Militarized Cancer: People with a Diagnosis and the War in Ukraine
By Olha Labur
War is an extraordinary and powerful event in a person’s life. It changes destinies, evokes feelings of helplessness and doom, and brings suffering and death. War militarizes lives, languages, and everyday experiences – even disease becomes a metaphorical image. When we talk about something dangerous or threatening, we often use such metaphors. Metaphors of war have also long penetrated the world of cancer for a long time, for instance with the so-called ‘war on cancer’. The term’s history closely intertwines with a speech given by American President Richard Nixon in 1971. For the first time, a war on cancer was declared on an official level and a law was passed to create a network of research centers investigating the disease. The aim was to turn cancer into an illness from which to recover. The efforts of many researchers and government support led to positive results. Mortality from the disease decreased, but in public discourse, the term ‘war on cancer’ is still used. The militarized vocabulary of the struggle and battle for life refers to those who ‘won’ or ‘lost’ against the disease, whether they are celebrities or ordinary people. When one conducts a quick Google search for ‘war on cancer’, it leads to many articles about the medical and social aspects of this war, to the discourse on ‘winners’ or ‘losers’, and to the battle of doctors and patients against the sickness. Some doctors and journalists also call to abandon the use of the ‘war on cancer’ metaphor and apply the more neutral expression, such as ‘recovery from cancer’, or to say that “we are ‘living with cancer’ for as long and as well as we can”.
However, what happens to this militarized language during a real war? In this context, it is important to understand Ukraine’s experience since 24 February 2022, when Russia began its invasion of its territory. Tracking the connection between the ‘real war’ and the ‘war on cancer’ in the digital media can help us see certain trends that have been emerging since the first days of the war. It seems that militarized language in connection to cancer was not widely represented in the media or in broader public discussions in Ukraine before the war and rather emerged during it. For example, in June 2022, Professor of Zaporizhzhia Medical Academy of Postgraduate Education, expert of the Ministry of Health of Ukraine Oleksii Kovalov Kovalov published an article on cancer and war on the special medical portal Health-ua.com. In this article, he described “risk factors for the development of malignant tumors in the military and civilians during and after the end of hostilities”. Although he doesn’t utilize militarized language, I see this as an attempt to find a connection between war and cancer, to establish a relationship between them.
Similarly, a Google search for “war and cancer control” in Ukrainian yields primarily articles about cancer care during the war. In contrast, the only mentions of “war” or “fight” with cancer in the titles of articles before Russia’s full-scale invasion are the dates of international cancer days (e.g., Breast Cancer Day), and especially the general International Cancer Day on 4 February. This suggests that militarized language was underrepresented in the Ukrainian media before the war, With the outbreak of the war, however, the situation began to change and both vocabularies (the war itself and the war on cancer) began to resonate and grow in the media. In particular, the physical destruction of the medical infrastructure and the disruption of the usual system of cancer care since 24 February 2022 have become real battles for survival.
Google, however, leads to another type of article linking cancer and war when the search is in English (e.g., “cancer & war Ukraine”). The authors of these articles agree that a new, hitherto unknown situation has emerged in Ukraine that threatens to disrupt the oncological system of the country. For example, a representative of King’s College London, Richard Sullivan, suggests that the situation with cancer care in Ukraine is more complicated than in previous wars in Syria, Afghanistan, or Palestine: “One of these differences is the sheer volume of cancer care required for the Ukrainian population”. Negative metaphors of war also appear in another article by an anonymous author entitled “Russia’s war in Ukraine is killing cancer care in both countries”. It appeared in the digital edition of the journal The BMJ (British Medical Journal), one of the oldest and most cited scientific journals in the field of medicine. Reading it, you understand the author’s motives for anonymity. We can assume that they are familiar with oncology, especially in Russia. With the possibility of prosecution (or punishment) for using the words “Russia’s war in Ukraine” and “killing cancer care”, the author was forced to remain anonymous. Nonetheless, he/she tries to be objective in the text and assess the situation in the oncological system in Ukraine. The article’s title already presents a figurative and associative comparison of the oncological system with the combat space. Both have frontlines with killing, casualties, the wounded, and an enemy that brings destruction and extermination. That is, through metaphors of war, the anonymous author identified possible threats to and casualties among cancer patients and doctors, as well as the destruction of hospitals and violations of procedures and treatment systems. Notably, this article appeared on 23 March 2022, less than a month after the full-scale invasion of Ukraine. It was a prompt response to the dangers that the field of oncology in Ukraine may face.
In the first months of the war, other articles also described the oncological system as a theatre of operations and as an extraordinary and powerful event in the lives of oncologists and patients – such as, for example, the article “War in Ukraine and Cancer Patients: Early experiences from the frontline” in the oncology journal ECancer. They are all written by medical specialists, and their readership is mainly those in the same field or researchers of the history of medicine. Therefore, the information space here is specific and somewhat localized. Nonetheless, there is a pattern in the fact that the first militarized words about cancer and the war in Ukraine appeared in medical journals. They are tangential to the oncological sphere and sensitive to sudden changes in it.
The war has not only affected medical discussions about oncology, but also drawn broader media attention to the issue. Previously, medical issues, especially such sensitive ones as oncology, were rarely discussed, but now the problems of people diagnosed with cancer are brought into the public media space. Since the outbreak of the war, the number of publications about oncology has increased dramatically. And each of them contains the topic of war. For example, in March 2022, BBC News Ukraine published an article about children with cancer. One of the subheadings read, “they [the young patients] are fighting two wars”. The author of the article quotes pediatric oncologist Roman Kazym, who is “very angry about what happened [author’s remark: with Russia’s attack on Ukraine]” and regrets that “now these children fight two wars – one with cancer, the other with Russia”. Another article appeared in The Village, in which the author talks about the experiences of different people who are “fighting cancer during the war”. She relates the experiences of 17 people who had or learned about their ophthalmological diagnosis only on the eve of the war. These are 17 short stories, and each of them describes not only treatment, but also the war. The latter is presented as an event that complicated treatment, made the ‘fight’ more difficult, and became a ‘second war’. The words of one of the authors – that the war deprived her of “a chance to fight the disease” – sound like a verdict for many people in Ukraine who were diagnosed with cancer.
During the first two months of the war, articles about war and cancer began to appear first sporadically and then regularly. The publications featuring such articles range from local and regional media to central and official newspapers. These digital publications of differing status, purpose, frequency, and scope of distribution raised the issue of cancer in their discussion of the war. The only component uniting these articles is the use of exclusively military vocabulary and cancer. Frequently, they used phrases such as ‘second war’, ‘second front’, ‘war to the power of two’, and ‘two wars’.
Military vocabulary occurred in both the headlines and the texts of these articles. The headlines usually compared or identified war and cancer. The texts often also featured metaphors for heroism, endurance, and courage. For example, one article includes the phrases “I stood in line for chemotherapy for seven hours” and “the only chance to survive is to go abroad”. The articles seem to be set in a combat space where there are literal and metaphorical enemies, defense forces, and military tasks. In addition, for successful conduct during the war, new military tactics, methods, and circumstances of treatment are needed. Even doctors and organizations that support cancer patients have switched to military rhetoric: “One war [was] with cancer, the second – in Ukraine. It was sheer despair,” recalls Olena Semenyuk, coordinator of the support program for the Tabletochki Charitable Foundation, about the first months of the war. Readers get the impression that new operational bases are formed from patient communities and charities, which seem to take command of the ‘oncological front’. Moreover, the use of military vocabulary appears naturally, so the reader may not even think about it. It seems to have organically entered the public information space surrounding cancer. In times of war, militarized metaphors are part of everyday life. People start comparing the world around them to war and military metaphors.
Nevertheless, some emotional remarks, like “it was sheer despair”, make you stop and wonder: What really happened in the first two months of the war with the state’s cancer treatment service? Moreover, who led this service during that time? Obviously, states and local medical structures temporarily lost control of the situation. Various patient communities and charitable and medical organizations took over the management of the process. Therefore, it is not surprising that Volodymyr Zelenskyy, the President of Ukraine, declared the “complete stop of the treatment of cancer patients”. “Complete stop” meant the disruption of the entire cycle and system of providing cancer treatment and care, with hospitals, partially or completely destroyed, without patients and doctors. This is the reality of war: when everything is being shelled, patients and doctors are evacuated and all planned operations are stopped. In other words, during the first two months of the war, the destructive processes that doctors metaphorically warned about in their digital medical media took place: the destruction of hospitals, restrictions on medical care, migration of doctors and patients to safe areas, and the need for global cancer care.
Here, I can also see a comparison with the events of the Second World War, during which the oncological system underwent the same destruction. At that time, oncological care was provided in extremely difficult conditions, “the premises and equipment were looted, patients were treated in buildings half-destroyed during the bombings.” Scientific and medical institutions were evacuated to the rear, to safer areas. Many doctors and midlevel medical personnel were also drafted into the army. During the war itself, some prominent scientists died. One big difference now is time: what happened over five years during WWII occurred in six months of the current Russo-Ukrainian War. The slogan ‘Never again’, associated with the tragedies of WWII, remains, unfortunately, only a phrase.
Terribly, in the current Russo-Ukrainian War there have been unexpected losses of doctors. This occurred not on battlefields, where doctors were mobilized to the Armed Forces of Ukraine, but from the Russian bombing and shelling of peaceful Ukrainian cities. In addition, these losses became a tragic part of the newly created information space about cancer and war. For example, during the shelling of Kyiv, Oksana Leontieva died on the way to the hospital Okhmatdyt, where she worked in the bone marrow transplant department for 11 years and treated children with blood cancer. Taras Gavrilenko, an oncological surgeon at the Zaporizhzhia Regional Anticancer Center, was killed during the rocket attacks on Zaporizhzhia. The same fate befell Yevhenii Lutsenko, a young and promising oncological-thoracic surgeon at the Center for Modern Oncology in Chernihiv. All this brings to mind the words of Hryhoriy Klymniuk, a children’s oncologist at the National Cancer Institute: “overcoming cancer in military conditions is almost a [death] sentence.” This is difficult to read considering that every oncologist saves hundreds and thousands of lives, and especially when knowing the hopes for recovery of thousands of people who are ill in Ukraine. The scale of the disaster as stressed by Sullivan when he writes of “the huge amount of cancer care that Ukrainians need” is evident.
Up until 24 February 2022, there were 1.3 million cancer patients in Ukraine, a country with a population of 44 million. Over the past 10 years, the incidence rate has increased almost 35 times. Every year, there are about 160–180 thousand new cases. Moreover, more than half of them are residents of the eastern part of Ukraine, where fighting is now actively underway. The last two pandemic years somewhat slowed down the usual rhythm of cancer detection and treatment. The number of newly discovered cases and deaths decreased. Doctors expected a boom of newly diagnosed patients in 2022, with most of them in the last stages of the disease. Many doctors and managers were ready to implement changes that would improve the cancer situation. In particular, the agenda included an increase of the funding to the medical guarantees program and a transition to a new prevention and treatment practice. To modernize health care, the construction of a new oncology center with the latest technologies was planned in Kharkiv for 2022. It would have been a stronghold for providing assistance to several eastern regions simultaneously. But the war nullified these plans, as well as the general availability of timely treatment and assistance. Many people had to face the problem of stopping cancer treatment and care. There are thousands of such cases and each person faces the decision of what to do instead.
There have also been changes in the rhetoric of the patients themselves, who described their stories to journalists after February 24. One could claim, that some of them began to talk about undergoing treatment during the war as a heroic deed, about medical personnel as heroes, and about themselves as ‘winners’ in the war. They used metaphors of ‘heroism’ to describe the process of undergoing chemotherapy: “extreme”, “heroic” eight hours of waiting in line for an appointment or hunting for medicine and medical instruments. From the occupied territories, patients added to the theme of ‘heroism’ descriptions of how they managed to get to and inside medical institutions: “[we] stood under the scorching sun for four hours”, “it was necessary sail by boat to get treatment”, or “I will never forget how we drove under shelling, and how [they] inserted a catheter for 30 minutes, also under fire”. Journalists also contributed to this idea of heroism in their comments: “They are used to fighting, but now they are forced to battle on two fronts”. This use of the military metaphors ‘fighting’ and ‘two fronts’ emphasizes and enhances the importance of survival, turning the healing process into a frontline of war. War and cancer treatment become close in their significance and semantic content. Sometimes, patients and their loved ones took the stress of war as an incentive for recovery: “Due to an emergency, patients recovered 3–4 times faster”.
Nevertheless, their stories carry despair, fatalism, and a feeling of helplessness. Patients talked about going to where there are doctors, hospitals, medicine, and equipment as their only chance of being saved – that is, either to Western Ukraine or abroad. They described their search for treatment as more difficult, exhausting, and destructive now: “[my] panic attacks started from fear about where and how to be treated now, and [I] lost six kilograms in a week because of this”. Others believed that the only chance to survive was to travel abroad. People were frightened by an uncertain future, the fate of abandoned homes, and the difficult pursuit of survival. By telling such stories, they reinforced the devastating aspects of the war, showing themselves as its unjust victims. Only later, when they managed to improve their situation, they felt calmer about themselves, their lives, and their experiences. The hope for survival is full of references to treatment abroad. Nevertheless, there are few such statements among the patient stories in Ukrainian online publications. Their life experiences are mostly represented on social networks and only sometimes in such online publications.
Lastly, articles about the initiatives of some patient and charitable organizations and volunteers are unexpected and inspiring. They allowed cancer patients to navigate extremely difficult conditions and helped them make important decisions. Above all, the activities of two Ukrainian organizations helped cancer patients, even before the war. These are the charitable foundation Inspiration Family and the patient organization Athena: Women Against Cancer. Both were created by people who themselves once faced this disease. The war greatly changed their activities, forced them to respond quickly to challenges, and turned them into important agents of influence. In the first three months of the war, they received more than 3,000 appeals from cancer patients. According to Anna Uzlova, the head of Inspiration Family, “the first week was psychological hell… I just sat at the computer and kept answering questions. The number of requests was tearing me apart”.
In interviews, participants of organization say that many people turned to them for help with finding doctors, medication, and money. Later, they organized a network of free online consultations with oncologists and created Telegram groups, Facebook pages, and Instagram posts. They provided information about the Contact Center of the Ministry of Health, the possibility of obtaining treatment and residence in Western Ukraine, and the availability of oncological drugs. A new feature of their information campaigns was the possibility of treatment abroad. There was information about free assistance for Ukrainians through the REGINA MARIA – Rețeaua Privată de Sănătate network in Romania, the National Cancer Institute in Lithuania, and the OmeaLife Foundation in Poland, among others. Another important area of work was collecting information about the required medication that had run out and the writing of letters of requests for humanitarian assistance from foreign manufacturers.
Strikingly, their rhetoric, their descriptions of the events, and the words they used to express their feelings have changed since the start of the war. “Russia doesn’t only kill with bombs” is how they defined their experience and the reality they faced in the first months. The destruction of the established system of cancer care led to numerous invisible victims of the war. Many patients could not get help on time and began to die. Getting to the hospital was heroism, a brave and courageous act. Scientists estimate that at least 3,600 more deaths from cancer are expected in the following years, according to their statements to the media. Because of the war, patients began to express their thoughts and experience events through militarized metaphors and to describe the world in which they sought cancer treatment through the language of war, fighting, and combat.
The phenomenon of the militarization of the oncological sphere is evident since the start of the war. In online publications of various fields and types, the number of articles on cancer, expressed in the language of war or compared with it, has increased significantly. These articles heroise or victimize cancer patients, doctors, patient organizations, and charitable foundations. The language of military metaphors make these stories visible and accessible and allow the reader to perceive their attitudes toward reality. The ‘second war’ and the ‘to the power of two’ are the most common militarized metaphors, which emotionally color the experiences of those connected to cancer and reveal the depth of the humanitarian crisis caused by the war.
The militarization of the oncological sphere during the war is not only a prompt reaction to the new situation in the Russo-Ukrainian War, but also impacts and transforms it. More than before, the voices of people who are marginalized and made taboo because of the disease have a wider reach. They are recognized as more involved in socially important processes, and their stories become valuable to society.
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Olha Labur is a historian from Kyiv who researches women’s experiences in the 20th century. She works as an associate professor in the Department of History of Igor Sikorsky Kyiv Polytechnic Institute. Since 2017, she teaches the post-graduate course “The Gender History of Ukraine”. She is a member of the Ukrainian Association of Women’s History Researchers and of the Gender Center at Igor Sikorsky Kyiv Polytechnic Institute. In the spring of 2022, she received a scholarship from the Free University in Berlin. Previously, Olha was on the organizing committee and a participant of the fifth and sixth International Scientific and Practical Conferences, “Women in Science and in Education: The Past, the Present, the Future” (2010 and 2011). She also taught the online course “The History of Ukraine, 1917”. Of the ten lectures, one of the topics was “Interesting Women” during the revolutionary year 1917. In 2016, as a part of the screening of the film The Right to a Woman (1930), directed by Oleksiy Kapler, Olha gave the lecture “The Right to a Woman – The Right to a Burqa” in cooperation with Maryna Voronina. Olha Labur is a 2022/2023 Prisma Ukraïna Fellow at the Forum Transregionale Studien from October to December 2022.
Other recent articles in the TRAFO series War, Migration and Memory:
Olha Haydamachuk, The ‘Emergency Grab Bag’ of Memory, or the Tonalities of News Headlines About the War in Ukraine – Part Twо, 22 June 2023
Alina Mozolevska, The Power of Maps and Geographic Imagery in Digital Communication: Narrating Russia’s War in Ukraine, 4 May 2023
Mykola Homanyuk and Janush Panchenko, From a Pilfered Nail to a Stolen Tank: The Role of a Media Event in the Consolidation of the Ukrainian Political Nation, 4 April, 2023
Citation: Olha Labur, Militarized Cancer: People with a Diagnosis and the War in Ukraine, in: TRAFO – Blog for Transregional Research, 13.07.2023, https://trafo.hypotheses.org/47898