Cancer care crisis in Gaza

The cancer started in Fatima Hassami’s breast before spreading to her bones, leading to multiple fractures in her left leg and constant pain for the 70-year-old.



“I feel so sorry for my mother,” her daughter Ahlan Hassami said. “Every time she complains, I suffer with her.”



Fatima is among 15 cancer patients currently admitted to the oncology ward at Shifa Hospital, the largest such facility in Gaza. But the hospital, according to Ziad Khazander, head of the oncology department, has no medicine to treat cases like Hassami’s.



“She needs medication to strengthen her bones,” he told IRIN. “There’s a treatment available but we haven’t had the necessary drug here at Shifa for six months now.



“She has a spinal cord compression, which requires urgent radiotherapy. But because her bones are so weak and she already has multiple fractures it’s impossible to move her.”



Gaza is suffering chronic shortages of painkillers, surgical equipment and critical drugs, including for chemotherapy due to delays in the approval of drugs bound for Gaza by the Palestinian Authority in Ramallah and restrictions imposed by Israel’s blockade.



Radiotherapy is not available at all, according to medical sources. As a result, most cancer patients in Gaza have to be referred abroad for treatment, but this process can be costly, time-consuming and bureaucratic.



From a list of 460 essential drugs, Gaza’s health ministry medical store is currently missing 170 items, said the store’s director Mohamed Zemili. While the shortage has affected all departments in Gaza’s hospitals, oncology is among the hardest hit:



“For instance, we are currently missing a drug used to strengthen the bones of cancer patients,” Zemili said. “We haven’t had this for three to four months. We’re also missing painkillers. Without these drugs, patients are suffering greatly.”



According to Gaza’s health ministry, 1,523 cancer patients were referred through Egypt or Israel in 2010, of whom 165 were children.



Security concerns



The Israeli authorities say the transfer of medical supplies to the occupied Palestinian territory depends on requests from Gaza and is largely unimpeded, except when there are security concerns.



“All of the medical supply we transfer to Gaza is based on requests from Gaza and approval from the Palestinian Authority in Ramallah,” Maj Guy Inbar, the Israeli Coordinator of Government Activities in the (Palestinian) Territories, told IRIN.



“Israel only becomes involved when there is a security issue,” he added. “There are some drugs that have a dual use and can be used for terror activities. These, we will only allow to enter with international organizations. There is also some medical equipment, such as MRI and X-Ray machines, which can be used for terror.



“In 2010, 18,000 people and their companions passed from Gaza through Israel to receive medical treatment - 80 percent of applications were permitted to enter.”









''Circumstances here were better before the blockade - we were able to administer chemotherapy… We have seen an increase in mortality rates here because cancer patients are not receiving the right treatment, and they develop complications.''

The cost of hospital treatment outside Gaza is covered by the Palestinian Authority but travel, food and accommodation costs for anyone accompanying a patient, are not.



Security concerns also mean that anyone from Gaza accompanying a patient referred for treatment in an Israeli hospital cannot leave the hospital grounds during their stay. They are obliged to buy food from the hospitals’ shops and cafes. Yet, some courses of treatment require patients - and their companions - to stay in hospital for up to six months.



With more than 40 percent unemployment in Gaza, these costs can be crippling. As a result, some of the 100 cancer patients referred out of Gaza every month, Khazander said, could not afford treatment.



Costly treatment abroad



Wafer Abu Habel, 43, who has ovarian cancer, is in the room next to Hassami at Shifa. Before the February unrest in Egypt, Abu Habel had crossed into that country for a treatment to correct a fistula that had resulted from a particularly aggressive tumour.



Now she was back in hospital in Gaza within days of her return, with diarrhoea and pain. “We spent two and a half months in Egypt,” her mother Sobhaya Abu Habel said.



“We had to rent a flat and go back and forth from the hospital. The flat alone cost US$1,000 a month. We are both widows. I had to borrow the money from friends to pay for all this. We had a very tough time - it was so expensive we struggled to buy food.



Gaza, she believes, could offer equally good treatment. “It is just that they don’t have the facilities here or the medication,” she said. “They have good intentions but they don’t have the means to treat us.”



Khazander said his ward had struggled to provide adequate treatment despite the blockade. “Circumstances here were better before the blockade - we were able to administer chemotherapy,” he explained. “We have seen an increase in mortality rates here because cancer patients are not receiving the right treatment, and they develop complications.”



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