25 May 2016
Last week, breast cancer surgeon and UK MP Dr Philippa Whitford wrote in the Guardian about the obstacles to effective breast cancer access for Palestinian patients in Gaza. During her visit to Gaza with MAP last month – her first time returning to the territory since she volunteered there with MAP in the early 1990s – she met with medics and patients to assess the gaps in care for Palestinian women affected by the disease. She was also given a tour of Gaza by the UN Office for the Coordinator of Humanitarian Affairs (UN OCHA).
Some of the claims made in Dr Whitford’s article about the impact of the blockade and its impact on medical care have been challenged since its publication. We are setting out here evidence for these claims in statements made by the UN, international NGOs and others:
The closure of Gaza places severe constraints on the right of Palestinians to move freely in and out of the territory. For medical professionals – such as doctors, surgeons and technicians – this can mean getting out to attend conferences or training in the West Bank or abroad can be very difficult. In a report from 2010, the World Health organisation (WHO) stated:
“No specialist surgeons are available for several types of cancer such as cancer of the oesophagus, pancreas and lungs. Israeli restrictions on the movement of people out of Gaza curtail opportunities for medical staff to receive training in specialized fields of oncology – as well as in other medical fields.”
Earlier this year, Israeli human rights NGO B’Tselem highlighted that this is still the case:
“As part of the siege, Israel limits the import of medical equipment into Gaza. It also imposes restrictions on doctors traveling outside the Gaza Strip to pursue further medical training and specialization.”
For women with breast cancer, radioactive isotopes can be used for guided biopsy of axillary lymph nodes – to assess the spread of the disease. These isotopes have no dangerous application. However, they are subject to prohibitive import regulations and cannot be procured in Gaza. This leads to an increase in the number of women receiving full mastectomies with clearance of the lymph nodes, even where it may not be necessary. This more drastic surgery can lead to uncomfortable complications such as lymphedema.
Again, the WHO has identified this problem, stating in 2013 that:
“Gaza lacks radioisotope diagnosis and radiotherapy services due to the highly restrictive Israeli policies controlling movement of people and goods into Gaza, as well as due to the poor financial situation of the Palestinian Ministry of Health … These restrictive conditions have led to the current situation of a lack of trained physicians and technicians to support the services, as well as a lack of radioisotope equipment and materials, some of which Israel considers to be “dual use” and therefore subject to lengthy coordination procedures.”
This issue has also been raised by UK parliamentarians before Dr Whitford. In a Westminster Hall Debate in 2011, Michael Connarty MP said:
“… radiotherapy drugs for cancer patients are banned, because Israel says—for some reason—that they are a dual use product. I am not quite sure how to extract the small amount of radioactivity from radiotherapy drugs and how it could be used for anything other than medical purposes.
"I know, Mr Dobbin, that you come from a medical research background and so you will know that a small amount of radioactive material, with a very low level of radioactivity, is generated by every hospital in the country. I do not see anyone saying that we need to rush around and put that material in a high security facility, so the Israeli attitude is nonsense and an imposition on patients.”
In Gaza, doctors often face an uphill battle to obtain the drugs needed to treat conditions like breast cancer, meaning that, as Dr Whitford further explained in her article:
“Several patients reported having had their chemotherapy course interrupted when drugs could not be supplied, or simply having been unable to complete the course at all.”
This month, the Palestinian Ministry of Health reported that 29% of essential medicines are at ‘zero stock’, meaning that less than one month’s supply remains. This included 15% of cancer drugs.
Last year, UN Secretary General Ban Ki-Moon suggested that the closure of Gaza is at least part of the reason for these shortages:
“The human cost of the blockade has been enormous. The limited availability of electricity and potable water, the shortage of medical supplies, the perpetuation of reliance on food aid and the collapse of the industrial and agricultural sectors had resulted in a humanitarian crisis and a substandard quality of life even before the 2014 escalation.”
Similarly, in 2012, the WHO reported that:
“Chronic drug and disposable shortages have been reported in Gaza since 2006, caused primarily by political divisions between the West Bank and Gaza and exacerbated by the blockade on Gaza.”
The UN Special Rapporteur on the situation of human rights in the Palestinian territories occupied since 1967 has argued that it is Israel’s responsibility to ensure adequate medical supplies as the occupying Power:
“According to article 55 of the Fourth Geneva Convention, as the occupying Power, Israel “has the duty of ensuring the … medical supplies of the population … if the resources of the occupied territory are inadequate”.”
Dr Whitford also witnessed the slow pace of reconstruction in Gaza following Israel’s attacks in 2014 and the impact this was having on inhabitants. Last October, UN Secretary General Ban Ki-Moon highlighted that construction materials entering the territory were inadequate to meet construction needs
“A range of materials, including many essential building materials, such as cement, are restricted by the Israeli blockade of Gaza. Between 27 August 2014 and 30 April 2015, only 7,500 truckloads of construction materials, mainly cement, aggregate and steel bars entered Gaza. In October 2014, the Shelter Cluster estimated that 800,000 truckloads were required to meet housing needs in Gaza caused by the destruction of homes in recurring escalations and a chronic housing deficit.”
The UN Office for the Coordinator of Humanitarian Affairs (UN OCHA) said last month that, by the end of March, only “about 17 per cent (3,000) of the approximately 18,000 homes destroyed or severely damaged had been reconstructed or repaired,” leaving 75,000 still displaced from their homes nearly two years on from the conflict.
Part of the reason for the sluggish reconstruction is the struggle Palestinians face obtaining building materials in Gaza. Since the article was published, the Israeli authorities have lifted the ban on private imports of cement, though just last month the World Bank estimated that, at the current rate, it would take a further “two years to import materials needed to rebuild and repair all housing units impacted by the war.”
For families still displaced from their homes after the 2014 attacks, another two years is a long time to wait.
Featured image: Dr Whitford is briefed by UN OCHA in Gaza