. However, as Prof Omar Shamieh and his colleagues at the King Hussein Cancer Centre have shown, this also remains poorly integrated into care for refugees.
Many of the current conflicts in Gaza, Lebanon, Sudan and Ukraine reflect the magnitude and complexity of delivering cancer care in conflict settings and to refugees. However, Ukraine has shown what can be achieved with political will and rapid action.
The reality at present is that many refugees will present with advanced disease, requiring good palliative care
Ukrainian refugees have been able to access high-quality cancer care across Europe through the EU’s Temporary Protection directives and a huge international effort has been put into providing continuing care within the country itself. However, as radiation oncologist Dr Horia Vulpe has shown with his work with Ukrainian refugees in Romania and Moldova, the pathways and therapeutic geographies for displaced people seeking care remain as complex as those seen in conflict-hit parts of the Middle East. This means we have little idea about the quality of care delivered or its outcomes. Better-organised cancer patient evacuations have been provided for children through the Supporting Action for Emergency Response, or Safer, programme run by St Jude’s Children’s Research hospital in the US. Some adults with complex blood cancers have also been included.
The case of Ukraine has also been instructive in just how sensitive modern equipment for treating cancer – imaging equipment and radiotherapy – is to power cuts. In all the conflicts mentioned the key lesson learnt has been that cancer treatment is rapidly degraded and destroyed by modern warfare. This does not require a direct hit on hospitals – shockwaves from explosions kilometres away are enough to disable high-tech medical equipment.
Ukraine has been an outlier for conflict and cancer. For much of the world, conflict has meant the destruction of infrastructure – such as in Gaza or Sudan – the enormous migration of refugees, and competing demands on resources and personnel for other more basic health requirements such as trauma, reproductive and public health.
The UN and the wider international NGO system does not currently have a way of adapting cancer care to these situations and serious gaps remain between what these patients and host countries need and what we know. The idea that cancer care is a luxury that can be addressed after the conflict has not yet been dispelled.
Re-priortising cancer care for refugees and conflict zones will require affordable evidence-based guidelines, better cancer intelligence and horizon scanning, the hardening of technologies to reduce vulnerabilities and new models of care. Countries must adapt their services and systems, and we will need a new political and economic model for cancer care in conflict to support those nations that host refugees.
One of the maxims of the great Muslim scholar and physician Ibn Sina – “In the end, I have learned that we have neither learned nor understood anything” – perhaps sums up best where we are in our understanding of how to deliver cancer care to refugees. Herculean efforts are still needed to properly examine, through research, the needs of refugees with cancer. Such efforts are needed to ensure that we develop the best practices and policies to support patients and countries that bear much of the burden not just across the Middle East, but the world.
Nepotism is the name of the game
Salman Khan’s father, Salim Khan, is one of Bollywood’s most legendary screenwriters. Through his partnership with co-writer Javed Akhtar, Salim is credited with having paved the path for the Indian film industry’s blockbuster format in the 1970s. Something his son now rules the roost of. More importantly, the Salim-Javed duo also created the persona of the “angry young man” for Bollywood megastar Amitabh Bachchan in the 1970s, reflecting the angst of the average Indian. In choosing to be the ordinary man’s “hero” as opposed to a thespian in new Bollywood, Salman Khan remains tightly linked to his father’s oeuvre. Thanks dad.
Martin Sabbagh profile
Job: CEO JCDecaux Middle East
In the role: Since January 2015
Lives: In the UAE
Background: M&A, investment banking
Studied: Corporate finance
Killing of Qassem Suleimani
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Green ambitions
- Trees: 1,500 to be planted, replacing 300 felled ones, with veteran oaks protected
- Lake: Brown's centrepiece to be cleaned of silt that makes it as shallow as 2.5cm
- Biodiversity: Bat cave to be added and habitats designed for kingfishers and little grebes
- Flood risk: Longer grass, deeper lake, restored ponds and absorbent paths all meant to siphon off water
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Killing of Qassem Suleimani
MOUNTAINHEAD REVIEW
Starring: Ramy Youssef, Steve Carell, Jason Schwartzman
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5 of the most-popular Airbnb locations in Dubai
Bobby Grudziecki, chief operating officer of Frank Porter, identifies the five most popular areas in Dubai for those looking to make the most out of their properties and the rates owners can secure:
• Dubai Marina
The Marina and Jumeirah Beach Residence are popular locations, says Mr Grudziecki, due to their closeness to the beach, restaurants and hotels.
Frank Porter’s average Airbnb rent:
One bedroom: Dh482 to Dh739
Two bedroom: Dh627 to Dh960
Three bedroom: Dh721 to Dh1,104
• Downtown
Within walking distance of the Dubai Mall, Burj Khalifa and the famous fountains, this location combines business and leisure. “Sure it’s for tourists,” says Mr Grudziecki. “Though Downtown [still caters to business people] because it’s close to Dubai International Financial Centre."
Frank Porter’s average Airbnb rent:
One bedroom: Dh497 to Dh772
Two bedroom: Dh646 to Dh1,003
Three bedroom: Dh743 to Dh1,154
• City Walk
The rising star of the Dubai property market, this area is lined with pristine sidewalks, boutiques and cafes and close to the new entertainment venue Coca Cola Arena. “Downtown and Marina are pretty much the same prices,” Mr Grudziecki says, “but City Walk is higher.”
Frank Porter’s average Airbnb rent:
One bedroom: Dh524 to Dh809
Two bedroom: Dh682 to Dh1,052
Three bedroom: Dh784 to Dh1,210
• Jumeirah Lake Towers
Dubai Marina’s little brother JLT resides on the other side of Sheikh Zayed road but is still close enough to beachside outlets and attractions. The big selling point for Airbnb renters, however, is that “it’s cheaper than Dubai Marina”, Mr Grudziecki says.
Frank Porter’s average Airbnb rent:
One bedroom: Dh422 to Dh629
Two bedroom: Dh549 to Dh818
Three bedroom: Dh631 to Dh941
• Palm Jumeirah
Palm Jumeirah's proximity to luxury resorts is attractive, especially for big families, says Mr Grudziecki, as Airbnb renters can secure competitive rates on one of the world’s most famous tourist destinations.
Frank Porter’s average Airbnb rent:
One bedroom: Dh503 to Dh770
Two bedroom: Dh654 to Dh1,002
Three bedroom: Dh752 to Dh1,152
The five pillars of Islam
1. Fasting
2. Prayer
3. Hajj
4. Shahada
5. Zakat
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The specs
Engine: 2-litre 4-cylinder and 3.6-litre 6-cylinder
Power: 220 and 280 horsepower
Torque: 350 and 360Nm
Transmission: eight-speed automatic
Price: from Dh136,521 VAT and Dh166,464 VAT
On sale: now
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Zayed Sustainability Prize
Where to donate in the UAE
The Emirates Charity Portal
You can donate to several registered charities through a “donation catalogue”. The use of the donation is quite specific, such as buying a fan for a poor family in Niger for Dh130.
The General Authority of Islamic Affairs & Endowments
The site has an e-donation service accepting debit card, credit card or e-Dirham, an electronic payment tool developed by the Ministry of Finance and First Abu Dhabi Bank.
Al Noor Special Needs Centre
You can donate online or order Smiles n’ Stuff products handcrafted by Al Noor students. The centre publishes a wish list of extras needed, starting at Dh500.
Beit Al Khair Society
Beit Al Khair Society has the motto “From – and to – the UAE,” with donations going towards the neediest in the country. Its website has a list of physical donation sites, but people can also contribute money by SMS, bank transfer and through the hotline 800-22554.
Dar Al Ber Society
Dar Al Ber Society, which has charity projects in 39 countries, accept cash payments, money transfers or SMS donations. Its donation hotline is 800-79.
Dubai Cares
Dubai Cares provides several options for individuals and companies to donate, including online, through banks, at retail outlets, via phone and by purchasing Dubai Cares branded merchandise. It is currently running a campaign called Bookings 2030, which allows people to help change the future of six underprivileged children and young people.
Emirates Airline Foundation
Those who travel on Emirates have undoubtedly seen the little donation envelopes in the seat pockets. But the foundation also accepts donations online and in the form of Skywards Miles. Donated miles are used to sponsor travel for doctors, surgeons, engineers and other professionals volunteering on humanitarian missions around the world.
Emirates Red Crescent
On the Emirates Red Crescent website you can choose between 35 different purposes for your donation, such as providing food for fasters, supporting debtors and contributing to a refugee women fund. It also has a list of bank accounts for each donation type.
Gulf for Good
Gulf for Good raises funds for partner charity projects through challenges, like climbing Kilimanjaro and cycling through Thailand. This year’s projects are in partnership with Street Child Nepal, Larchfield Kids, the Foundation for African Empowerment and SOS Children's Villages. Since 2001, the organisation has raised more than $3.5 million (Dh12.8m) in support of over 50 children’s charities.
Noor Dubai Foundation
Sheikh Mohammed bin Rashid Al Maktoum launched the Noor Dubai Foundation a decade ago with the aim of eliminating all forms of preventable blindness globally. You can donate Dh50 to support mobile eye camps by texting the word “Noor” to 4565 (Etisalat) or 4849 (du).
Mohammed bin Zayed Majlis
Mohammed bin Zayed Majlis
KILLING OF QASSEM SULEIMANI
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About Karol Nawrocki
• Supports military aid for Ukraine, unlike other eurosceptic leaders, but he will oppose its membership in western alliances.
• A nationalist, his campaign slogan was Poland First. "Let's help others, but let's take care of our own citizens first," he said on social media in April.
• Cultivates tough-guy image, posting videos of himself at shooting ranges and in boxing rings.
• Met Donald Trump at the White House and received his backing.
The bio
Who inspires you?
I am in awe of the remarkable women in the Arab region, both big and small, pushing boundaries and becoming role models for generations. Emily Nasrallah was a writer, journalist, teacher and women’s rights activist
How do you relax?
Yoga relaxes me and helps me relieve tension, especially now when we’re practically chained to laptops and desks. I enjoy learning more about music and the history of famous music bands and genres.
What is favourite book?
The Perks of Being a Wallflower - I think I've read it more than 7 times
What is your favourite Arabic film?
Hala2 Lawen (Translation: Where Do We Go Now?) by Nadine Labaki
What is favourite English film?
Mamma Mia
Best piece of advice to someone looking for a career at Google?
If you’re interested in a career at Google, deep dive into the different career paths and pinpoint the space you want to join. When you know your space, you’re likely to identify the skills you need to develop.
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MATCH INFO
Who: UAE v USA
What: first T20 international
When: Friday, 2pm
Where: ICC Academy in Dubai
MATCH INFO
Uefa Champions League quarter-final second leg:
Juventus 1 Ajax 2
Ajax advance 3-2 on aggregate
GRAN%20TURISMO
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PREMIER LEAGUE FIXTURES
Saturday (UAE kick-off times)
Watford v Leicester City (3.30pm)
Brighton v Arsenal (6pm)
West Ham v Wolves (8.30pm)
Bournemouth v Crystal Palace (10.45pm)
Sunday
Newcastle United v Sheffield United (5pm)
Aston Villa v Chelsea (7.15pm)
Everton v Liverpool (10pm)
Monday
Manchester City v Burnley (11pm)
Killing of Qassem Suleimani
Killing of Qassem Suleimani
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Directed by: Michael Fimognari
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Two stars
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match info
Athletic Bilbao 1 (Muniain 37')
Atletico Madrid 1 (Costa 39')
Man of the match Iker Muniain (Athletic Bilbao)
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