Children with cancer in Beirut have nowhere to turn for treatment after a pair of explosions decimated four local hospitals on August 4, shattering infrastructure and wiping out caches of medical supplies.

The explosions were caused by the detonation of 2,750 tons of improperly stored ammonium nitrate, a chemical compound found in bombs and fertilizers. The blasts killed 220 people and wounded 6,000 others, making it one of Lebanon’s deadliest industrial disasters to date. Houses and office buildings burned, and several hospitals—including Saint George Hospital University Medical Center, the oldest health care facility in the nation—suffered such serious damage that they were forced to evacuate their patients, many of them children undergoing chemotherapy.

Now those children face multiple obstacles to continuing their care, Peter Noun, MD, the head of Saint George’s pediatric hematology and oncology department, told The New York Times on August 12. There are few vacancies at any of the remaining functional hospitals in Beirut.

“Our major concern now is where to continue the chemotherapy for our kids,” Noun explained. “Most of those in severe need went to another center to continue receiving their treatment, but the capacity there is full.”

Several field hospitals were constructed to accommodate the sudden influx of sick and injured people but not fast enough to prevent nearly half of Noun’s patients from missing one or more chemotherapy sessions.

It may take weeks to resume their treatment schedules, he said.

The COVID-19 pandemic, he added, poses yet another danger to newly displaced pediatric cancer patients. Owing to the immunosuppression that accompanies chemotherapy, people with cancer are particularly vulnerable to the novel coronavirus, which has infected almost 11,000 people and killed 113 in Lebanon since late February.

"Now not only have we lost our centers that dealt with [COVID-19], but we are waiting to see the impact of the blast because, you know, once we have that, we have funerals, people gathering again,” Eid Azar, MD, an infectious disease expert and the chief of staff at Saint George, told NPR on August 15. “Social distancing is impossible in situations like this.”

But even if all of Noun’s patients were admitted to another hospital tomorrow, they would not necessarily be able to restart treatment straightaway. Besides causing injuries, claiming lives and razing residential and commercial structures, the explosions destroyed a government-owned warehouse that housed a major stockpile of chemotherapy drugs.

“This is hugely concerning,” Rabih Said, MD, an oncologist at Saint George, told the Lancet, a medical journal, on August 13, “as there was already a shortage of cancer treatments due to Lebanon’s financial crisis and the cost of cancer drugs, making access to various expensive medications a challenge even before the blasts.”

For the pediatric cancer patients themselves, the damage inflicted by the explosions has been twofold. Forced to flee the hospitals where they have been receiving care to take refuge at home, on the streets or in temporary shelters, patients have been deprived of not only necessary and potentially lifesaving medical treatment but also of the close friendships they formed with other children on the ward.

Two such friends are 7-year-olds Marita Reaidy and Yuri Abou Mrad, who are among Noun’s 110 patients. Yuri and his father, Omar, were at Saint George when the explosions occurred; an audio recording made by Yuri’s father captures the atmosphere of confusion and terror created.

“Yuri, are you OK?” Omar Abou Mrad could be heard calling out in the recording, a frantic note in his voice.

He was answered with crying.

Both Yuri and Omar suffered minor injuries: Omar broke his hand and fractured a rib. But cuts and scratches and even breaks and fractures, according to Said, are only the tip of the iceberg of the explosions’ toll.

“The incident caused major emotional and psychological distress to our patients, many of whom were already vulnerable due to their cancer diagnosis and treatment,” he said. “We lost some of our colleagues in the explosions, while patients witnessed the traumatic death and serious injury of family members and others within the hospital.”

At least one parent, the father of a young girl who had just been diagnosed with cancer, Noun said, was mortally wounded.

“The trauma of having cancer so young and then to see your father, blood coming from his head, blood everywhere,” he said. “All she can say now is, ‘Baba will now see me from above, he will help me from heaven.’”

In the wake of the explosions, many families of children with cancer are considering leaving Lebanon for good.

“I love my country,” Gobran Pierre Tawk, the father of 3-year-old Saint George patient Amanda, told the Times. “But I should not have to worry about whether my children live or die here.”

The fallout from the explosions only adds to the turbulence that has consumed the Middle Eastern nation in recent months. Massive protests against perceived government corruption and incompetence culminated in the resignation of Prime Minister Saad Hariri in October 2019; the need to accommodate Syrian War refugees has pushed the economy to the breaking point; and COVID-19 patients have overwhelmed hospitals. Over the past year, the value of the Lebanese pound has fallen by 80%, forcing citizens into poverty or massive debt to pay for even basic medical care.

To read more about pediatric cancer, click here. And to learn about how chemotherapy can improve children’s chances of surviving cancer, click here and here.