Israel-Pakistan cooperation gives Afghan children a chance to survive cancer

Children in Afghanistan are being given a chance to survive a potentially deadly eye cancer through an extraordinary international effort led by an Israeli team working with medical centers in Pakistan.

Neither Pakistan nor Afghanistan has formal diplomatic relations with Israel.

Doctors from Sheba Medical Center, Israel's biggest hospital, teamed up with Pakistani medical centers to create the Retinoblastoma Silk Road Program, in which Afghan children diagnosed with the deadly cancer are transported across the border into Pakistan for lifesaving treatment.

What is Retinoblastoma?

Retinoblastoma is a rare malignant eye cancer most commonly found in young children up to age five. In high-income countries, where children with the disease can receive a variety of treatments, almost all survive, although many lose the affected eye. However, in low-income countries, survival rates are below 50%. The World Health Organization is aiming for a 60% global survival rate by 2030.

In Afghanistan, about 100 new cases of the cancer are diagnosed every year, but the country lacks the medical infrastructure to administer the necessary treatments.

Prof. Ido (Didi) Fabian, an expert in ocular tumor treatment at the Sheba Medical Center, spearheaded the effort to transport Afghan children with the disease into Pakistan for treatment. He had been conducting a study into the cancer in 2017 when he noticed a particularly strong need for help in Afghanistan.

However, after the Taliban took control of Afghanistan in 2021, it became much more difficult for Afghans to obtain permission to leave the country. Fabian felt he had to help, and saw an opportunity to transport children and their families into Pakistan to receive treatment.

“If you don’t treat it in an effective way, the child will die,” Fabian said. “Not only lose vision, not only lose an eye or both eyes, but the child will die. … They don’t have any treatment centers in Afghanistan.”

Fabian coordinated with doctors from several Pakistani medical centers but ended up working primarily with the Children’s Hospital in Lahore, Pakistan's second-largest city.

“For all those patients who are diagnosed with retinoblastoma in Afghanistan, unfortunately, local facilities are not available to offer treatment for these little kids. The treatment is readily available here in Pakistan,” said Dr. Huma Zafar, a pediatric oncologist with the Children’s Hospital.

Because of the hurdles Afghans face when traveling, Fabian requested and received funding from the Sheba Medical Center to organize three teams. The first is a Sheba team based in Israel that helps coordinate the program. The second team, in Afghanistan, is tasked with driving the children and their families to the capital, Kabul, to obtain special permission to enter Pakistan for medical treatment. That team then drives the families to the Pakistani border. At the border, on the Pakistani side, the third team receives them, delivers them to Lahore, and finds accommodation for them during the treatment period.

“Accommodation issues and other logistics—traveling and staying here for a long, long time—these were a few challenges with the families we were already facing,” Zafar said.

This Israeli hospital uses telemedicine to speed up treatment

To speed up evaluating patients, Sheba uses telemedicine. When a child arrives at a health center in Afghanistan, tests are run, and data is sent to the team in Israel for them to consider the best treatment.

“In the old days, you had to sit in the same room and go through imaging and all kinds of diagnostic tests,” Fabian said. “But it’s much easier today to do it online through all the applications you have—Zoom, Skype, doesn’t really matter.”

The virtual consultations help Sheba determine what the child is suffering from and whether helping the family cross into Pakistan is the best decision for the child. While the logistics are complex, the results can be life-altering.

“Politics is for politicians. We’re all medical professionals, so there are no borders in our world,” Fabian said. “What I see in front of me is children with retinoblastoma that cannot be treated, and the idea is to get them to a specialized treatment center and treated as soon as possible.”

Since the program began operating several months ago, the teams have transported about 10 patients. Zafar said the Children's Hospital had successfully treated several children, and one child had already been returned home to Afghanistan after a successful procedure. Both Zafar and Fabian said they hoped Sheba would continue to provide more funding so the program can grow and help many more children.

“I hope that they get enough funding, that they can make it to our center in time,” Zafar said. “If they diagnose a patient and there is a timely transfer to us, I think that’s the best time to provide them treatment and it is how we can save a life.”

Afghan treatment center is the 'main goal,' Israeli doctor says

But Zafar also said the ultimate hope was that the program would enable Afghans to establish a retinoblastoma treatment center of their own.

“Along with providing services to these patients, we will start working and train the local teams, so maybe after a few years they will be self-sufficient to treat their own patients,” Zafar said. “Fewer resources will be required if we actually make a center over there. … With the help of some funding, maybe that’s another option, that they can come to Pakistan and go back and start their own center.”

Fabian said he hoped the program could be a model for other nations to increase access for underserved communities to lifesaving medical procedures.