TIME Diet/Nutrition

5 Tricks to Avoid Being Hungry All the Time

Woman drinking water
Daniel Ingold—Getty Images/Cultura RF

Once, one of my clients half-jokingly requested an exorcism from the demon possessing her body: hunger. Kind of a gruesome analogy but, truth be told, it’s fairly accurate considering how out of control she felt. When my clients struggle like this, I often say I wish I could wave a magic wand to make it all better, which of course I can’t. But what I can do is offer some tried and true advice to effectively rein in appetite and help regain a sense of balance. The five strategies below are tops for doing just that, and each also has the power to enhance your overall health. Win-win!

Make sweating fun

Have you ever found yourself hungrier after working out, and then “ate back” more calories than you burned exercising? It’s a common phenomenon, and the trick to breaking the cycle may just be choosing ways of being active that feel like fun. In a recent Cornell University study, researchers asked two groups of adults to take a two kilometer walk before lunch or a snack. Those who were told they had been on an exercise walk wound up eating 35% more chocolate pudding for dessert at lunch and 124% more M&Ms at snack time than those who were told they had been on a fun, scenic walk.

Health.com:25 Exercises You Can Do Anywhere

Other research shows that intense exercise—sweat sessions that are perceived as work—can lead to eating more overall. In other words, a “no pain, no gain” mentality may wind up wreaking havoc with your appetite. If you’re in a similar boat, try mixing things up. Trade grueling workouts for activities that get your heart rate up but seem like play. Think dancing, hiking, roller skating, and swimming. Many of my clients find that even if they burn fewer calories, engaging in recreational activities often helps them lose more weight, because they don’t experience rebound hunger spikes.

Get enough sleep

Catching too few ZZZs is notorious for not only ramping up hunger, but also increasing cravings for junk food. One study from University of Texas Southwestern Medical Center found that too little sleep triggered excessive eating and weight gain, and getting more sleep slashed the consumption of carbs and fat, leading to weight loss. Another from the University of Chicago found that getting 4.5 hours of sleep (rather than 8.5) ups hunger and appetite, especially in the early afternoon.

In addition to causing appetite craziness, sleep deprivation has been tied to a number of health problems, including weakened immunity, and a greater risk of type 2 diabetes, depression, and heart disease. For these reasons, in my opinion, making sleep a priority may even be more important than exercise for weight loss. If you’re falling short like most people, read up on ways to improve your slumber.

Health.com:14 Reasons You’re Always Tired

Drink more water

Research backs what I find to be true for myself and my clients: drinking plenty of water can help manage appetite. One study found that people who drink about seven cups of water per day eat nearly 200 fewer daily calories compared to those who gulp less than one glass. Another found that when adults drank two cups of water right before meals, they ate 75 to 90 fewer calories. A second study by the same researchers showed that when two groups of people followed the same calorie-limited diet for 12 weeks, those who downed two cups of water before meals lost about 15.5 pounds compared to about 11 pounds for the water-free bunch.

Finally, a German study showed that a 16-ounce dose of water resulted in a 30% increase in metabolic rate within 10 minutes. The effect peaked 30 to 40 minutes after consumption, but was sustained for more than an hour. To take advantage of the benefits, drink about 16 ounces of H2O four times a day. If you dislike the taste of plain water, spruce it up with wedges of lemon or lime, fresh mint leaves, cucumber slices, fresh grated ginger, or a bit of mashed fruit.

Eat on a schedule

Your body loves consistency, which is why in my own personal experience, as well as my clients’, eating at the same times every day can go a long way in regulating appetite. Try eating breakfast within one hour of waking up and spacing your remaining meals about three to five hours apart. In addition to consistent meal times, strive for a steady meal structure in terms of the foods and proportions you include.

Health.com:15 Ways to Lose Weight Without Trying

For example, I recommend always including: produce, lean protein, plant-based fat (like avocado), and a small portion of a healthy starch. I’ve seen that mixing up the foods you choose within these categories, while keeping the types and quantities comparable, can have a huge impact on regulating hunger, supporting sustained energy, and creating a predictable return of hunger, almost like clockwork. In other words, when your meals are all over the place, it’s much easier to feel hungry all the time or confuse true hunger with boredom or other emotions.

Learn how to deal with stress

For most of my clients, stress is the number one eating trigger. And research backs the old adage: “stressed is desserts spelled backwards.” One recent animal study found that female monkeys chronically exposed to stress overate calorie-rich foods, unlike their calm counterparts. They also ate more throughout the day and evening, while the chilled-out chimps naturally restricted their noshing to daytime hours only. This behavior parallels what I see in so many people, and until they find effective ways to reduce stress, emotional eating is a difficult pattern to break.

Health.com:25 Surprising Ways Stress Affects Your Health

The best place to start: stop beating yourself up. Instead of berating yourself for not having enough willpower, acknowledge that when your stress hormones are surging, you’re programmed to reach for chips or chocolate. Speak kindly to yourself, and shift your energy toward testing out positive ways to cope, like listening to guided meditation, venting to a friend, spending time outdoors, reading, stretching, drawing, or whatever gives you a mini-vacation from the intensity of your emotions. That strategy, rather than “dieting,” is a much better way to set yourself up for successful weight control and better overall health.

Cynthia Sass, MPH, RD, is Health’s contributing nutrition editor, and privately counsels clients in New York, Los Angeles, and long distance. Cynthia is currently the sports nutrition consultant to the New York Rangers NHL team and the Tampa Bay Rays MLB team, and is board certified as a specialist in sports dietetics.

This article originally appeared on Health.com.

TIME Aids

This Is What We Lost Aboard Malaysia Airways Flight MH17

UKRAINE-RUSSIA-POLITICS-CRISIS-MALAYSIA-AUSTRALIA-AIDS-FILES
Leading AIDS researcher Joep Lange during a conference on AIDS in Paris on July 14, 2003 . Jean Ayissi—AFP/Getty Images

Late last night, a terrific HIV vaccine researcher, Wayne Koff, sent me a quick note, indicating Joep Lange perished aboard the jet senselessly shot down over Ukraine. I reeled. Joep was one of the group of “Young Turks” from Amsterdam, amazing AIDS researchers that in the 1990s led the way to our modern treatment era.

This morning’s news is still uncertain, but it seems Lange was on board along with some 100 of his Dutch compatriots, and many of the passengers shared an ultimate destination – the twentieth International AIDS Conference in Melbourne, Australia. Some probably highly premature news accounts indicate a third of those shot out of the sky were en route to the conference. One additional has been confirmed – Glenn Thomas, AIDS specialist in the World Health Organization communications office.

There was a time when we convened in these meetings and whispered the names of friends, colleagues, and loved ones that wouldn’t be coming this year because they died of AIDS. In our gatherings in the 1980s, grief hung like a curtain over everything, alongside anger over the way governments were responding, the lack of funding, the stigma, and so many other aspects of what it was like to live in the World of AIDS before there was treatment. We fought through the mourning to get the job done, whatever that job might be: activist protesting, scientific investigation, fundraising, even journalism. The great oratory leader of the early AIDS fight Jonathan Mann would whip us into a fever of determination to stop discrimination against people with AIDS, fight for research funding, and find a cure for the devastating disease. Jonathan, who started the first global AIDS program at WHO, was the early pandemic cheerleader, pushing everybody forward, encouraging teams of scientists to work together in ways biologists and clinicians never previously had, for any disease struggle.

The Young Turks from Amsterdam were a special breed. There were so few of them yet they accomplished a long list of spectacular breakthroughs in understanding how HIV disrupted the human immune system, smart ways to prevent transmission of the virus among drug users, careful but rapid drug discovery and testing. Joep and Jaap – two prominent Dutchmen we foreigners had trouble pronouncing. What is the world is the difference in saying Joep Lange and Jaap Goudsmit? We marveled at the pragmatism of the Dutch. To put it bluntly, they got the job done.

In 1996 the one and only joyous AIDS Conference convened in Vancouver – a meeting marked by announcement of successful combination therapy that knocked the dastardly virus down to levels undetectable in blood. There was hope for a cure, thanks in large part to the Dutch work. Some dared to speak of eradicating HIV all together.

Two years later, as hundreds of thousands of HIV-positive men and women living in wealthy countries were thriving on those treatment combinations, hope dominated the pandemic, until 1998 when Swissair Flight SR11 crashed off Nova Scotia, killing all on board. Among them, Jonathan Mann and his new wife, AIDS vaccine researcher Mary Lou Clements. Their sudden loss felt like a kick in the gut for the world AIDS community.

Here we are, sixteen years later, facing airline tragedy again. As I write this in haste we don’t have more names and the scale of the AIDS community’s loss is unclear. But the loss of one is tragedy.

Like so many of the great AIDS scientists that toiled through the years of extreme loss and urgency before there was effective treatment, Joep Lange absorbed the political dimensions of the pandemic, and gained the skills necessary to translate lab and clinical findings into high-level battles inside the United Nations and across the global stage. He became a leader, in the fullest sense of that word. Like Jonathan Mann, Joep blended science, medicine, and an activist spirit to help bring the life-sparing medicines to people in all of the world – not just rich countries.

The last time Joep and I spent time together we argued, I’m sorry to say. And I may have been completely wrong, he completely right. The saga we argued about hasn’t played out yet. Joep believed without hesitation that effective treatment, “is like a vaccine,” as he put it. The global epidemic could be stopped, he said, simply by getting every HIV+ person on the planet put on an effective regimen of treatment. Once on medicines, he insisted, the load of viruses in their blood, vaginal fluids, and semen would drop so low that they would not be contagious. And that, he said with a grin, will be the end of AIDS. I was skeptical – there were too many cases of drug resistance, non-adherence to treatment, supply chain failures to deliver vital drugs to remote or impoverished areas. I resented use of the word “vaccine” to describe universal treatment – we still desperately need an actual HIV vaccine, I insisted.

I want Joep’s optimism about eliminating AIDS through treatment to win out. I want to be wrong.

I just wish Joep was going to be around to see the great experiment play out.

A Tweeter asked me if the loss of Joep, Glenn, and other AIDS researchers and activists possibly on board MH17 would prove a major set-back in the fight against AIDS. No, I said. One of the glories of the AIDS community is that its bench is deep, its talents enormous, and its sorry history of processing grief and moving on is unparalleled. The dead, as has always been the case since this awful virus emerged in the late 1970s, will be mourned. And then energies will be mustered, to get the job done.

Until there is a cure.

Laurie Garrett is a senior fellow for Global Health at the Council on Foreign Relations. This essay also appeared on http://lauriegarrett.com/blog/.

TIME Drugs

FDA Warns Against Powdered Caffeine

The agency issued a statement Friday recommending that consumers avoid the potent powders

The U.S. Food and Drug Administration issued a warning Friday about the dangers of pure powdered caffeine after the death of a teenager in Ohio in May.

A mere teaspoon of pure powdered caffeine, the FDA said, is equivalent to 25 cups of coffee and can be lethal. “Pure caffeine is a powerful stimulant and very small amounts may cause accidental overdose. Parents should be aware that these products may be attractive to young people,” the agent noted. The substance can be easily purchased online.

Taking too much of the drug can result in heartbeat disruptions, seizures, vomiting, diarrhea and disorientation. “These symptoms are likely to be much more severe than those resulting from drinking too much coffee, tea or other caffeinated beverages,” according to the statement.

The announcement comes almost two months after Logan Steiner, 18, of LeGrange, Ohio, died after overdosing on powdered caffeine on May 27.

TIME plague

3 New Plague Cases Confirmed in Colorado

The state health department has found a total of four people infected with the pneumonic plague

Three new cases of plague have been identified in Colorado for a total so far of four, the state health department announced Friday.

The four people diagnosed all had contact with a dog that died of the plague. The initial patient remains hospitalized but the three infected later “all had minor symptoms, were treated with appropriate antibiotics, recovered and are no longer contagious,” the health department said in a release.

Plague is spread from rodent—in this case prairie dogs—to other animals, including humans, by rogue fleas.

Of the 60 cases of plague in its various forms that Colorado has seen in recent years, nine people have died from the disease, according to a Bloomberg report. Doctors recommend keeping a safe distance from any rodents, alive or dead.

TIME Australia

After MH17 Ukraine Crash, Global AIDS Researchers Mourn Lost Colleagues

The cause of HIV/AIDS research will be set back because of experts lost in the Malaysia Airlines Ukraine disaster

+ READ ARTICLE

[UPDATE: 7/18/14, 11:52 AM EDT]

There was a pall over the 20th annual International AIDS Conference in Melbourne even before the crash of Flight MH17 in eastern Ukraine, which killed an estimated 100 delegates who were en route to the meeting. [Update: Later reports suggest that the number of delegates lost is much lower.]

In the past couple of years the vibrant showcase event—part serious science, part activist networking and carnivalhas been headily optimistic, as HIV treatments improved and the possibility of a cure no longer seemed so far off. “The mood is always an important part,” says Professor Mike Toole, an international communicable diseases veteran with Melbourne’s Burnet Institute who has been at the HIV/AIDS front line since the pandemic began some 30 years ago.

Toole remembers that the landmark Durban International AIDS Conference back in 2000 demonstrated to this eclectic crowd—a disparate crew of laboratory researchers, front-line health workers, activists and people living with the infection—their powerful potential. It was in Durban that the commitment to deliver then-prohibitively expensive antiretroviral drugs to the world’s poorest populations ignited, and was carried through over the next few years by organizations like The Global Fund and the U.S. President’s Emergency Fund for Aids Relief.

The past two International Aids Society (IAS) meetings, in Vienna and Washington DC, have been buoyed by signals that a breakthrough was close, and the expectation was that the momentum would continue into Melbourne. Then, barely a week ago, came a serious blow. For over a year many members of the HIV/AIDS community had been pinning their hopes for a breakthrough on the so-called Mississippi baby, an HIV-positive infant that had apparently been cured through aggressive drug treatment soon after birth. But on July 10, news came, that the child was showing symptoms that the virus had returned.

Although there are other programs that indicate that it might be possible to eliminate HIV infection from a human body, the apparent relapse of the Mississippi baby “depressed people incredibly,” says Toole.

Then came yesterday’s tragedy. For Toole and others HIV/AIDS experts the crash summoned up ghosts. “It reminds me of the Swissair flight, New York to Geneva, when Jonathan Mann died,” he says. Mann then the founding director of the World Health Organization’s global AIDS program was killed with several other researchers, including his wife Mary-Lou Clements-Mann, en route to AIDS meetings when the plane crashed in Canada, September 3, 1998. “I lost five friends on that flight.”

In Sydney, at a pre-conference gathering on July 18, about 200 delegates spent the day closely monitoring Twitter and exchanging snippets of news, desperate for updates on who would and would not be joining them in Melbourne. The word there was that a substantial number of the 100-plus delegates reported to be on the downed aircraft were part of the global network of activists and people living with AIDS.

With only a handful of names of the deceased confirmed by Friday, it’s difficult to measure the overall impact on HIV/AIDS research and advocacy. But the loss of internationally renowned Dutch researcher Joep Lange—a former president of the IAS—would be a massive blow. “It will have a big psychological effect,” says Toole. “He was one of the leaders in the field.”

Another known casualty was Glenn Thomas, a British media officer working for WHO in Geneva. Thomas was to be part of a media launch on July 20 revealing new tools to reduce harm to users of intravenous drugs. He was also recognized as a particularly effective communicator on the links between HIV/AIDS and tuberculosis, says Toole. (The risk of developing TB is up to 20 times greater in people infected with HIV, and in 2012, of the 8.6 million new cases of TB diagnosed internationally, 1.1 million were among people with HIV.)“And the other hundred [on board]—we don’t know who they are, what it means.”

The annual AIS conferences are like no other medical gathering, says Professor Rob Moodie of the University of Melbourne, a former senior WHO official and longtime Australian public health specialist. “You have this incredible mixture of scientists and clinicians, public health people, civilian organizers, human rights activists, people who have the virus … who all have some sort of sense of ownership and collective leadership.”

The energy and collaborations of these gatherings have helped drive the huge advances achieved in understanding and responses to HIV/AIDS in a relatively short time. “We learned more about HIV in the first 10 years than we did in a century with other diseases,” says Moodie. The involvement of grassroots activist groups—as well as lab researchers—has been key to that success. MH17’s toll would not only be measured in the loss of medical expertise, but of advocacy, understanding and hard-won personal experience.

“There is a black cloud on this conference,” says Toole. “I don’t think there is anything that can retrieve that.”

Still, Toole was confident that delegates would be driven to achieve as much as they could in memory of their colleagues. He welcomed the move by the City of Melbourne on July 18 to cancel fireworks that had been scheduled to kick off the conference, but was disappointed that that’s night fixture in the Australian Football League competition—to which AIDS2014 delegates had been given tickets as part of the cultural program—did not pause for a minute of silence.

TIME

Chikungunya in Florida Man Is First Case Acquired in the U.S.

98736416
WS photography—Getty Images/Flickr RF

The Centers for Disease Control and Prevention (CDC) says that the first case of the mosquito-borne virus chikungunya infection picked up in the U.S. occurred in a Florida man who had not recently traveled abroad.

This year, 243 people in the U.S. became infected, but this is the first case of a disease believed to originate from a mosquito in the U.S.

Chikungunya is a disease caused by a virus that leads to fever, joint pain, headaches, swelling and rash. The infection is usually not fatal, but the pain can be debilitating.

“The arrival of chikungunya virus, first in the tropical Americas and now in the United States, underscores the risks posed by this and other exotic pathogens,” Roger Nasci, chief of CDC’s Arboviral Diseases Branch said in a statement.

The CDC is teaming up with the Florida Department of Health to confirm how the Florida man became infected and is monitoring the area for additional cases. The CDC believes that chikungunya in the U.S. will follow a similar pattern to that of the dengue virus, in which imported cases cause some local transmission, but did not cause a widespread outbreak. Public health officials are investigating how the mosquitoes were infected with the virus, including whether the insects acquired the virus by biting infected individuals. Since 2006, there have been an average of 28 cases a year of chikungunya infection; none of those cases have prompted an outbreak, however. Countries in Africa, Asia, Europe, India, the Middle East, and the French side of the Caribbean island of St. Martin have experienced outbreaks in the past and 23 countries have experienced local transmission of the virus in recent years.

The best way to stay protected from the virus is to keep mosquitoes at bay by wearing repellants and creating a physical barrier from being bitten, with long sleeves and pants when possible. Health officials also recommend getting rid of any standing water outside the home, where mosquitoes generally breed.

TIME

Alcohol Plus Energy Drinks Makes You Want to Drink More, Study Says

114330672
New study finds people drinking alcohol with energy drinks have a greater desire to drink Chris Stein—Getty Images

A small study shows people drinking vodka Red Bulls want to drink more

A recent Australian study found that when people drink alcohol with energy drinks they have a stronger desire to keep drinking compared to people who just drank a vodka soda.

The study, published in the journal Alcoholism: Clinical & Experimental Research, assigned 75 participants between the ages 18 and 30 to either just drink alcohol, or drink an alcohol and energy drink combination. The people in the energy drink group received a 60 ml of vodka and a Red Bull energy drink. The other group drank a vodka soda. All the drinks had some fruity beverage added to them so they didn’t taste terrible. The participants then filled out questionnaires about their drinking experience before and after.

The alcohol-energy drink imbibers had a stronger desire to continue drinking compared to the group just drinking alcohol. The researchers note that although the participants in the study drank the same amount, there are some pretty significant implications if there happens to be something about drinking alcohol with energy drinks that makes people want to keep boozing. As people get more tipsy, it can become harder to cut themselves off.

The study is small and preliminary, but there’s a growing interest in how energy drinks and alcohol interact in the body. The energy drink industry is continuing to grow, starting as a $3.8 billion business globally in 1999 to $27.5 billion in 2013, according to market research firm Euromonitor. Knowing the spectrum of their effects is important for safe socializing.

TIME sexual abuse

Childhood Sexual Abuse Raises Heart Disease Risk In Adulthood

Researchers link early sexual abuse to greater risk of developing blocked heart arteries

Sexual and physical abuse during childhood can have long term effects on both mental and physical health, and previous studies have linked childhood sexual abuse to a greater risk of heart attack and other heart events—but it has been unclear exactly why. New research published Thursday in the journal Stroke adds to the case, showing thatwhether or not women had other risk factors for heart problems, a history of childhood sexual abuse remained a strong potential contributor to their atherosclerosis.

“What was a surprise was that when we controlled for [heart disease] risk factors, such as smoking and obesity, the association didn’t go away. We just couldn’t get rid of the association,” says Rebecca Thurston, director of the Womens’ Biobehavioral Health Laboratory at the University of Pittsburgh, who led the research with a team of colleagues.

MORE: Viewpoint: Why a Mandatory Child Abuse Reporting Law Could Backfire

More than 1,000 middle-aged women of various ethnic backgrounds from across the U.S. had yearly clinical exams beginning in 1996 for 12 years. At the end of the study, they also answered questions about sexual and physical abuse and had an ultrasound of their carotid arteries. About a quarter of the women reported being sexually abused as a child, and a similar percentage reported the experience as an adult.

When Thurston compared the women’s answers to their ultrasound, she found that those who reported childhood sexual abuse showed higher rates of plaque buildup in their arteries. They also had hearts and vessels that looked about two to three years older than those of women who hadn’t been abused.

MORE: Psychological Abuse: More Common, as Harmful as Other Child Maltreatment

Thurston’s findings suggest that whether or not the women had other risk factors for heart problems, their history of childhood sexual abuse remained a strong potential contributor to their atherosclerosis.

Thurston plans to continue the work by studying women who have had heart events – in this study, only women without heart disease were included – to see if the correlation still holds. She also wants to better understand how the early abuse affects women in later life. There is some evidence that traumatic experiences may change the stress response system in lasting, and possibly permanent ways.

While none of the women had signs of heart disease at the start of the study, Thurston says the results hint that physicians should be considering childhood experience, particularly traumatic ones, as part of comprehensive heart care for women. If the results are validated, then they might lead to ways of intervening with stress reduction or other psychological techniques to hopefully slow down the hardening of the arteries and lower their risk of heart disease.

TIME Heart Disease

A Common Cholesterol Drug’s Safety Is In Question

New studies suggest Niacin doesn't help, but harms users

Two new studies suggest significant dangers from the common cholesterol drug niacin, and some doctors say the risks are not worth it.

One of the studies published in New England Journal of Medicine looked at extended-release niacin, and the other study looked at the combination of extended-release niacin and another drug, laropiprant, that makes it more effective. Neither found significant benefits, and both found high risk for adverse side effects in the gastrointestinal and musculoskeletal systems like bleeding, diarrhea and even gout. The niacin-laropiprant study found a 9% increase in death risk.

In a corresponding editorial, “Niacin and HDL Cholesterol — Time to Face Facts,” Dr. Donald Lloyd-Jones of Northwestern University in Chicago writes, “on the basis of the weight of available evidence showing net clinical harm, niacin must be considered to have an unacceptable toxicity profile for the majority of patients, and it should not be used routinely.” He notes that niacin may still have a role for patients at a very high risk for cardiovascular disease who do not tolerate statins.

It’s been thought in the past that niacin, a type of B vitamin, are a viable alternative or complement to statins. But the NEJM studies show that not only does niacin not work as well as statins, but it has some serious side effects. The researchers found that people taking niacin had about the same rates of disease as people on placebos, suggesting that the drug is not as effective as it’s thought to be.

Though many people will likely remain on niacin, members of the medical community caution people on the drugs, warning they should talk to their doctors about whether or not they should continue.

TIME Syria

Cancer Wages Its Own War Against Syrian Refugees

A higher rate of cancer among Syrian refugees is forcing doctors, patients and humanitarian organisations to make difficult decisions about who does, and does not, receive care

+ READ ARTICLE

It was just before Syrian civilians started rising up against their government in 2011 that Fayhaa al-Dahr, 22, from the northern city of Raqqa, noticed a strange swelling in her neck. Doctors advised surgery to excise the tumors growing on her vocal chords, but even though Syria has one of the best government-subsidized medical systems in the Middle East, the operations and the follow-up treatment would be expensive.

To pay for al-Dahr’s care, her father sold some land than had been in the family for generations. When another tumor appeared, he sold more land. By the time the third tumor was taken care of, there was no more land to be sold, and the uprising had turned into a war that made it impossible for al-Dahr to travel to the capital for her chemotherapy appointments. When a rocket destroyed her home in December, al-Dahr and her family saw no choice but to take refuge in neighboring Lebanon. At least there, they believed, al-Dahr could continue her treatments. They were wrong.

Lebanon is host to some 1.1 million Syrian refugees, part of an exodus of 2.9 million seeking shelter from a war that has claimed more than 160,000 lives and has wrought untold damages to the middle-income country. Unlike refugees fleeing conflicts in Africa, where diseases of poverty such as diarrhea, malaria or cholera take their toll, Syrian refugees are afflicted with chronic and costly illnesses like diabetes, heart disease and cancer. The international humanitarian agencies that provide for refugees the world over simply do not have the funds to treat these diseases, leaving many, like al-Dahr, without access to proper medical care. Her cancer has metastasized, and she now has a tumor in her upper thigh so excruciating, she says, “I am living on painkillers.”

A recent study published in The Lancet Oncology journal documented a high demand for cancer treatments among refugees from the recent conflicts in Iraq and Syria, with host countries and refugee organizations struggling to find the money and the medicines to help. Cancer, writes Dr. Paul Spiegel, Chief Medical Expert at United Nations High Commissioner for Refugees (UNHCR), is likely to play a much greater role in refugee care going forward. “Cancer diagnosis and care in humanitarian emergencies typifies a growing trend toward more costly chronic disease care. Something that …. is of increasing importance because the number of refugees is growing.”

As it is, the UNHCR warned on July 3 that the organization had received only 30 percent of its $3.74 billion budget for Syrian refugee programs for this year, a shortfall that would see many vital programs, including health care, slashed.

Al-Dahr’s doctor in Damascus had warned her of the consequences of missing chemotherapy appointments, and when she first arrived in Lebanon, she did try to continue her treatment. But the costs—$1,900—were twice what she paid in Damascus. Her family was able to borrow enough cash to pay for one round in January, but when her Lebanese doctor called a few weeks later to remind her of her follow up, she knew she couldn’t afford another session. “He was very worried about me, and called several times to beg me to come, but there was nothing we could do and nothing he could do.” The doctor may have been willing to volunteer his time and expertise, but the drug and hospital costs are immutable.

“It’s a sad story,” says Dr. Dr. Elie Bechara, an oncologist in Beirut who works with other doctors to treat refugees pro-bono. “We are overwhelmed by these cases from Syria. Sometimes we are standing still, watching, and we are not able to help them. It is frustrating.”

Lebanon boasts some of the finest medical facilities in the Middle East, but nearly 90% are privately run, and most of them are for profit. UNHCR has spent tens of millions of dollars on treatment for refugees at private hospitals, but funds are limited. With the rising number of refugees — 1.5 million, a third of the Lebanese population, are expected to have registered by the end of the year — costs too will rise, forcing UNHCR to choose between funding emergency care and primary health clinics that can save thousands of lives and spending thousands of dollars to save one life.

Last year UNHCR covered medical treatment for 41,500 refugees in Lebanon, but each of those cases was judged on specific criteria: the cost of the intervention against the chances of a positive outcome. “It’s a horrible decision to have to make,” says Spiegel. “If there is a poor prognosis, we can’t go that route. It doesn’t mean the patients won’t get treatment—they may search elsewhere, and sometimes embassies or private donors step in—but we can’t afford to help where there is no hope.”

Palliative care, at least, is not that expensive, adds Spiegel. “We never say, ‘There is nothing we can do, go away.’ We just say we can’t treat the cancer but we will treat the consequences.” Al-Dahr falls into that category. Instead of chemotherapy, she gets painkiller injections at her local pharmacy, and she tries not to dwell on her illness. “When you don’t know what is going to happen, it is better to stay in the present,” she says. “Thinking about the future only brings more problems.”

Given the funding shortages, cases like al-Dahr’s are likely to become more common, says Spiegel. “Syria is our biggest and most expensive operation to date, and there is a question of how long donors will continue supporting it as things get worse. If we continue like this, there will be more like this woman who will not be able to receive treatment.”

Like a cancer patient with a poor prognosis, Syria is starting to look like a hopeless cause, and thus less likely to receive aid.

With reporting by Hania Mourtada / Anjar, Lebanon

Your browser, Internet Explorer 8 or below, is out of date. It has known security flaws and may not display all features of this and other websites.

Learn how to update your browser