Underutilisation of rehabilitation for children with cancer in Gaza: the experience of the non-governmental organisation Children Not Numbers.

Introduction: The conflict in Gaza has severely affected children there, as well as healthcare, rehabilitation and paediatric cancer services. There is limited literature on how conflict impacts rehabilitation and physical activity for children with cancer, and our report explores the underutilisation of rehabilitation for children with cancer in Gaza. Context: Each year, 210 children are diagnosed with cancer in Gaza. Due to inadequate healthcare facilities, many cancer patients frequently sought care outside the territory. Due to Israeli military attacks, Gaza's only paediatric hospital and its paediatric cancer department were forced to close. Most rehabilitation facilities and vital infrastructure in Gaza have been damaged or destroyed, with many of the rehabilitation workforce displaced, injured, or killed. Programme: The non-governmental organisation Children Not Numbers was established in response to the conflict and provides health services, including rehabilitation, to children in Gaza. Over an 18-month period, sixty-seven children in Gaza with suspected or confirmed cancer were registered with CNN, many of whom exhibited symptoms such as pain, fatigue, and weakness. Despite these symptoms and impairments where rehabilitation could have been considered, none of this cohort was referred to the CNN rehabilitation team. Discussion: Globally, utilisation of rehabilitation services is generally low. Most of our cohort of children with cancer faced diagnostic and treatment challenges, and other factors that likely contributed to underutilisation of rehabilitation, including inadequate analgesia, undernutrition, conflict-related environmental risks, medical evacuation and other psychological and social difficulties. Conclusion: Protecting health and rehabilitation infrastructure and workforce is of immediate priority, alongside the swift, unobstructed evacuation of children with cancer, in accordance with international humanitarian law. With one in five of the world's children living in conflict zones, it is vital to better understand the rehabilitation and physical activity needs of children with cancer in these areas. Limitations: Literature on rehabilitation and physical activity needs of children with cancer in conflict settings is scarce. Our report may omit other rehabilitation issues in Gaza, as children with suspected or confirmed cancer were not referred to or assessed by the CNN rehabilitation service. CNN's experience may not be generalisable to other contexts or organisations.