National analysis of cancer care for refugees in Moldova during the war in Ukraine (2022–2025).

Abstract

1602 Background: Following Russia's invasion of Ukraine in February 2022, Moldova, a non-EU country of 2.3 million, had one of Europe's highest refugee-to-population ratios (6.4%). To meet refugee cancer care needs, the Institute of Oncology and Moldova's Ministry of Health (MOH) established a multi-sectoral financing model with the International Organization for Migration (IOM) and the Blue Heron Foundation (BHF), an American NGO. Refugee patients received a free MOH-funded consultation and access to screening and early detection. Diagnostic tests were then funded by IOM and treatment costs covered by BHF for the initial 15 months of the war, after which all services were reimbursed by IOM-led projects. Methods: We conducted a retrospective review of Ukrainian refugee cancer patients at Moldova's main oncology centers from May 1 2022 to July 30, 2025, with near complete national data. We analyzed demographics, diagnoses, diagnostic tests and treatments, and per-patient costs adjusted for PPP. Results: Of 1,398 Ukrainian refugees evaluated with suspicion of cancer, 681 (48.7%) were diagnosed with malignancy. 412 unique patients (60.5%) remained to receive medical services in Moldova. Among these, 391 were seen at the Institute of Oncology, 25 at Medpark International Hospital (including 7 seen at both institutions), and 3 at Republican Clinical Hospital. The cohort included 221 women (53.6%) and 191 men (46.4%) with an average age at presentation of 58.8 (range 5 – 88 years-old). The most common malignancies were breast (n=71, 17.2%), urological (n=62, 15%), colorectal (n=51, 12.4%), head and neck (n=40, 9.7%), and gynecological cancers (n=38, 9.2%). 292 patients (70.9%) had locoregional disease, 82 (19.9%) were metastatic, and 38 (9.2%) were unstaged. Diagnostic tests over 39 months included 400 CT scans, 70 bone scans, 69 MRIs, 5 PET-CTs, 83 mammograms, 129 endoscopies, and 20,265 lab tests. 326 (79.1%) received treatment, including 203 surgeries, 695 chemotherapy administrations, and 46 radiotherapy courses. Total costs for diagnostics and treatments covered by IOM and BHF at the Institute of Oncology were available for 305 patients, amounting to 9,943,111 MDL, equivalent to $552,782 USD at an average exchange rate of 18.02 MDL/USD. This corresponds to a mean cost of $1,812 per patient, or $4,502 per patient in purchasing-power-adjusted (PPP) international dollars, using a Moldova PPP conversion factor of 7.24. Conclusions: This analysis shows that comprehensive cancer care for refugees in resource-limited settings is possible via rapid partnerships among different sectors. Moldova’s model offers replicable lessons for other nations facing similar humanitarian challenges. However, to this day, refugees continue to depend on humanitarian donors such as IOM for cancer services, highlighting the need to develop sustainable financing mechanisms that move beyond emergency response.