2 February 2018
Breast cancer is now one of the best understood, and most treatable, forms of cancer. Nevertheless, a diagnosis is a significant worry for any person, and the journey through treatment – which can include surgery and lengthy courses of chemo- and radiotherapy – is a long and stressful one.
For women living in the West Bank and Gaza, the stress and uncertainty of a breast cancer diagnosis is compounded by living under Israel’s 50-year military occupation.
The main Palestinian hospital providing specialised cancer treatment, Augusta Victoria Hospital, is located in occupied East Jerusalem and is therefore cut off from the rest of the occupied Palestinian territory by Israel’s separation wall. It is the only Palestinian hospital able to offer radiotherapy treatment, necessary in many cancer cases, and also provides surgeries and chemotherapy.
For patients being treated at the Augusta Victoria Hospital, who are not residents of East Jerusalem, this can mean repeated travel through Israeli military checkpoints. Access is controlled by a complex system of permits, and is a time-consuming process fraught with delays. Family members who wish to travel with patients to support them through their treatments are also frequently denied.
Barriers to movement throughout the West Bank also make it harder for women to access diagnostic services, such as mammography, that are only available at hospitals and health clinics in bigger cities. This is particularly true for women living in rural communities and Area C, which represents 60 percent of the West Bank where Israel maintains complete civil and military control and where Palestinians are unable to build permanent clinics.
Even where diagnostic services are accessible, gaps in health information and public understanding of the disease, and social, cultural and environmental factors mean that women are often late to get checked or seek treatment. Breast cancer is consequently often detected late, with more than 60% detected in the third stage of the disease. Early detection is a vital factor to recovery, and survival rates for Palestinian women are far lower than in neighbouring Israel.
This is why Medical Aid for Palestinians (MAP) has, for the last two years, been supporting the Dunya Women’s Cancer Centre in Ramallah. Dunya is the only community-based clinic in the West Bank to specialise in breast and gynaecological cancer. It supports around 1,900 women each year, providing a range of specialised services including diagnostic ultrasound and mammography, with the aim of ensuring early, accurate diagnosis and to therefore reduce mortality amongst women affected by cancer.
Women who visit its modern facilities can receive more holistic services at all stages of their treatment journeys, from diagnosis to aftercare. This includes individual and group psychological counselling, and is particularly important given the additional stresses faced by Palestinian women. Women can also receive physiotherapy at Dunya, which is especially vital for those who have undergone mastectomy surgery and are suffering side-effects such as lymphedema.
The centre also runs outreach activities, particularly during October’s annual breast cancer awareness month, when they use radio advertising, concerts, theatre and fun runs to spread understanding of the disease and encourage women to self-check for symptoms of cancer.
In 2016 MAP launched a partnership with Bethlehem University to provide the very first Higher Diploma in oncology and palliative care for nurses in the occupied Palestinian territory. This programme is helping to increase the number of nurses in the West Bank who have the specialised skills, knowledge and evidence-based practice needed to provide high-quality care to patients with cancer in the West Bank. Thanks to the support of people like you, MAP and the Dunya Centre are ensuring that Palestinian women in the West Bank can be diagnosed earlier and are supported at every stage of treatment.
There is still much more to do, however. The blockade and closure means that many women in Gaza remain cut off from services in the West Bank, including East Jerusalem. In June 2017, Israeli authorities granted just 50% of all exit permits for patients referred for treatment outside Gaza.
Among these were many cancer patients who were either denied access to the treatment they needed – including radiotherapy, completely unavailable in Gaza – or who received no responses to their applications and therefore missed hospital appointments. Surgeons, oncologists and other medical professionals are also often prevented from leaving to attend specialist training opportunities outside Gaza. This professional isolation limits the application of modern best-practice and new techniques for treating cancers.
MAP has been campaigning for barriers to the right to free movement for patients to be removed – including Israel’s permit regime and the blockade and closure of Gaza. These political changes are vital to the long-term realisation of Palestinians’ rights to health.
We have also expanded our programme, supporting breast cancer care to Gaza. In September, a multi-disciplinary team visited the West Bank and Gaza to assess current levels of care and identify new opportunities for training and material support to cancer treatment in the occupied Palestinian territory.
The mission was headed by Dr Philippa Whitford, senior breast cancer surgeon, Member of Parliament, and former MAP volunteer medic. At hospitals in East Jerusalem and Ramallah, the team performed surgeries for women with breast cancer to teach new techniques.
It is hoped these will reduce the number of radical mastectomies performed (where the whole breast is removed), while also helping to improve survival rates. In Gaza, Dr Whitford returned to Al Ahli hospital – where she volunteered with MAP over 25 years ago as a surgeon – to teach these techniques. The team also held educational seminars, sharing the best-practice in breast cancer care with local Palestinian teams. MAP hopes that this new programme of work will improve breast cancer diagnosis, treatment and care across the occupied Palestinian territory as a whole.
With your support, MAP is working to help ensure more Palestinian women survive cancer. To find out more about breast cancer in the oPt, watch our animation here.
If you would like to support MAP’s work and the work of our partners, please consider making a donation today.
