“WE LOSE 60 women with breast cancer for every one hundred that we treat,” the medical director of the Al Ahli Arab Hospital, in Gaza, Dr Maher Ayyad, says.
“Our limited resources, and the blockade all around, make the treatment and prevention of cancer very difficult,” he says.
Breast cancer is the biggest killer of women in Gaza. “There is a clear rise in the incidence of all cancers in Gaza,” the head of the World Health Organization (WHO) in Gaza, Dr Mahmoud Daher, says. “But this is not so different from elsewhere in the world. The issue is the treatment: the success rate here is actually going down.
“In Gaza, only 46 per cent of women with breast cancer survive the first five years from diagnosis. In Israel, a few miles away, the survival rate is 87 per cent; and in Jordan about 67 per cent. And, in 2010, the five-year survival rate in Gaza was actually 59 per cent.”
The Al Ahli Hospital — the oldest and the only Christian hospital in Gaza — is proud of its improved diagnostic capabilities, and is encouraging patients to come forward for screening.
“The problems start after surgery,” Dr Ayyad explains. “Because drugs are very expensive, we refer patients to the government hospital, Shifa, to have chemotherapy. They give a first dose, a second dose; then for the third dose they say, ‘We don’t have this medicine; so we will change to another,’ which is bad for the patient.
“After they have finished the chemotherapy, they need radiotherapy, but we don’t have radiotherapy in Gaza. We have to refer the patient to travel outside.” The route to Israel and the West Bank lies through the Erez Crossing. Steel turnstile gates stand at the end of a long walkway, fenced in with wire. Beyond the wire and steel is a long line of passport-control booths, of which only two are manned.
“The ability of these people to go out of Gaza is deteriorating. For instance, in 2015, about 80 per cent of those who wanted to go out of Gaza Strip were receiving permits to go out. At the end of 2016, only 60 per cent, ” Dr Daher says.
For those who succeed in making the journey, the pale stone tower of the Augusta Victoria Hospital, in east Jerusalem, rearing high above the Mount of Olives, must be a welcome sight. It has the only comprehensive oncology department with access to radiotherapy for the five million Palestinians of the occupied territories.
In a crowded upper corridor, Nura Aliyan, a 44-year-old woman from Gaza, waits to go home after chemotherapy. “She must stay two weeks at home, and then return,” a senior nurse, Mohammed al-Qadi, says. “But she does not know if she will be allowed back here for the next dose. Chemotherapy patients from the West Bank have written permission for three months, but the Gaza permissions are written for one day only: if they stay longer, they face arrest.”
Delays in getting permits are costly. Sama’a, aged 36, after a mastectomy and chemotherapy in Gaza, was referred to the Augusta Victoria for radium in 2016. A biopsy showed that the cancer had spread to the left side. She had to return to Gaza at the end of the radiotherapy treatment, and then waited three months for permission to come back to the Augusta Victoria, during which time the tumour had spread considerably.
Finally returning, in May 2017, she was told that her condition was now complicated enough to rule out surgery on the second breast. She was prescribed a new chemotherapy drug, perjeta, as herceptin was no longer effective, but was told that it would require private funding.
Travel difficulties are particularly acute in the case of babies and young children, since mothers, because of their youth, are deemed a security risk. “Unfortunately, many mothers are forbidden to come here; so you will see nine grandmother-companions and one mother-companion as a percentage,” Mr al-Qadi says.
Dr Ayyad and his team are hoping for a partnership with a United States cancer organisation, MD Anderson, which would offer training for specialist doctors, but not funding for the linear accelerator needed for radiotherapy.
The Archbishop in Jerusalem, the Most Revd Suheil Dawani, would like the Al Ahli to become a centre for cancer treatment. “We are committed to working with all parties — Israeli and Palestinian — to provide the very best cancer treatment we can in Gaza,” he says.
A mission from the WHO will enter Gaza in early June to assess the situation of cancer management. The combined cost of specialised buildings and radiotherapy equipment for two hospitals is estimated at about $US30 million; the cost of a single linear accelerator is about $US6 million.
But all healthcare is taking place against the increasingly harsh conditions of the siege, imposed on Gaza in 2007, when Hamas first took power. “Over 43 per cent of our people are unemployed, and 80 per cent are partially or wholly dependent on humanitarian aid,” Dr Ayyad says.
There is anecdotal evidence from young Gazans of a rising suicide rate. “The deteriorating social economic conditions make the people much more vulnerable. . .
We urgently need to break the blockade in order to give the people hope that they will have change in the future,” Dr Daher said.
“We still have hope, but it is faint. We need help to keep it alive,” Dr Ayyad says.
For more information about the Al Ahli Hospital and its work in Gaza, visit www.j-diocese.org.