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Doctors Say Stress in Prison Made Rajaei’s Condition Worse

September 11, 2017
Shima Shahrabi
5 min read

A photograph of journalist and activist Alireza Rajaei in hospital has been shared on social media, fuelling outrage and renewed calls for prison conditions to be improved in Iran. 

The photo, circulated on September 7 after Rajaei underwent 14 hours of surgery, shows the journalist lying in his hospital bed. The bandages seen in previous photographs, which had also been widely shared, have now been removed, revealing that his right eye has been closed up and that a significant part of his face, from under his right eyebrow to the upper jaw, has been removed. Large stitches surround the grafted skin. 

Rajaei is a prominent Iranian journalist and member of the political alliance known as the "Nationalist-Religious" Coalition, which is often seen as being in opposition to the government. For four years, from May 2011 to October 2015, he was in prison on charges of “acting against national security” and “propaganda against the regime." Immediately after being released from prison he sought treatment for a pain in the right side of his face, which he had been suffering from while in prison. He was diagnosed with advanced cancer of the sinuses, which had by then spread to other parts of his face.

According to Rajaei’s cellmates, the prison clinic treated him only with painkillers, administered through pills and injections. Prison officials refused to send him to a hospital outside the prison — disregarding the opinion of the prison’s own doctors.

“The symptoms started somewhere in early 2015,” Rajaei’s brother Gholamreza Rajaei, a medical doctor, told the newspaper Etemad on September 2. “He felt pain in his upper jaw and he got some relief by going to the prison clinic and taking painkillers. But in early summer of 2015 the tumor grew and protruded out of the sinus area. At that time, during my visits with him, I insisted on the need for a face scan.” He says that on five occasions, the prison clinic prescribed that his brother be sent to an outside hospital for a scan but, unfortunately, this was never done. “The face scan was done after his release and what was found was a malignant tumor that had spread.”

A day after Alireza Rajaei’s brother issued these statements, Gholamhossein Mohseni Ejei, spokesman for the Iranian judiciary, told a news conference [Persian link] that the reports of medical neglect were lies spread by media outlets outside Iran, including the BBC and Voice of America, and by Iranians who had escaped the country to work with Israel, the US and the UK. “This individual was released two years ago,” he said, “and when he was in prison he showed no symptoms of this disease. He has developed cancer like many others in this country who come down with cancer and die soon after.”

The Oncologist’s View 

Dr. J., an oncologist and a professor at Tehran’s Shahid Beheshti University, believes that while the stressful prison environment did not play a role in Rajaei contracting cancer, it definitely played a role in helping it to spread. “No textbook talks about a direct relation between developing cancer and various forms of stress and psychological pressure,” he says. “But a few years back, Australian scientists did an experiment that shows stress speeds up the spread of cancer. The researchers divided a number of cancer-stricken mice into two groups. They put the mice in the first group under increased stress and found out that stress causes cancerous cells to divide faster and metastasize into more tissues.”

Dr. J. says that he has personally observed this pattern among his own patients. “In patients who suffer from high levels of mental pressure, the treatment works more slowly and is less effective and the cancer advances very fast.”

Oncologists believe there is a direct relationship between how soon a patient seeks medical attention and how effective the treatment is, he says. “In other words, the sooner the patient is seen by the doctor, the better are the chances for treatment and for getting results. In his [Rajaei’s] case, the first symptoms appeared when he was in prison but when the cancer was finally diagnosed it was already advanced and had invaded neighboring organs, meaning that his sinus cancer had time to invade the eye and the jaw.”

Dr. J. emphasizes that both physical and mental stress can have an effect on how quickly cancer progresses, and prison life would have certainly contributed to that stress. “Sedentary living, lack of fresh air, electromagnetic waves used in some prisons for jamming wireless signals and even the bad quality of the food consumed can be factors in developing cancer or its spread.”

Stress and the Immune System

Dr. F., a specialist in internal medicine and a professor at Azad University, has also followed Alireza Rajaei’s case. He agrees that prison stress and pressures could have played a significant role in his condition. “Stress stimulates the hypothalamus-hypophysis [pituitary gland] axis and hypophysis’ secretions in turn stimulate adrenal glands to secrete a steroid called cortisol,” he explains. “High levels of cortisol can harm the body if they last for an extended period of time and suppress the body’s defense mechanisms. To put it more simply, stress weakens the immune system and lays the groundwork for cancer. A weakened immune system also makes it difficult to destroy cancer cells.”

He believes that the intensity of the stress and its duration is directly related to the development of cancer. According to him, research has shown that if an individual has experienced high levels of stress even before coming down with an illness, the body’s immune system is less able to fight the disease. “It does not matter whether Alireza Rajaei got cancer during his imprisonment or after it,” says Dr. F. “The stress and the psychological pressures of the prison played a role in him getting cancer and in its spread. The prison environment is one of the most stressful. Now imagine somebody who has suffered from it for four years.”

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Doctors Say Stress in Prison Made Rajaei’s Condition Worse