“I haven’t had my medication for months. I live on painkillers, anti-clotting Glexan injections, thyroid drugs, to name but a few of the drugs I need to take daily but can’t because they’re no longer available at a subsidized rate. I simply can’t afford to buy them privately. My teeth need urgent dental care because of all the chemotherapy I had, but can’t afford the treatment either. The latest PET scan I had showed two lumps in the thyroid gland that need to be removed and examined urgently. I’ve been waiting for over a month to be assigned an appointment for a biopsy, but haven’t heard anything and was told by my surgeon in Gaza that there are no operations available at Ash Shifa [Gaza] hospital before 2020.
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"It’s disastrous to be a cancer patient in Gaza. It’s humiliating and undignified. It’s being sentenced to a slow death. Cancer treatment is not available in Gaza and access to treatment outside of Gaza is controlled by the Israelis, the Egyptians and the Palestinian Authority, none of whom seem to care, take our condition seriously or deal with us in urgency. For them we’re just numbers. We’re just patients who are awaiting their death. Not people who have the right to access treatment with dignity, or people who might survive and live, and who have families and loved ones.
"Being a cancer patient is physically, psychologically and financially exhausting. We have to take care of all the procedures ourselves. We have to apply for the financial coverage for our medical referrals and for the Israeli permit to leave Gaza, and have to reinvent the wheel every time we need to leave Gaza for treatment. This can take weeks, even months. We have to wait in suspension, and be always ready to leave when we receive a message of approval from the Israelis. The text message sent to our mobiles often arrives either the night before the appointment or on the same day and the permit is valid for a day.
"I had to wait for five months before I received the Israeli permit to leave for East Jerusalem, by which time cancer had spread to new locations. After this I had to interrupt my chemotherapy three times because my permit application was pending, during which cancer had spread to the bone marrow.
"Although much of the medical treatment is financially covered by the Ramallah-based Palestinian Ministry of Health, I still had to take a huge loan to pay for my five-month trip to Egypt in 2013. Medical referral to Egypt doesn’t cover accommodation, living expenses and medical tests that are not available at hospitals. Since the Palestinian Authority cut down my salary by 40 per cent in March last year, I can no longer cover the loan’s monthly repayment. I’m left with no money. Every time I need to go to Jerusalem I have to borrow money from friends. The journey to Jerusalem cost between 75 to 450 shekels ($21-$127). And if I have a test in Tel Aviv, I have to pay another 600 shekels ($170) for a cab to take me there. I had to sell the furniture in my house to afford a journey to Jerusalem. Seven of my older children are university graduates, but are all unemployed. I find all this very humiliating.
"My doctor says I have to follow a nutritious diet and be positive. If I can’t afford to buy painkillers, or basic food – how would I afford nutritious food which is more expensive?!! How can I feel positive if I feel anxious about being able to leave for treatment?! How can I be relaxed if my medication is not available and I can’t afford it?! Or when I need to cross a military checkpoint to receive treatment?! Or have to do all the journeys to Jerusalem and back to Gaza all by myself, with no companion?!! How can I be relaxed when our everyday existence is out of our hands?! When the basic things like having access to clean running water is nonexistent? Electricity is available for four hours a day, during which I have to do all the washing, cooking, and baking.
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"Being a cancer patient in Gaza is being under siege: a siege of medication, siege of permits, siege of food, salaries and [border] crossings. It’s being under enormous psychological stress. But despite all this, I have to be strong, if not for myself, for my children.”
That is the story of Hana (a pseudonym), a 53-year-old refugee and mother of 10 children from Gaza, who is a cancer patient. This story is hardly unique: It’s the story of many cancer patients in the Strip whose access to treatment is being politicized and compromised by Israel’s 50 years of occupation; its more than 10 years of land, sea and air blockade; the bitter Palestinian political divide between the Ramallah-based PA and the Hamas authorities that govern Gaza – in addition to the recurrent closure of the Rafah crossing on the Gaza-Egypt border.
A newly released report by the World Health Organization indicates that 2017 witnessed the lowest number of Israeli permit approvals for patients leaving Gaza for treatment since 2008. Only 54 percent of patients’ applications to leave via Israel's Erez military checkpoint were successful in 2017, compared to 93 percent in 2012. Fifty-four patients died while awaiting approval to leave, 46 of whom were referred for cancer treatment or examinations.
In December 2017, three out of five companions of cancer patients were unsuccessful in obtaining a permit to leave Gaza via Erez. The Rafah crossing, which has been mostly closed since October 2014, was open for only four days in both directions in December 2017.
The rather grim figures from the WHO come in the context of recent alarming reports by the United Nations and the Israel Defense Forces' chief of staff to the effect that the Gaza Strip with its population of almost two million – half of whom are children – is on the verge of a humanitarian collapse.
Since April 2017 and the shutdown of the sole power plant in Gaza, critical services in the fields of health, water, sanitation and solid-waste collection have been operating according to an emergency fuel plan devised by the UN to run back-up generators. Between the end of January and early February, two hospitals had to be shut down; one was a psychiatric hospital, the soul mental health facility. Another hospital and 13 primary healthcare clinics were partially closed.
Out of 516 essential drugs, including those used in emergency-care departments, 40 per cent were completely depleted, as were 23 percent of 853 essential disposables. Electricity is supplied to Gaza households for 4 to 6 hours a day, and piped-in water for a few hours every four to five days. As 97 per cent of water in Gaza is unfit for human consumption, desalination plants have become the main source of drinking water, and these have been operating at less than 60 percent of their capacity.
Without a constant supply of emergency fuel, 55 cesspools will overflow with raw sewage, and the daily capacity to collect 1,700 tons of solid waste will be cut by one-third, rendering thousands of Gazans vulnerable to water-borne diseases. In the third-quarter of 2017, the unemployment rate was 46.6 per cent, 64.9 percent among youth and 71 percent among women. More than 70 percent of residents in the Strip receive some form of international aid, the majority of which is food assistance.
Gaza’s humanitarian crisis is manufactured and political. Fifty years of Israeli occupation, including a decade of blockade and isolation, and three devastating wars in the space of less than 10 years – since Operation Cast Lead, in December 2008-January 2009 – compounded by what seems like an irreconcilable Palestinian political divide, have left Gaza’s population and infrastructure in a state of unnecessary suffering, dependency and de-development. Allowing access to treatment and medical care for patients, especially those with critical conditions, regardless of age, sex or political-affiliation should be a priority.
“We’re humanitarian cases. We’re not a threat to anyone. We want to receive our treatment with respect and dignity,” concluded Hana.
Dr. Manal Massalha is a London-based urbanist and photographer. She researches the Palestinian city and space in Israel and the occupied Palestinian territory.