Gideon Levy :COVID-19 and the Absence of Israeli-Palestinian Coordination Spell Grim Fate for Gaza Cancer Patients

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It’s not easy to be sick with cancer, and it’s even more difficult in the Gaza Strip, which has been under siege for the past 14 years. More than two million people live in a place without a single radiation therapy unit or one PET-CT system; plus, other diagnostic means and cancer-fighting medications are in meager supply, too, and don’t always meet the needs of those whose lives are at risk.

The result is that people die.

The passage of Palestinians from Gaza to Israel, the West Bank or East Jerusalem has always entailed bureaucratic tribulations fraught with despair. But as if that weren’t enough, in the past few months, the lives of cancer patients in the Strip have become more hellish than ever. Two new ordeals are compounding the old ones: the spread of the coronavirus, which requires everyone who leaves Gaza for treatment in Israel to enter a three-week isolation period when they return home – time not always available to cancer patients, who need more treatments – and, even worse, the cessation of coordination between the Palestinian Authority and Israel.

The cancer patients of the Gaza Strip are the grimmest victim of that Palestinian decision. In some cases they pay for it with their life.

The only Palestinian radiation-therapy unit is located in Augusta Victoria Hospital in East Jerusalem. The diagnostic means and the treatment available in the hospital are also state-of-the-art, including a PET-CT imaging system. In the past few months, in the wake of its decision to end coordination with Israel – following the announcement of Trump’s “peace plan” and other developments – the PA has no longer been dealing with the transfer of patients from the Strip to Israel or to East Jerusalem. The hospital has thus taken that task upon itself, and now deals with Israeli officials to obtain the necessary authorization and to coordinate the transfer.This magnificent hospital atop the Mount of Olives, which is owned by the Lutheran World Federation, was built a little over a century ago by Emperor Wilhelm II of Germany in honor of his wife, Augusta Victoria, as a hostel for pilgrims and a sanatorium for malaria patients. It has now mobilized to save the lives of Gazans ill with cancer, more than ever.

The institution’s CEO is Walid Nammour, who studied hospital management in the United States and is wearing a suit and tie. Nammour, whose parents are from Jerusalem’s Katamon neighborhood, explains that there has been a dramatic decrease – of more than 50 percent, in recent months – in the number of patients from Gaza who have succeeded to get to Augusta Victoria. The hospital is currently treating 30 cancer patients from Gaza, who along with their escorts total almost 60 people who have all been forced to deal with Israeli bureaucracy.

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A year ago there were 100 cancer patients from Gaza here. In June, the hospital submitted 177 requests to the Israeli authorities for patients from the Gaza Strip. Only 51 were approved; 126 were denied entry. Those who do not succeed in getting here, including children, are sometimes fated to die in Gaza. In other cases they arrive far too late.

That was the fate, for example, of Ansam al-Najar, a sarcoma patient of 21, mother of a 4-year-old son, from Gaza’s Jabalya refugee camp. She fell ill during her pregnancy, in 2016, and since then had received treatment at Al-Makassed Hospital in East Jerusalem and at Augusta Victoria. Last February she underwent surgery at Makassed and was scheduled to return for a follow-up at the beginning of April. But she didn’t manage to get out of Gaza until the end of April, by which time her condition had deteriorated. The cancer had ravaged her body. She pleaded with her doctors in Gaza to amputate her leg to put a stop to the excruciating pain, but they could only offer her painkillers. A few days after she arrived at Augusta Victoria, she died in severe agony. Her father said at the time, “Cancer patients in the Gaza Strip have only God.”

A few of the lucky Gazans who have been able to get to Augusta Victoria in recent months and weeks gathered in the hospital’s conference room this week to talk to us. They are staying at two guest houses that the hospital maintains for them, in between treatments. The danger of the coronavirus lurks here in the hospital, too. Every visitor passes through a tent at the entrance where his temperature is taken, and everyone wears a face mask. The escorts who are staying here with the patients sometimes spend time in East Jerusalem, where some 160 people have been infected by the virus as of this week. That number is constantly mounting.Wearing masks, the patients and their escorts told us their anguished stories.

Udai Abdel Latif, 27, from the Rimal neighborhood in Gaza City, has a knapsack on his back and a Nike baseball cap on his head. In 2017, he fell ill with testicular cancer, and underwent surgery in Rantisi Hospital in Gaza. The cancer metastasized. He received chemotherapy, but when he underwent a CT scan, his doctors despaired: We can do no more for you here. He was referred to Assuta Medical Center, Tel Aviv, for a PET-CT. It took a month to get a permit to leave the Strip for one day. After that, the physicians told him again that they did not have the means to treat him, and referred him to Makassed in East Jerusalem for surgery. Initially, Israel denied him entry, but after another month and a half went by, he obtained a permit.The tumor grew and spread. Latif was referred to Augusta Victoria for chemo, but two more months passed before he received the proper authorization. The cancer metastasized to his stomach in the meantime. He received four rounds of chemo and returned to Gaza. Again he was referred to Makassed, but a month and a half went by before he received a reply to his request for an entry permit to Israel.

The pains started during the month of Ramadan (which ended on May 23). The original tumor had grown to seven centimeters (2.75 inches) and pressed on the kidney. We will refer you to Augusta Victoria, he was told in Gaza, but there is no coordination between Israel and the Palestinian Authority. Latif appealed for help from the International Red Cross, human rights organizations and even the World Health Organization. Tell me what to do and where to go, he pleaded.

Augusta Victoria rose to the challenge and obtained a permit for him. On July 5, he crossed into Israel via the Erez checkpoint – and he has been here since then. His condition has improved. His family has not been able to undertake payment for the treatments.

His mother, Amal, 52, is with him, and they don’t leave the guest house, because of the coronavirus crisis. “Think how it pains mother to see her son suffer,” she says. The next treatment is set for July 29, and he isn’t considering returning to Gaza before that.

Tahar Hawaither, 52, from Gaza City’s Zeitoun neighborhood, is a father of seven. Three-and-a-half years ago, he began coughing heavily. Three months passed before he was diagnosed with a 7.5-centimeter metastatic tumor in his right lung. It was another three more months before Israel gave him permission to leave the Gaza Strip. He had been denied entry for security reasons, they said. By then his condition had deteriorated, and he was brought to Augusta Victoria in an ambulance.Since cessation of coordination between Israel and the PA, it is no longer possible to transfer patients directly from one ambulance (Palestinian) to another (Israeli) at the Erez checkpoint; instead, they have to be moved a few hundred meters, on a stretcher or in a wheelchair.

Hawaither was not permitted to bring an escort: He has been in the hospital for months, with no visitors from home, alone with his fate. Roughly translated, his entry permit states: “Valid despite denial.” The permit expired on June 6, but he does not dare return to Gaza as long as the struggle for his life continues. He receives treatment every 14 days. If he returns to Gaza he will have to spend 21 days in isolation after which he will not be able to get to Israel, of course. From a faded envelope he takes out a disk with the results of the latest imaging he underwent, to show the improvement in his condition. He son is getting married in Gaza, but the wedding has been postponed repeatedly, as the family awaits his return.

Khaled Jarad, 28, is from Jabalya. A clothing store salesman, married, father of a 2-year-old boy. His wife is pregnant. Five years ago, he suffered an attack of high fever and pains. At Shifa Hospital in Gaza City he was given painkillers and cortisone, a treatment that continued for three years, without a diagnosis. Finally he was diagnosed with Behcet’s disease, a serious autoimmune syndrome. He went to Egypt to see a specialist, spent four months there alone, and his condition deteriorated. On his return to Gaza, he entered intensive care.

In mid-2019 Jarad was referred to Augusta Victoria. Four months went by before he received an entry permit. He arrived this past January, underwent biological therapy and returned to Gaza. He came back to August Victoria in February for my treatment with a three-month permit, which expired in May. A few days ago, he was stopped on the street by police, who dumped him across the Al-Zaim checkpoint, in the West Bank, east of Jerusalem. The hospital arranged for his return.

Now he’s alone here, without an escort. His wife, Najwa, was told that she has a permit but was denied entry at Erez. It’s not clear why. He is pleading for her to be allowed to be at his side. Jarad weighed 51 kilos (112 pounds) when he got to Augusta Victoria, but now weighs 71 kilos (156 pounds).

Walid Ashkar, 52, with six children, from the Nasser neighborhood in Gaza City, worked for years in the Alon Garage in Ashdod. He boasts to his friends about the remnants of Hebrew he has retained from that period. He’s escorting his wife, Silwa, 40, who fell ill with ovarian cancer four years ago. She underwent surgery in the Gaza Strip and waited about half a year for a permit to get to Augusta Victoria. In the meantime, the cancer spread to her liver. She started treatment here in 2017. She and Walid traveled back and forth from the Gaza Strip about 20 times, until her husband was denied entry. For security reasons.She was alone for about six months and her physical and mental condition alike deteriorated. Finally Walid was allowed to join her at the hospital, after being interrogated by the Shin Bet security service at Erez about his political activity. Subsequently, the PA decided that they had to return to the Gaza Strip and continue the treatment there. They spent 21 days in isolation in a Gaza hostel.

Silwa was then hospitalized in Al-Haya Hospital in Gaza City, where her condition worsened. She was transferred to Rantisi, but the deterioration continued. After she spent 45 days in the hospital, it was decided to move her urgently to Augusta Victoria. Here her condition has improved. She is already able to stand up without needing the support of four people, her husband says.

Majed Abu Hamad is accompanying his uncle, Jihad Shehadeh. Shehadeh, 33, from Rafah, began having breathing problems in March. He was given oxygen in the hospital, and also mechanically ventilated. He was transferred to Augusta Victoria on April 1 and has been here ever since. He has a tumor next to the windpipe. Abu Hamad was also detained by an Israeli police officer for being without a valid permit, and was released. He longs to return to his wife and his three children in the Gaza Strip, but Shehadeh’s wife has been unable to get an entry permit, so Abu Hamad has to stay here in her place.

Six patients from the Gaza Strip. One has already died. Two are alone, three have the company of an escort. Facing their fate. Facing cancer, the occupation, the siege, the absence of coordination with Israel – and the coronavirus.