At the entrance of the National Institute of Cancer Research and Hospital (NICH&R) in Dhaka, a 55-year-old woman hailed from Khulna burst into tears having been denied radiotherapy--the last antidote for her to live some more days.
Having undergone four consecutive sessions at a private hospital, Ratna Begum is left a pauper for skyrocketing cost of cancer treatment in times of untamed high prices of essentials. Desperate, she sought treatment at a public hospital, only to find all radiation machines out of order.
"I can't afford treatment in private hospitals anymore. Since there are no functioning radiation machines here, I am going back to Khulna without therapy," said an emotion-choked Ratna while talking to the FE writer recently and narrating her struggles to receive a must-have treatment. Following surgery and chemotherapy, doctors recommended 15 sessions of radiation therapy for her.
A field-level inspection by this correspondent reveals that not a single government hospital in Dhaka has currently functional radiation machines.
Only Chattogram and Bogura have got two radiation machines, but both dilapidated by now.
While chemotherapy is available, lack of radiation therapy leaves cancer treatments incomplete.
"My job seems redundant in this cancer hospital since there is no radiation machine," says a radiologist at the National Cancer Institute in Mohakhali. Many radiation oncologists come to the office just to sit idle, witnessing the misery of patients.
"I would have never chosen radiation oncology as my career if I had known the government would ignore such a crucial issue despite an alarming rise in cancer cases," a frustrated oncologist shares his traumatic experience with The Financial Express.
Director of the NICR&H Dr Md Jahangir Kabir says two radiation machines have been purchased and will be installed shortly.
He laments that the previous government had not purchased any radiation machine in the last fifteen years despite an alarming rise in the number of cancer patients.
Alarming data on cancer cases: A recent study by Bangabandhu Sheikh Mujib Medical University (BSMMU), released on February 1, 2025, reveal that Bangladesh has 106 cancer patients per 100,000 people, with 53 new cases emerging annually. The study, which surveyed 200,000 individuals, identified 38 types of cancer in the country. The five most common cancers are breast, oral, stomach, esophageal, and cervical cancer. Among men, the prevalent ones are esophageal, stomach, lung, oral, and throat cancers, while in women, they are breast, cervical, oral, thyroid, and ovarian cancers.
The study also highlights that 75.8 per cent of male cancer patients were smokers, and 40.5 per cent consumed smokeless tobacco, such as betel leaf or jarda. Among women, 60.6 per cent used smokeless tobacco. Shockingly, 46 per cent of all cancer cases were linked to tobacco consumption.
Notwithstanding such rising crisis, Bangladesh's healthcare system is failing to keep pace with demand. The country requires at least 200 radiation machines, yet only Chattogram Medical College and Bogura Medical College have one each.
Lack of cancer treatment facilities in public hospitals: Bangladesh has expanded its network of government medical colleges from 14 to 37 over the past two decades. However, none of the new ones has established a dedicated cancer department. Major public hospitals, including Mitford, Suhrawardy, and Mugda Medical College, still lack full-fledged cancer units due to poor planning.
Professor Golam Mohiuddin Faruque, oncologist and health economist and project director of Bangladesh Cancer Society, says more than 50 radiation oncologists are posted in different hospitals where no cancer department exists.
"Proper deployment of manpower is a must, otherwise only purchasing and installation of radiation machine would prove futile," he adds.
Purchasing medical equipment for government hospitals is a lengthy and bureaucratic process. The absence of maintenance contracts has led to machines breaking down, leaving hospitals incapable of providing essential cancer treatments.
Dr Mostafa Aziz Sumon, head of the department of Radiation Oncology, Kurmitola General Hospital, says 70 per cent of cancer patients need radiation therapy anytime in their life.
Additionally, medical physicists, who play a crucial role in planning targeted radioactive therapy, are not available in public hospitals. Young oncologists are becoming increasingly demoralised as they face stagnation in their careers for a lack of promotions and administrative support. Many have even started leaving the profession.
In the South Asian region, Bangladesh was once a pioneer in radiation therapy. In 1958, Kumudini Hospital was the first to install a radiation machine in the country, attracting students from India and Indonesia for training. However, lack of investment and infrastructure development has left the country far behind in cancer treatment.
Rising costs and economic burden on patients: With government hospitals being unable to provide adequate treatment, private hospitals have seized the opportunity to profit, charging nearly 20 times higher than public hospitals do. This financial burden forces many cancer patients to either forgo treatment or accumulate massive debts.
The out-of-pocket expenditure for cancer treatment has increased significantly as malfunctioning government machines leave patients with no choice but to turn to private facilities. Those who previously traveled to India for treatment are now stuck due to stricter visa policies, making treatment within Bangladesh even far more urgent.
Doctors at public hospitals have voiced their frustration, admitting that they feel helpless when forced to turn away patients who cannot afford private treatment.
"We are discharging our duties with a heavy heart, knowing that without radiation therapy, these patients will not survive long," says a senior oncologist.
Dr Sumon, who is General Secretary of the SAARC Federation of Oncologists, says cancer patients need Tk 15,000 per therapy in a government hospital while it takes more than 0.2 million in private hospitals.
A study conducted by the Bangladesh Institute of Development Studies (BIDS) in 2023 revealed the extent of the economic burden. A staggering 90 per cent of families with cancer patients face financial hardship to meet treatment expenses.
The study titled 'Out-of-pocket cost of cancer among Bangladeshi households: A field study', revealed that for treatment purposes, 77.78 per cent of families end up borrowing money, while 64.67 per cent pay with regular income, 56 per cent from savings, 39.56 per cent from selling assets and 27.11 per cent from assistance of relatives, friends and others.
The study found the average annual out-of-pocket cost of cancer at Tk 548,000. It is at Tk 331,000 if diagnosed in the first stage of the disease and Tk 700,000 for stage-four patients.
The suffering of the other members of the families is also shocking. The BIDS study found during the treatment period, 88 per cent of families face food deficiencies.
Need for urgent government action: Governmental reluctance to invest in cancer treatment has left thousands of patients suffering. A standardized setup was established in 2024 to outline what a medical college must have, yet no required steps had been taken to implement these changes.
Talking to the FE, some young oncologists expressed their frustration over the state of cancer treatments and their predicament.
"For a lack of promotions and incentives, many oncologists remain stuck in the same positions for their entire careers, forcing talented professionals to leave the field," says one of them.
In 2024, the government quota for cancer-related studies remained vacant as students avoided a profession that offers no growth or stability.
Bangladesh also lags behind in cancer research for lack of funding, and travel restrictions, that prevent local oncologists from accessing global advances in the field. Unlike other nations that heavily invest in research and technology, Bangladesh has failed to allocate sufficient resources to fight this growing crisis.
Experts have long been voicing a note of concern that the current crisis will only worsen if urgent intervention is not made. The call for change has grown louder that the government needs to prioritize cancer- treatment infrastructure, ensure equipment maintenance, and provide adequate research funding. Otherwise, Bangladesh will continue to see preventable cancer deaths rise at an alarming rate.
Professor Faruque feels that a coordinated effort from government, doctors, non-government organisations and civil society is imperative to develop the cancer treatment in Bangladesh.
"The government must realize the need and also provide incentives to the private hospitals to bring down the treatment cost for cancer patients," he suggests.
In 2019, the government took a project worth Tk 25 billion to establish cancer hospitals in eight divisions in a bid to decentralize the cancer treatment. However, the initiative has yet to see success.
Dr Sumon says physical structures have been built in some divisions, including Dhaka, under the project where the government could easily set up the machines for cancer treatment but it has been ignored.
"With the existing infrastructure, the government can develop cancer treatment within five years if it wants to do so," he adds, underscoring an inexplicable apathy.
Radiation machines were installed in 2001- 2009 period, but thereafter, cancer treatment faced extreme negligence from the government, he mentions.
Dr Faruque thinks the major crisis in cancer treatment is unavailability of radiation machine in cancer treatment.
Currently, 40 radiation machines are there but majority of those in government hospitals are non-functional, he adds.
If immediate action is not taken, countless lives will be lost-not owing to cancer itself, but due to sheer negligence and a failing healthcare system. And availability of cancer treatment would help the government save foreign exchange.
"Bangladesh has been left with no other alternative but to strengthen its healthcare system through an urgent action plan to address the growing burden of cancer," says Dr Sumon.
Professor Faruque further says for poor patients, the Ministry of Social Welfare allocates Tk 50,000 per patient, set in a decade ago, which must be increased to Tk 0.1 million.
He also suggests developing a cancer registry to get actual number of cancer patients in Bangladesh.
Doulot Akter Mala is Special Correspondent, The Financial Express
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