HealthCare Access Barrier (HCAB) framework for the barriers to cancer care during conflicts: perspective from Iraq.

The Iraqi population has lived under four decades of conflicts, warfare and political instability. The health consequences of the protracted conflict continue to persist. This work critically analyses Iraq's barriers to delivering and accessing cancer care during the conflicts that Iraq passed through from 1980 to 2017. To identify the barriers to accessing and delivering cancer care services, we used the HealthCare Access Barriers framework, which categorises the barriers into three groups: financial, structural and cognitive. Moreover, a structured search was performed in multidisciplinary databases. To produce a comprehensive body of literature, further materials were retrieved using alternative methods, such as hand-searching and snowballing. The key findings and themes identified in the literature were issues related to funding and affordability (within the financial), destruction and inaccessibility of facilities, therapeutic and diagnostic shortages, workforce and human resources and lack of national guidelines and awareness programmes (within the structural), awareness and knowledge and finally attitudes and beliefs (within the cognitive). These results demonstrated that the barriers to cancer care delivery are complex and inter-related. The financial and structural barriers were particularly intertwined with the protracted conflict, but this relationship was not demonstrable within the findings of the cognitive barriers. We concluded that the barriers facing the delivery and access to cancer care in Iraq are intertwined mainly with its protracted conflict. To ensure that future generations do not continue to pay the price of war, improved reconstructive efforts and further research are necessary.