The Unequal Weight of Cancer in Bangladesh

Abdur was only four years old when he developed a fever and swelling in his chest.

 At the age when a child's joy lights up a home, Abdur's suffering left Ripon sleepless and broken as he watched helplessly his son grew weaker by the day. Their first stop, a village doctor in Satkhira, dismissed it as nothing serious and gave some medicine. But Abdur kept suffering.  

Ripon then took him to Satkhira Medical College where doctors still could not find the cause. Desperate, Ripon took him to Dhaka, where he was told Abdur had a rheumatic fever. New medicines were given, yet nothing worked. Every day, Ripon felt his son slip further away, and with each wrong diagnosis, his hope dwindled. 

It was only on the fourth attempt that the truth came: Abdur had blood cancer. By then, Ripon had spent BDT 150,000, borrowing from everyone he could, and when urgent tests were needed, he had nothing left. Hopeless and penniless, he faced every parent's worst fear, losing his child before the fight had even begun. 

Cancer, a word that still strikes fear in nearly every household, has quietly become one of Bangladesh's most pressing public health crises. The scale of the crisis is impossible to ignore. In 2022, Bangladesh recorded an estimated 167,256 new cancer cases and 116,598 cancer related deaths, according to the International Agency for Research on Cancer GLOBOCAN 2022.  

These figures expose deep, long-standing gaps of Bangladesh's health system. Gaps that disproportionately fail people from underserved and low-income communities. For families already living on the edge, a cancer diagnosis is not just a medical emergency; it is a financial, social, and emotional catastrophe that often pushes them further into poverty and insecurity.  

The crushing cost of illness 

Cancer care in Bangladesh is marked by extreme financial vulnerability. Treatment costs often exceed the average household income, forcing 90% to debt, selling assets, or exhausting savings.  

A recent study published in the International Journal for Equity in Health estimates that the average annual out of pocket cost for cancer treatment is USD 6,504, (Approx BDT 793,000) more than double the country's average household income of USD 2,996 (Approx. BDT 365,000).  

The World Health Organization reports similar disparities for childhood cancer. More than 80% of children survive in high income countries, while in many low and middle-income countries, including Bangladesh, survival falls below 30%. Delayed diagnosis, interrupted treatment, and lack of follow up care remain the primary causes. These gaps show how geography and income together determine not only who receives care, but who survives. 

"Cancer exposes the deepest inequities in our health system. Too many families abandon treatment not because they lose hope, but because the system fails to support them. At SAJIDA, we believe health is not a privilege but a fundamental condition for happiness and dignity, which is why it has always been one of our core priorities. Our work in childhood cancer reflects our commitment to stand with the most vulnerable, ensuring care is continuous, compassionate and dignified." - Zahida Fizza Kabir, CEO, SAJIDA Foundation. 

Late diagnosis jeopardising lives 

Late diagnosis remains one of the most persistent challenges in cancer care. Most cancers in Bangladesh are detected at advanced stages, when treatment is more complex and survival chances fall sharply. Low public awareness, limited screening, uneven access to diagnostic services and inadequate machines delay care seeking, especially among underserved communities from rural areas. Facilities are concentrated in a few hospitals in Dhaka and even there patients face long waiting time for lack of functional and adequate radiotherapy, MRI and CT scan machines. In the National Institute of Cancer Research and Hospital (NICRH), the only fully specialised public cancer hospital, for instance, out of eight radiotherapy machines only two are currently operational as per latest news report. Outside Dhaka, cancer remains significantly underdiagnosed as specialist services are scarce, referral pathways are weak, and families are often left to navigate complex treatment plans alone.  

When the patient is a child, the burden becomes even heavier. 

Estimates from the International Agency for Research on Cancer and the World Health Organisation suggest that between 4,200 and 8,000 children in Bangladesh develop cancer each year.  According to the Bangladesh Bureau of Statistics, roughly one-third of cancer patients are children and adolescents aged 0 to 19 years. Among them, most are teenagers between 15 and 19, while about 13% are diagnosed before reaching the age of four. 

A recent cross-sectional study published in the Journal of Cancer Education on childhood cancer in Bangladesh highlights acute lymphocytic leukemia (46%) and blood cancers (37%) as the most common cancers among children. More than half of parents stopped working after their child's diagnosis, and nearly 39% of families spent more per month (USD 471–1,179/ approx BDT 57,000-144,000) on treatment than their total household income. Many families were forced to sell assets, and the lack of external support left them struggling to cover daily survival costs.  

Beyond finances, families faced social stigma, fear, and lack of awareness, particularly in rural areas, alongside challenges like poor facility conditions, high fees, and inappropriate provider behaviour. Children's schooling was frequently disrupted, and many families struggled to stay in Dhaka for repeated treatment. 

The impact also extends far beyond the hospital's ward. Education is disrupted. Siblings experience neglect, anxiety, and emotional distress. While some institutions and organisations provide counselling or limited assistance, comprehensive family-centred childhood cancer care remains rare. 

When support means survival 

A child living with cancer carries the same innocence, dreams, hopes, and limitless potential as any other child. Yet the absence of a comprehensive support system strips families of the ability to focus on anything beyond survival. Watching a child battle cancer is painful enough; it should not also mean losing the chance to celebrate life's small but meaningful milestones - saying the first word, learning to read, or taking pride in small achievements that define childhood. 

This is where SAJIDA Foundation's Childhood Cancer Project plays a critical role. Recognising that a key part of the care ecosystem is missing, SAJIDA chose to walk alongside families, like Abdur's, throughout the entire journey and started a cancer care project in 2022. The Foundation believes a child's treatment should never come at the cost of a family's survival and dignity. 

Rather than focusing on large scale infrastructure, SAJIDA has prioritised strengthening systems around families, because families struggling with cancer need more than treatment and one-off assistance. They need a continuous support system throughout the course of treatment, which is commonly available in high income countries but almost non-existent in ours. By leveraging existing public health services, fostering public private partnerships, coordinating stakeholders and maximising available resources, SAJIDA's cancer project therefore not only supports a child's treatment, but also the wellbeing of the entire household.  

This support is practical and sustainable. It includes transportation to treatment centres, nutritious food during prolonged hospital stays, temporary accommodation near hospitals, and follow-up visits - interventions that can continue for up to thirty months, covering the full course of treatment. By addressing everyday pressures, the project reduces the risk of families being forced to abandon care simply because they cannot afford to continue. 

For Abdur's family, this support has been life changing. When Ripon struggled financially to continue treatment after diagnosis, SAJIDA stepped in with financial assistance and arranged temporary accommodation in Dhaka. A doctor from SAJIDA Hospital remains in regular contact with Abdur and his family, ensuring they receive not only medical guidance but also much-needed mental and emotional support during this difficult time. 

Today, ten children from extremely vulnerable households are receiving continuous support through the project, with plans to expand further. Many are now continuing maintenance chemotherapy, something that would have been impossible without sustained assistance. For parents, the relief is not only financial. It is the dignity of knowing that their child's life is not determined by poverty.  

A reform agenda Bangladesh must urgently act on 

Bangladesh urgently needs a concerted and comprehensive cancer control strategy anchored in early detection, decentralised screening, and strong financial protection to prevent catastrophic out-of-pocket spending in fighting cancer. This will require decisive leadership from the new government and meaningful engagement from the private sector. Expanding treatment facilities and the oncology workforce across the country must go hand in hand with reducing VAT and import duties to make cancer medicines and care more affordable.  

Over the long term, local production of active pharmaceutical ingredients (APIs) is essential to ensure sustainable access, alongside increased fiscal allocations that reflect the needs of the country's population. These reforms must be underpinned by robust cancer registries and data systems to guide planning, resource allocation, and accountability. 

For childhood cancer, treatment availability alone is insufficient. Policy must prioritise uninterrupted care, psychosocial support, and long-term survivorship services. The private sector has a critical role to play, building on effective initiatives such as SAJIDA's, which demonstrate that continuous medical, logistical, and psychosocial support can reduce treatment abandonment and improve outcomes, even in resource-constrained settings. 

Cancer treatment in Bangladesh is a test of our systems and our values. Whether cancer remains a death sentence or becomes a manageable condition will depend on the policy choices made now and public-private partnership to deliver equitable, timely and affordable care. For children like Abdur, those choices will determine not only survival, but the chance to dream beyond hospital walls.