29 September 2017
Medical Aid for Palestinians’ (MAP) Advocacy and Campaigns Manager, Rohan Talbot, reports on this week’s latest medical delegation to Gaza:
This week I have been fortunate enough to accompany a multi-disciplinary team of breast cancer and palliative care specialists into Gaza. The team comprises oncologist Mohanamurali Jayan, radiologist Andrew Evans, palliative care specialist Mhoira Lang, and breast cancer surgeon and MP Philippa Whitford – all from the UK – and surgeon Omar Abdul Shaffi from August Victoria Hospital in East Jerusalem. They are here with MAP to assess the current status of breast cancer treatment here, and how local medical providers might be supported to improve outcomes for women affected by the disease.
Speaking to surgeons, radiologists, oncologists and many other specialists, we have heard how living in Gaza presents many barriers to breast cancer care. Fear and cultural factors, and a lack of population screening for the disease, means that many women enter treatment at a later stage than is typical in the UK. Chronic medical shortages, with 35% of essential medicines currently completely out stock in Gaza, including many cancer drugs, mean that chemotherapy can often be interrupted and therefore less effective.
Local medics also told us that typically most women who undergo surgery to treat breast cancer in Gaza receive an operation called a mastectomy – which means the removal of the breast – and full clearance of the axillary lymph nodes which sit under the armpit. This may be happening in many cases regardless of whether the cancer has spread to the lymph nodes or not, and can have painful and uncomfortable life-long side-effects including lymphodema of the arm.
The reasons for this appear to be twofold. Firstly, patients currently have nearly as little as a 50/50 chance of getting out of Gaza if referred for radiotherapy outside, particularly at the Augusta Victoria Hospital in East Jerusalem, which is the only Palestinian hospital able to provide this treatment. The World Health Organization reported that in August 2017 45% of patients were unable to access health care outside the Gaza .Though there is a linear accelerator (the machine used for radiotherapy) in Gaza’s Al Shifa Hospital, it has never functioned, and they have been unable to fix it, particularly given the difficulties of getting specialist technicians into Gaza. Without guaranteed access to radiotherapy, as women can expect in the UK, surgeons told us that they usually consider it best to undertake mastectomy and clearance procedures as the safest way ensure the survival of the patient.
Another potential reason for the high rate of these procedures is the lack of access to further specialist training for Gaza’s surgeons. This week we have heard how many doctors, nurses and other health professionals struggle to receive the permits they need from the Israeli authorities who control the Erez crossing to travel to and complete training in West Bank, including East Jerusalem, or abroad. This means surgeons are unable to exit to learn newer, more advanced techniques from their peers outside. Without a permit, they are cut off from the world. For any medic wishing to advance their skills and provide better and safer care for their patients, this must be an extreme frustration.
Amid these difficulties, and the deteriorating humanitarian situation in Gaza caused by a decade of Israel’s blockade and closure and the ongoing electricity crisis, the continuing dedication and passion of Gaza’s medics to save lives is remarkable.
With your help, we are able to support them by bringing medical delegations, like this one, to provide training, advice and equipment at Gaza’s hospitals. On Monday, at the Al Ahli Hospital, one of the visiting team, Dr Philippa Whitford, performed and trained local surgeons in a ‘sentinel node biopsy’ procedure in Gaza. This is a more targeted surgical technique which will hopefully mean her patient can keep her breast and avoid the complications of full mastectomy and clearance.
Equally importantly to this direct technical support, is supporting our campaigning work. You can stand with Palestinians to demand an end to the many political barriers to health and dignity in Gaza – including the blockade, and Israel’s 50-year occupation of the West Bank, including East Jerusalem, and Gaza.
If you would like to support MAP’s programmes improving breast cancer care for Palestinian women, please donate today.
