By Tamar Fleishman
Radiation treatment of cancer patients was introduced in the mid-20th century and is second in importance only to surgery.
In numerous cases of malignant tumors such treatment is considered as effective and at times even more so than surgery, as it might spare the patient invasive operation, amputation and chronic disability.
Radiation treatment is custom-prescribed following an initial examination with PET CT equipment, vital to determine the size and precise location of the malignancy, and identifying metastasis if present.
Every oncology ward in Israeli hospitals is equipped with several apparatuses for radio-thermal treatment and PET-CT equipment. The treatments take place in a series of 29 or 30 consequent days. Each treatment session is 4-5 minutes long, and each patient is scheduled for treatment at his/her personal convenience.
But Not in Palestine
However, that which is so very obvious and accessible to patients inside the State of Israel is neither obvious nor accessible for patients in Palestine.
In all of the hospitals throughout the West Bank and the Gaza Strip, serving about 3.5 million human beings, there is not a single apparatus for treating cancer patients with radiation therapy, nor a single PET-CT device, so patients must travel to either Israel or Jordan for treatment. This travel entails great physical and mental hardship and considerable expenses.
(And all of this could be avoided, if radiation treatment equipment were available in the West Bank and the Gaza Strip).
Most Palestinian cancer patients in need of such treatment are referred to Augusta Victoria, the only hospital in East Jerusalem to offer radiation treatment. However, unlike the existence of ample equipment in Israeli hospitals, Augusta Victoria – that belongs to the Lutheran Church establishment – has only two such apparatuses, for lack of resources and reliance on donations.
Often, as we learn from the patients, one of them malfunctions. But the meager number and low state of maintenance of such equipment is not the main difficulty for those who need it. At fault is rather the fact that this hospital is not accessible to patients with Palestinian IDs who, in order to reach it, are required to obtain special entry permits (for residents of Palestine do not enjoy freedom of movement into their own city of East Jerusalem).
Even after they obtain such permission to enter East Jerusalem, the obstacles on their way every day are numerous.
Hellish Journey
Dozens of cancer patients leave their homes every morning of every weekday, assemble in the city of Nablus and travel from there by public transport provided by the Palestinian Authority to Qalandiya Checkpoint.
They must cross the checkpoint on foot and board a vehicle that takes them to the hospital, for those bringing them from the West Bank are not permitted to proceed to East Jerusalem, nor transfer the patients over to the other side of the checkpoint by performing the back-to-back procedure that is accepted as ambulance routine.
(And all of this could be avoided if radiation treatment equipment were available in the West Bank and the Gaza Strip).
Although the daily treatment session lasts no more than 5 minutes, the patients return to Qalandiya Checkpoint only in the afternoon. One can see them arriving, a woman and another woman and a man and another child, exhausted humans shivering with cold in the winter, exposed to the seething summer sun against which the doctors strongly advise, of course.
Like human shadows they sink onto the metal benches in the checkpoint shed to wait for the entire group to re-assemble in order to board the transport that will take them back to Nablus.
From there – to each his own. The trip stretches from morning until evening.
A woman patient from Tul Karem, who said that she leaves home at the crack of dawn in order to make it in time for the transport from Nablus and gets back after dark, asked: “Why are we treated this way, how long do we still have to live? Why aren’t we allowed to live the time that is left us?”
(And all of this could be avoided if the radiation treatment equipment were available in the West Bank and the Gaza Strip).
The Pain of Gaza
Being a cancer patient in Israel is no child’s play, and in the West Bank it is that much worse. But being a cancer patient in the Gaza Strip is hell on earth. For aside from the physical and mental torment of the illness itself, the Gazan patient and his/her family members are doomed to struggle against the bureaucratic barriers imposed by the Israeli authorities who practically incarcerate all humans inside the Gaza Strip, and in order to exit for treatment the patient – as well as his/her accompanier – need the sovereign’s permission.
When the bureaucratic obstacle is finally overcome, the question of lodging arises, for most radiation-treated patients are not hospitalized and must finance their own lodgings.
A resident of the Gaza Strip who crosses Erez Checkpoint for treatment is sentenced not only to a month’s separation from his/her family, but also to exorbitant financial expenses. At times the extended family is recruited to help, at others a funding campaign takes place, and still at others, when this is not sufficient, the patient and family are shackled to heavy debts hardly deemed re-payable.
(And all of this could be avoided if the radiation treatment equipment were available in the West Bank and the Gaza Strip).
Cancer is indeed a blow of fortune, but the scarcity of treatment measures for cancer patients in Palestine is nothing but the consequence of the Occupation authorities’ policy:
Every single piece of goods or device transported into the Occupied Palestinian Territories is moved through Israeli territory and must be approved by the state security system.
The Civil Administration and COGAT (Coordinator of Government Activities in the Occupied Territories) are the executive arm of government policy regarding governance and administration of the Occupied Territories.
Beyond all of the above, the reality of poverty and inaccessibility of advanced medical systems often create situations that resemble absurd cinematic scenes. An example of this is an ambulance delivering a semi-conscious cancer patient to Qalandiya Checkpoint, referred by his doctors to undergo an MRI test.
However, since in all six Palestinian hospitals of East Jerusalem there is not a single MRI device, the man was transferred to Ramallah, which does have one. The patient was passed from one ambulance to another and from one stretcher to another, and if he would survive the day, he would have to undergo the entire ordeal yet again on his way back to hospital in East Jerusalem.
Exposed to the facts, I looked into reality in closer detail, spoke with patients and medical teams on the ground and contacted Mor Efrat of Physicians for Human Rights who answered all my questions and enriched my knowledge, for which I owe my many thanks. I studied the sovereign’s obligations to the health of its protected occupied subjects, as they appear in international law, among them the following:
Israel’s responsibility for health in the Occupied Territories in light of international law following the Oslo Accords –
“Everyone has the right to the best bodily and mental health attainable.”
“13. Actual physical accessibility of the basic right to health.
Maintaining health as part of human dignity – a person with no access to elementary medical care is a person whose human dignity has been impaired. The protected subjects must be treated humanely in a manner that respects their dignity.”
I addressed the spokesperson of COGAT, requesting an explanation for the absence of this vital equipment inside Palestinian territory, and for the reason that Al Najah Hospital’s request to purchase PET-CT equipment was denied. I asked why there is no free access or at least some levity regarding cancer patients who arrive at Qalandiya every morning.
I assumed I would be told that security reasons prevent the presence of radioactive equipment in Palestinian territory, but was wrong.
The answer I received was no more than passing on responsibility, indicating that not they – as the dominant sovereign on the ground – are responsible by law for the medical welfare and accessibility of health care, and respect for the dignity of Palestinian patients.
However, since I do have a copy of a letter sent by Mor Efrat (the Occupied Territories department at Physicians for Human Rights) of September 3, 2015, requesting permission to purchase a PET-CT device for the Al Najah University Hospital (Nablus), and since the reality on the ground is well known, and since it is inconceivable that hospitals in the West Bank and the Gaza Strip are not interested (as could be deduced from COGAT’s response) in obtaining life-saving equipment, I can only say that this response casts serious doubt as to its credibility.
The response of COGAT, verbatim:
“Hospitals in the West Bank are located within the jurisdiction of the Palestinian Authority and it is familiar with and responsible for the equipment in its hospitals. No request has been filed to introduce radiation equipment for treating cancer, nor any PET-CT devices, to the hospitals in the West Bank and the Gaza Strip, or to Al Najah University Hospital, and there is no reason not to introduce such equipment to these territories. Let it be noted that CT equipment in general does not require security permits in order to be introduced into the West Bank, and the Civil Administration is responsible for coordinating such actions.
As for transport to August Victoria Hospital, the hospital is the party that should file the request for coordinating passage without passenger disembarkation at the permitted terminals from the West Bank into Israel. Let it be noted that most such requests are met positively and we know of no such request on behalf of Augusta Victoria Hospital.
As for accompanying cancer patients, the Civil Administration examines the medical urgency of case and enables exceptional accompaniment in order to help receive urgent medical treatment. This is also the case of accompanying patients from the Gaza Strip.
OTR
The Civil Administration coordinates the entry of Palestinians into Israel for medical treatment and during the past year over 102,000 Palestinians entered Israel for medical treatment at Israeli hospitals.
No requests are known to have been filed for introducing radiation equipment for treatment of cancer patients into the Gaza Strip. If such a request will be made, it will undergo the proscribed permit procedure. In addition, may we add that Red Crescent ambulances with an Israeli license plate may collect patients at Erez Checkpoint and transfer them for treatment into the West Bank or Israel.
Sincerely,
COGAT Spokesperson”
(Translated by Tal Haran.)
– As a member of Machsomwatch, once a week Tamar Fleishman heads out to document the checkpoints between Jerusalem and Ramallah. This documentation (reports, photos and videos) can be found on the organization’s site: www.machsomwatch.org. The majority of the Spotlights (an opinion page) that are published on the site had been written by her. She is also a member of the Coalition of Women for Peace and volunteer in Breaking the Silence. She contributed this article to PalestineChronicle.com.
