This session is a panel, and we have a number of speakers, local speakers from Palestine, and we also have international speakers who have been to Gaza who have done a lot of international work. The aim of this session is just to shed light on the struggle of cancer patients in Palestine, and specifically in Gaza, amidst everything that is happening now. Because when it comes to conflict, when it comes to political instability, when it comes to war, people tend to think of the immediate consequences of war, which is the number of people who have been killed, the number of people who have been injured, and it’s so unfortunate - the numbers are so heartbreaking it’s unimaginable. But at the same time, being in the healthcare field, we know that what’s coming is even harder. Because all patients with chronic diseases, especially cancer patients, have been denied treatment for months now. There obviously has been progress in their disease, and we expect to see a huge impact, negative impact, on the outcomes of their survival, their rate of relapse, their mortality, and all of it. All of it is going to be affected, and one of the things that people don’t pay attention to is that in the majority of conflicts, the majority of deaths actually happen because of the spread of infectious diseases and the progression of non-communicable diseases. That is an indirect consequence of war that we might not be able to see from the beginning.
We felt it is important for this international platform which we have, speakers from all over the world, to just shed light on their current situation, but at the same time provide context. Because this didn’t start a few months ago, it has a long, long history of struggle, of inequities, of discrimination, of lack of access, of limited resources. We just feel that by providing this context and also discussing what’s happening now and engaging all of the international community, we hope to come up with solutions on how we can help. Everyone’s feeling helpless these days, and we all want to do something, and by these collaborative efforts, I believe there must be something that we can do.
What is the cancer care situation in Gaza and the rest of Palestine like and what was it like before the war?
I’d like to start before October 7th. The cancer situation was dire from the beginning, because first of all the only comprehensive cancer centre is located in East Jerusalem. For patients residing in the West Bank and in Gaza they must obtain an Israeli permit, a medical permit, to get to East Jerusalem. A lot of these patients don’t get a permit, which means that they’re completely denied. When you’re talking about a cancer patient and you’re denying them treatment, that is a death sentence. You’re basically leaving them to die. A lot of patients have died, it’s been documented in the WHO reports. Their stories are so heartbreaking when you read them. They deserve more exposure, people need to know more, and even the ones who end up getting the permit, a lot of them get a lot of delays.
Imagine the delays in diagnosis, the delays in treatment, how much they affect survival. Actually, a study done by the WHO showed that patients who received denials and delays in their permit applications were 1.5 times less likely to survive cancer, which shows that there is a direct impact of this political situation on the health of patients, which puts a huge responsibility on the medical community, scientific community, everyone who is involved in healthcare on an international level.
By providing context about these challenges, including the referalls, including the permits, including the limited treatment, like radiotherapy is completely denied in the West Bank and Gaza, and the majority of cancer patients will require radiotherapy at a certain stage in their life. The majority of them will end up having to go to East Jerusalem to receive radiotherapy. There are regular shortages of chemotherapy, especially in Gaza hospitals, and I’m talking about before the war. In addition, of course, to the lack of psychological support, a lot of children diagnosed with cancer, their companions, their parents have to apply for a permit too. Their parents don’t get the permit, so what happens in this situation is that children have to proceed to the treating facility with no companion.
Imagine a child being diagnosed with cancer, going to get treatment. You know how difficult that treatment journey can be, and they’re going through this alone. They’re going through this without their mum, without their dad, because they have been denied permits, and in the majority of cases there’s no justification. They don’t even know why they weren’t given this permi. That’s a very important issue that needs people to be aware about, because not a lot of people understand and comprehend all the consequences of occupation. This applies, as I said, to patients in the West Bank and in Gaza. They both have to go through the similar process, including obtaining their permit, crossing the checkpoints, then finally making it to the treating facility.
That’s how this situation was before. The situation now, I don’t think there’s any vocabulary to describe the situation now, because the healthcare system is completely broken. The only facility that was providing cancer treatment had to close its doors because of frequent attacks by the Israeli forces, and at the same time because of lack of treatment. The health professionals have been attacked, a lot of doctors have been kidnapped, have been killed, so it’s non-existent. There’s no healthcare, there’s almost no cancer treatment in Gaza during these days and in the past few months, so a number of cancer patients have managed to be evacuated by a lot of international efforts, a lot of international institutions. In collaboration, they managed to evacuate some patients, but a lot of patients are still in Gaza facing war and facing cancer at the same time.
Even the ones who managed to evacuate, I need you to think of how they evacuated, because these patients got out of Gaza with no medical records, with no medical history. Most of them have no idea about their medical regimens they have been taking, the drugs that they have been taking, the chemotherapy they have been taking, so they have no idea. A lot of patients have a very basic knowledge about their diagnosis and their treatment plan, and they go to these facilities, and they’re supposed to continue their treatment. It’s completely going to be based on how the physicians perceive them to be, and how they think is the best way to move forward, but it’s definitely not the most ideal treatment that they should be getting.
What is currently being done and what are the plans to improve this situation?
I think, first of all, providing protection. That’s the thing that makes most sense: providing protection for the civilians, innocent people, everyone there, and providing protection also for the healthcare providers and professionals. Because who would risk to go to Gaza now, knowing that they might put their life in danger? Providing protection and safety would be the first thing to do. Then, sending medical professionals to Gaza to help in rebuilding and reconstructing the healthcare system that is completely broken now. Of course, working on funding, collecting funding, doing fundraising so that by the time that we have some kind of stability and we can rebuild we have the resources to start rebuilding.
I believe that is extremely important, and of course raising awareness, just raising awareness, talking about how important it is for the medical and healthcare community to be involved, and not just in Palestine, in any area that is affected by political instability. We see that the impact of this political instability is significant on their health. This puts a huge responsibility on all of us, on everyone in the international community. So, just by raising awareness, creating these spaces in which we share stories, we share data, we also centralise Palestinians themselves to talk about their experience, to talk about how the situation was, how the situation is, and how it should be.
That is the whole point of this session: just to create the space to share opinions and share ideas, and see how we can help, what we can do, because there must be something that we can do. We believe by starting the conversation, this is the first step towards doing something and implementing some interventions.
What is the impact of war on health and does it cause more cancer cases?
A hundred percent, because first of all, we still don’t have enough data from Palestine, or unfortunately when it comes to conflict a lot of data gets lost. So it’s really hard to assess the impact of the political instability and the weapons that have been used on the cancer incidence and progression. What we do see in the MENA region is that there’s a huge rise in the incidence of cancer, and it is expected to have the highest rates by 2030. This also makes us think that one of the things that we know about the Middle East is the fact that a lot of countries suffer from political instability, suffer from conflict. A lot of people have been subjected to different kinds of weapons, and we obviously know that environmental factors play a huge factor in getting cancer. Even the psychological factor of war – being put under so much stress, it must play a role in being susceptible to developing cancers more.
Unfortunately, we still don’t have data, so I cannot say in a very precise way how conflict is affecting the cancer prevalence and progression, but based on what we know generally speaking we predict that there must be a rise in the incidence directly because of the things that people get exposed to, whether they are weapons that they are subjected to or the psychological stress and the trauma that they’re subjected to as well.
