20 October 2021
Breast cancer is the most common cancer among Palestinian women, comprising 29% of all cancer diagnoses in the West Bank and 20% in Gaza. Yet Israel’s restrictions on Gaza negatively impact the availability of oncology services locally while also preventing many breast cancer patients from reaching the treatment they need outside. During Breast Cancer Awareness Month, Medical Aid for Palestinians (MAP) highlights how the situation has worsened amid the COVID-19 pandemic and Israel’s 11-day military offensive in May.
14 years of illegal closure and blockade have resulted in a protracted economic and humanitarian crisis in Gaza, causing de-development in the healthcare system and its essential cancer services. In August 2021, the Ministry of Health (MoH) had less than one month’s supply of 44% of essential oncology and haematology medications. There are no radiotherapy services in Gaza and certain chemotherapy treatments are unavailable locally. Israel’s restrictions on Gaza include a prohibition on the import of certain “dual-use” medical items that it considers to have a potential security use, including radioisotopes used in breast cancer biopsy.
As a result, many patients must leave Gaza to access the care they need in hospitals in the West Bank, in particular East Jerusalem, or abroad. But accessing hospitals outside of Gaza is another major challenge. Patients must navigate an arduous application process to receive permission from the Israeli authorities to exit Gaza, which is not guaranteed to be approved.
According to the World Health Organization (WHO), in August 2021 Israel approved just 64% of permit requests for patients and 40% for companions seeking to accompany them to treatment. All other applications were either denied (1%) or delayed past the date of the patient’s appointment (35%), interrupting vital care and threatening recovery. Almost a quarter (23%) of delayed permits were for cancer treatment.
The COVID-19 pandemic has further complicated the journey to recovery for Palestinian cancer patients. Movement restrictions have increased, and during periods when Gaza had low rates of infections many patients had to balance the health risks of interrupted or delayed care with the risk of infection outside Gaza when their immunity is already compromised. According to the WHO, there was a decline of more than 90% in permit applications from patients and companions from Gaza and the West Bank in April 2020, compared to the preceding two months.
During and after Israel’s 11-day military offensive in Gaza in May 2021, the situation for breast cancer patients only worsened. Israel tightened its blockade, imposing further restrictions on the movement of people and goods in and out of Gaza. Between 11-23 May, in parallel with the ongoing assault, Israeli authorities completely closed the Erez crossing, blocking the passage of Palestinian patients.
Between 24-31 May, due to the tightening of closure measures, the Israeli authorities continued to deny all but 20 patients (of whom 19 needed life-saving treatment) entry to hospitals in the West Bank, including East Jerusalem, and Israel.
Breaking down the barriers to diagnosis and treatment
Early diagnosis is one of the most important factors for breast cancer recovery. In Gaza, screening is very limited and the MoH has only one mammography machine dedicated for screening, which is currently broken. In Israel, however, 84% of women aged 50 to 69 receive mammogram screening.
According to a United Nations Population Fund and MoH projection, 60% of breast cancer deaths in 2016 in the occupied Palestinian territory were premature and could have been prevented if effective screening, early detection and a referral pathway was put in place.
Significant inequalities in screening, diagnosis, and treatment contribute to a much lower five-year survival rate for women with breast cancer in Gaza (65%) compared to among women in Israel (88%).
Women with breast cancer in Gaza also face serious stigma. “Breast cancer is the last disease that women in Gaza like to think about,” said Fikr Shalltoot, MAP’s Gaza Director. “Even though I work in this area and I am keen to spread awareness about it, even my mother has never accepted to go for a screening and has never wanted to talk about it. When I go to the breast cancer outpatient clinic, I see sadness and depression in the patients’ eyes as well as their companions. It is unfortunate that some patients come alone to their clinic appointments.”
The obstacles to effective treatment in Gaza make the journey unbearable for Palestinian women and contribute to an avoidably high number of women dying of breast cancer. Living under a suffocating blockade and witnessing perpetual violence also places a heavy psychological toll on patients at a particularly vulnerable and frightening time in their lives.
The only effective way to sustainably remove the barriers to better care is to end restrictions on the movement of patients, health workers and essential medical materials in and out of Gaza and, ultimately, to lift the blockade. MAP calls on the international community to urgently address this injustice, to save lives and improve the quality of life for every Palestinian, including those suffering from breast cancer.
Until this happens, MAP is supporting breast cancer patients in Gaza, including by procuring supplies of essential medicines such as fluorouracil and oxaliplatin used to treat the disease; promoting public understanding and promoting self-checking; and supporting physiotherapy and psychosocial support services for affected women.
Please consider donating to MAP to bring life-saving medicine and treatment to breast cancer patients in Gaza.
