Patients queue from midnight to get appointment for cancer treatment

It was 4:00 am on 15 October 2026. We set off for the National Institute of Cancer Research and Hospital in Mohakhali, Dhaka. The roads were empty, and the journey did not take long. We arrived just before 4:30 am.

At the collapsible gate of the hospital's administrative building, we found around 50 people. Some were lying on mats or sheets spread on the floor. Others had nothing and were sleeping directly on the floor. A few had mosquito nets. Mosquito coils were burning near some people's feet. To keep mosquitoes away and cope with the heat, some were sitting and fanning themselves with hand fans.

One of those lying on a mat was Ismat Ara Begum, aged over 60. She was thin, but her legs were swollen. Every now and then, Ismat Ara would cry out in severe pain, her voice faint but intense. Her helpless relatives could do little beyond gently stroking her body.

Nearby, we found Faruk Howlader, Ismat Ara's nephew. He said they had come from Bikrampur. Ismat Ara has cervical cancer. After coming to Dhaka, they first went to Dhaka Medical College Hospital. From there, she was referred to the Cancer Institute three days earlier. For the past three days, doctors had been asking them to undergo various tests. To get an appointment for the tests, patients' relatives have to queue from midnight the previous night.

Faruk said they had not been able to get Ismat Ara admitted to the hospital. Doctors told them she could be admitted after reviewing her test results. At night, he stays with Ismat Ara in front of the administrative building. In the morning, hospital Ansar personnel start blowing their whistles, forcing them to leave the area. They then carry Ismat Ara inside the administrative building and lay her on the floor.

Speaking with a mixture of helplessness and anger, Faruk said, "If we have to leave the patient like this, how will she survive? We have come to this government hospital because we are poor."

Tipu Sultan, a resident of Mohammadpur in the capital, was trying to secure an appointment for radiotherapy for his wife, Majeda Khatun, who has breast cancer. He was given a date in May next year. On 22 October last year, he wrote on Facebook: "Radiotherapy is needed immediately, but I have been given a date in May 2027. How can a cancer patient wait so long for treatment?"

We contacted Tipu Sultan. He said his wife was diagnosed with cancer last year. After initially receiving chemotherapy, she underwent surgery at the Cancer Institute last September. They are still waiting for an appointment for radiotherapy.

When contacted again on 10 November, Tipu Sultan told Prothom Alo that his Facebook post about the radiotherapy appointment had caught the attention of the director of the Cancer Institute. The director had asked him to meet. Finally, on 10 November, his wife underwent a CT simulation test, a preparatory procedure to determine the treatment plan before starting radiotherapy. He now hopes she may not have to wait until May 2027 for the treatment.

The National Institute of Cancer Research and Hospital is the country's largest specialised institution for cancer treatment. Cancer patients and suspected cancer patients seeking treatment at government hospitals at the upazila and district levels across the country are referred to this hospital. It is also the last resort for poor patients. Diagnostic tests are relatively inexpensive, medicines cost less, and treatment is provided free of charge.

However, the difficulties in accessing treatment at the hospital seem endless. Patients' relatives queue from midnight to secure appointments for diagnostic tests. Over the past 12 years, the number of beds at the hospital has increased, but its workforce has not. Some medical equipment has remained out of order for a long time. Meanwhile, cancer patients continue to arrive from across the country. The hospital authorities are unable to ensure timely treatment without the associated suffering.

On that day, 15 October, after witnessing the suffering of patients and the helplessness of their relatives at the Cancer Institute, we went to the office of its Director, Professor Mostafa Aziz Sumon, shortly before noon.

He told Prothom Alo that giving a patient who needs radiotherapy an appointment in 2027–28 would be as good as not giving one at all. That is why patients' relatives have been asked to contact the hospital every six weeks in case an appointment becomes available. He said the hospital now provides radiotherapy in three shifts until late at night to cope with the pressure. Even so, the number of patients continues to rise.

Access to treatment is everyone's right. But doctors at the National Cancer Institute have to make choices about which patients have a better chance of survival. They admit this themselves.

Asked about the issue, Director Professor Mostafa Aziz also sounded helpless. He said managing the patients was a major challenge.

There are no accurate statistics on exactly how many people in the country are living with cancer, how many die from the disease each year, or how many are newly diagnosed. No nationwide survey has been conducted on the issue.

However, according to the latest (2024) estimates by Globocan, an agency affiliated with the World Health Organization that focuses on cancer, around 187,000 people in Bangladesh are diagnosed with cancer every year. Around 138,000 die from the disease annually. Meanwhile, 358,000 people are living with cancer (patients diagnosed within the past five years). This means an average of 21 people are diagnosed with cancer every hour, while 16 die from the disease.

According to Globocan, 32 types of cancer are prevalent among people in Bangladesh. The five most common types are oesophageal, lung, stomach, lip and oral cavity, and cervical cancers.

Cancer affects men and women differently. Some types of cancer occur only in women. The five most common cancers among women are cervical, breast, oesophageal, lung and stomach cancers. Among men, the five most common are oesophageal, lung, stomach, lip and oral cavity, and hypopharyngeal cancers.

These statistics, however, do not provide an accurate picture of the country's cancer situation. Three cancer specialists and a public health expert told Prothom Alo that a population-based cancer registry is the way to obtain an accurate picture of the country's cancer burden.

A team of researchers led by Associate Professor Md Khalequzzaman of the Department of Public Health and Informatics at Bangladesh Medical University is conducting a population-based cancer registration study in Hossainpur upazila of Kishoreganj district. Among a population of 250,000, cancer has been detected in 116 people. The researchers found that 7.4 per cent of patients do not receive any treatment even after being diagnosed with cancer.

Experts say a population-based cancer registry is the most reliable way to establish a country's cancer profile. However, data from a small area such as Hossainpur cannot represent the entire country.

Md Khalequzzaman, the lead researcher of the cancer study in Kishoreganj, told Prothom Alo that conducting population-based cancer registration in eight to 10 regions of the country could provide a clearer picture of the national situation.

An official at the World Health Organization's (WHO) Dhaka office, who did not wish to be named, told Prothom Alo that the country lacks facilities for cancer screening and early diagnosis. There is a shortage of reliable cancer diagnostic facilities and trained personnel. The number of cancer treatment centres is also far below what is required.

Several cancer specialists told Prothom Alo that the country needs one cancer treatment centre for every one million people, each equipped with at least one radiotherapy machine. This is because at least 60 per cent of cancer patients require radiotherapy. A comprehensive cancer treatment centre also needs the necessary equipment and specialist personnel.

Professor Mostafa Aziz, director of the National Institute of Cancer Research and Hospital, told Prothom Alo that the country needs 200 to 250 radiotherapy machines, but only 31 are available. Of these, seven are in government facilities.

Apart from the National Cancer Institute, government facilities with radiotherapy machines include Bangladesh Medical University (BMU), Dhaka Medical College Hospital, a unit operated by the Bangladesh Atomic Energy Commission in Savar, Osmani Medical College Hospital in Sylhet, Chittagong Medical College Hospital and Rajshahi Medical College Hospital.

The remaining 24 radiotherapy machines used for cancer treatment are in private hospitals, almost all of which are located in the capital. As a result, cancer treatment remains largely Dhaka-centric.

During the tenure of the Awami League government, which was ousted in the July mass uprising, one building after another was constructed in the healthcare sector, but sufficient staff were not recruited. Meanwhile, a large number of medical equipment were purchased, but much of it remained unused. Equipment was often unavailable where it was actually needed.

For example, in 2012, the Health Ministry sent a linear accelerator machine to Khulna Medical College Hospital despite there being no demand for it. AFM Ruhal Haque was the health minister at the time. The machine cost Tk 100 million. The hospital had neither the specialised room (bunker) nor the manpower required to operate it. The machine has remained exposed to the elements for years and has never been used.

A major example of the lack of attention to cancer treatment, failure to recognise its importance and bureaucratic complications is the absence of medical physicists in government hospitals. Medical physicists are essential for properly operating equipment such as linear accelerators.

Experts have been calling for the recruitment of medical physicists in government hospitals since 2006. However, no medical physicists are being appointed in government hospitals. The Directorate General of Health Services and the Health Ministry are not giving the issue due importance.

Professor Habibullah Talukder, a former physician at the National Cancer Institute and a cancer epidemiologist, told Prothom Alo, "Cancer services in the country are unorganised, flawed and incomplete. That is why patients suffer so much. The suffering is not limited to this institution; it exists in almost all public and private hospitals across the country."

The country also lacks a leading figure or institution in cancer care. Professor Ibrahim and the Bangladesh Diabetic Association have helped the country make significant progress in diabetes treatment. Thanks to Brigadier General Abdul Malik and several others, cardiac treatment in the country has become much more advanced and, in some areas, reached international standards. The International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) is a world leader in cholera and diarrhoeal treatment. In cancer care, however, no individual or institution has emerged to provide comparable leadership.

Health Minister Sardar Md Sakhawat Hossain has said the situation will change. Speaking to Prothom Alo on 8 November, he said, "There has been no development in the health sector over the past 17 years. There has only been plunder. Cancer care is no exception. However, we have taken initiatives to recruit manpower, purchase new and modern equipment, and establish institutions. People's suffering will certainly be alleviated."

The National Institute of Cancer Research and Hospital began its operations in 1982 in a tin-shed building at Dhaka Medical College Hospital. In 1986, the hospital was relocated to Mohakhali.

In 2015, the national institution was upgraded to a 300-bed hospital. It was subsequently expanded to 500 beds in 2018 and, most recently, to 700 beds on 16 September. Administrative approval was also granted to provide treatment to patients in an additional 200 beds. However, the workforce remains based on the 300-bed capacity. Even then, not all approved posts are filled.

The hospital has 1,197 approved posts based on its 300-bed capacity. According to information received from the hospital on 8 November, 244 of these posts are vacant. Hospital Director Professor Mostafa Aziz told Prothom Alo that at least 1,600 additional personnel are needed to run the institution. He has requested the government to provide the manpower, but the Ministry of Public Administration has approved only 200 posts.

Several machines at the hospital have expired, while some are out of order. Five machines in the Department of Radiation Oncology—two linear accelerators, two simulators and one brachytherapy machine—and three machines in the Department of Radiology and Imaging—two CT scanners and one mammography machine—have exceeded their service life. These are no longer used. The hospital's only MRI machine has been out of order since 2023.

The country's largest government hospital is providing radiotherapy using only two machines. At most, 250 patients receive this service every day. On average, each patient requires six weeks of therapy. Once treatment for 250 patients is completed, another 250 begin their sessions. As a result, there is a long queue of patients.

Hospital authorities said that until recently, patients were being given appointments for radiotherapy in 2028. Following criticism over the long waiting period, the authorities changed the appointment system. Patients are now asked to contact the hospital every six weeks to check for available slots. In April this year, the number of patients who had applied for radiotherapy was 6,500. By November, the figure had risen to 8,000.

Professor Parveen Shahida Akhtar, president of the Medical Oncology Society of Bangladesh, told Prothom Alo, "There are clear guidelines on when radiotherapy should be administered. Patients recover when it is given at the right time. If patients do not receive radiotherapy on time, their lives are put at risk. Giving radiotherapy six months or a year later to someone who needs it now is meaningless."

With government treatment facilities limited, patients from across the country are referred to the National Cancer Institute. During visits to the hospital in the early hours of the morning, in the morning and at noon on 15 and 25 October, 8 November and 11 November, we witnessed almost the same scene: an apparently endless stream of patients. There were crowds at the ticket counters and in front of different departments. Unable to find places to sit, people had made arrangements on corridors and floors on different levels of the hospital.

At around 5:00 am on 15 October, we went to the ground floor of the hospital building and saw a crowd gathered in front of the Pubali Bank counter. It looked as though the staff inside would start calling out people at any moment. But the counter would not open before 8:00 am.

We asked a man who had come from Dinajpur, "What is your serial number?"

"Seven," he replied.

"But we cannot see anyone ahead of you," we said.

Smiling, he explained that six bottles of water and soft drinks are placed in front of him. That was how he had secured the seventh position.

Some people had placed not only bottles but also patients' files and bricks to reserve their places in the queue. Even while we were there, disputes over these serial numbers nearly turned into physical altercations among several people. One man showed a photograph on his mobile phone as proof that he had placed the bottles there.

As daylight began to break, the crowd in front of the toilets on the ground floor grew. One patient was taking a long time to finish bathing, while outside, an argument at the washing area was on the verge of breaking out.

By then, the scene in front of the administrative building had begun to change. Some people were folding their mosquito nets. Others were brushing their teeth with toothbrushes, charcoal or tooth powder. Some relatives were combing their hair or applying a little cream to their faces to prepare for the day. Those who had spent the night there had brought almost all the everyday household essentials with them. One person was even seen sitting on a mat and cutting vegetables.

There is a place near the hospital where people can cook. It costs Tk 10 to cook rice and another Tk 10 to prepare curry. However, long queues also form there.

Before 7:00 am, Ansar personnel began blowing their whistles. People who had spent the night there started packing up their temporary households. They stuffed everything into large bags, preparing for another day of struggle. Would they get a hospital bed? Would their names be called for the tests they had queued for, including echocardiograms? Everything was uncertain. They did not even know how many more days they would have to endure this suffering.

Patients living in Dhaka and its surrounding areas also began arriving. By 8:00 am, the pressure of patients and their relatives had made it difficult even to walk through the hospital.

We spoke to Mizanur Rahman, who works as an outsourced supervisor at the hospital. After his wife was diagnosed with breast cancer last year, she underwent surgery, chemotherapy and radiotherapy at the same hospital. In his view, the patient pressure at the hospital is enormous. He believes this pressure cannot be reduced unless modern hospitals are established outside Dhaka.

Patients also face various irregularities at the National Cancer Institute. There are allegations that patients have to pay bribes or tips to see doctors, undergo tests or secure earlier appointments for radiation therapy. A 2025 report by the Implementation Monitoring and Evaluation Division (IMED) of the Planning Commission stated that 41 per cent of patients faced harassment while seeking treatment at the Cancer Institute.

Cancer treatment takes a long time and is expensive. The disease often pushes families into financial catastrophe.

There has been little research in Bangladesh on the cost of cancer treatment. A study by Professor Syed Abdul Hamid of the Institute of Health Economics at the University of Dhaka and his colleagues found that the average cost of treating breast, cervical and oral cavity cancers is Tk 1.5 million. Among these, breast cancer treatment is relatively more expensive.

Another study conducted by Abdur Razzak Sarker, a researcher at the Bangladesh Institute of Development Studies (BIDS), and his colleagues found that 90 per cent of families face financial catastrophe while seeking cancer treatment.

A large section of wealthy patients travel abroad for cancer treatment, particularly to Singapore, Thailand, India and China. Ahmed Ehsanur Rahman, a member of the Health Sector Reform Commission formed during the interim government and a scientist at icddr,b, showed in one of his studies that cancer is the fourth leading reason why Bangladeshis travel to India for medical treatment. The three leading reasons are heart surgery, cataract surgery and kidney-related diseases.

One section of the middle class seeks treatment at private hospitals in the country, while another goes abroad.

For example, Yasmin Ara, a professor at a private university, was diagnosed with breast cancer in 2024. She told Prothom Alo that she opted for treatment at a private hospital in Bangladesh because of the suffering involved in getting treatment at government hospitals. Her treatment expenses so far have amounted to around Tk 2 million.

She also said her elder brother died of liver cancer on 21 October. His treatment in India and Bangladesh cost Tk 1.8 million.

Yasmin Ara is the president of Bangladesh Rogi Odhikar Songrokkhon Parishad (Bangladesh Patient Rights Preservation Council), which works for cancer patients. On 21 June, she organised a human chain in front of the Cancer Institute, demanding, among other things, an increase in the number of radiotherapy machines.

Yasmin Ara said she had to spend Tk 215,000 to obtain 15 sessions of radiotherapy at a private hospital. The cost is much lower at government hospitals. "But with cancer, patients cannot afford to simply sit and wait for their turn," she said.

On the other hand, Ismat Ara's family, whose case we mentioned at the beginning of this report, could not afford treatment anywhere other than a government hospital.

As we were finalising this report on 10 November, we called Faruk, Ismat Ara's nephew. He said Ismat Ara had died at 9:00pm on 15 October. Early that morning, we had seen her writhing in pain on the floor of the National Cancer Institute.

Faruk expressed his regret, saying, "We kept struggling to get my aunt treated at the hospital, but could not even get her admitted. In the meantime, she died."