D27-05 Navigating Care for Individuals With Cystic Fibrosis Affected by the Gaza War: Insights From a Single Center

Abstract Cystic fibrosis (CF) is a progressive multisystem genetic disorder caused by CFTR mutations, leading to chronic pulmonary disease, malabsorption, and complications including liver disease and diabetes. In resource-rich countries, advances in newborn screening, airway clearance, antimicrobials, nutrition, and CFTR modulators have improved quality of life and extended survival beyond 50 years1,2. In contrast, children with CF in low-resource or conflict-affected regions face limited diagnostics, restricted access to medications, lack of multidisciplinary teams, and minimal follow-up support. In Gaza, where CF prevalence is ∼7.52 per 100,000, many patients carry modulator-eligible variants such as F508del but experience clinical decline due to lack of standard therapies³. This case series describes clinical and ethical challenges in managing two pediatric patients transferred to a U.S. center via the Palestinian Children’s Relief Fund (PCRF). Case 1 A 6-year-old male with pancreatic insufficiency was transferred after displacement from Gaza. He had Pseudomonas infection, recurrent exacerbations, malnutrition, and likely deficiency-related vision impairment. He had no access to spirometry, airway clearance devices, dornase alfa, or inhaled antibiotics. Chest CT showed mild bronchiectasis. He received antibiotics, airway clearance, nutrition support, and caregiver teaching. Genotyping revealed D1270N (modulator-eligible). Visa limitations required return to Cairo, raising continuity-of-care concerns. Case 2 An 11-year-old female with advanced lung disease, pancreatic insufficiency, CF-related liver disease, and severe malnutrition arrived in respiratory distress requiring PICU care. CT showed extensive bronchiectasis and cirrhosis. Genotyping showed F508del and p.Arg697Lysfs*33, qualifying her for Trikafta. Her course included multidrug-resistant Acinetobacter and growth failure. She experienced significant trauma, including family loss and displacement. She also returned to Cairo due to visa restrictions. Discussion These cases illustrate profound global inequities in CF care. Children in conflict zones face preventable morbidity due to lack of basic therapies. While both patients briefly accessed standardized care, limited health literacy and high treatment complexity posed challenges. Both required psychiatric and social support. Transitioning back to low-resource settings raises ethical concerns, particularly regarding access to modulators. Improving equity requires sustained global partnerships, policy advocacy, and long-term care infrastructure development. This abstract is funded by: none