In Syria these days, people talk about a ‘‘cancer of fears.’’ They blame the tumors in the bodies of their children on the traumas of war: on the daily fear of government airstrikes and opposition attacks; on the fumes breathed in from the use of dirty fuel since the oil fields were taken over by ISIS; on bodies weakened and warped from shortages of food. Many fear that even if the war ends, the conflict will mark the health of future generations. The effects of the carcinogenic materials used in the war will most likely only be reflected in Syrian cancer rates years down the line. An oncologist working in a clinic in besieged Eastern Ghouta, the site of chemical attacks, already reported significantly rising rates of cancer in her patients.

The fear of the parents at Al-Bayrouni — that the war was the cause of their children’s cancers — is hard to prove or disprove. But the effects of the war on treatment and survival rates are clear. Delays in treatment can quicken progression and worsen outcomes. With cancer, after all, timing can be everything. If caught early, roughly 70 percent of patients with Ewing’s sarcoma, the rare cancer Shahd was fighting, are alive five years later; but after the disease has spread, that figure drops to around 30 percent. For the most common form of childhood leukemia, five-year remission rates can reach 85 percent, but this can depend on its stage at diagnosis and how rapidly the cancer responds to treatment. The six-year conflict has claimed the lives of more than 300,000 Syrians, but as of 2014, 200,000 more have died from chronic diseases, including cancer. Of the millions who have fled the country, an estimated 27,000 were skilled physicians, more than half the total number of medical doctors who worked in the country before the conflict. Half the nation’s hospitals and health centers have been destroyed, in many cases deliberately.

The Al-Bayrouni cancer center once received as many as 1,400 patients a day. Doctors there had high hopes of expanding the center, but now most of the beds lie empty, with wards damaged by shelling abandoned. After years of conflict, most hospitals, including Al-Bayrouni, face shortages of medicines and medical equipment, as well as a limited number of oncology professionals. The Ministry of Health’s national cancer registry has reported that this year an estimated 25,000 new cancer patients will be in need of treatment. But the actual number of cancer patients is very likely much higher, possibly up to three times that number, because of disruptions in the registry’s reporting and the mass displacement of people. In Damascus, oncology facilities have been overwhelmed, with patients coming from all over Syria to the capital. The Syrian government provides anticancer medicine free of charge in its public oncology facilities, but since the war began, these are not always available. Wars are expensive, and so the health budget has repeatedly been cut. The World Health Organization, according to a report it published in April, needs almost $7 million in the coming year to increase access to treatment for Syria’s cancer patients. People who must procure medicine or medical supplies on their own turn to private pharmacies or black-market traders. But since the war began, the average salary of working Syrians has plummeted to around $70 a month. The cost of a single course of chemo can be equivalent to a year’s salary.