Gaza’s health sector under siege
Nasma Abu Lasheen died on 16 October, 2010 from treatable leukemia, 155 kilometres from adequate medical facilities. She had spent most of her two years sick, ferried around Gaza and Israel between blood tests, treatments and doctors in six different hospitals.
Her family had celebrated her second birthday in Gaza City, waiting on permission from Israel to continue the chemical treatment. By the time it came, Nasma was too weak to move. Her tragedy is the story of hospitals, doctors, clinics and medicine under siege.
- Doctors rush two Gazan infants to treatment during Operation Cast Lead (Photo Reuters)
UNKNOWN DISEASE
Nasma was the fourth child of Neja Abu Lasheen, a police officer with the Palestinian National Authority in Gaza City. She was born on October 8, 2008 in Shifa hospital, Gaza’s largest, older than Israel itself. When Nasma was three months old, Israel invaded Gaza in what became known as Operation Cast Lead. During the first hour of the invasion, over 300 Palestinians perished in Shifa’s crowded halls because the hospital, like Gaza’s entire health sector, lacked the capacity to deal with the mass trauma. A planned additional surgical building, which could’ve saved many at Shifa during the invasion, had been blocked by Israeli siege policy according to the World Health Organization (WHO).
During the havoc, Nasma was immunised on April 8, 2009. The small shot was a bad sign - what inoculates normal babies afflicted her. She stopped eating and her temperature rose. After five days of illness, she needed a deeper examination. Doctors discovered her spleen and liver were enlarged. They did not know what ailed the baby, but they knew doctors outside of Gaza would. Nasma stayed in Shifa for over a month until May 21, waiting to leave.
GAZA UNABLE
“Everything is on the verge of collapse in Gaza since Operation Cast Lead. But even before that it was very, very bad,” said Reut Katz, project coordinator for Physicians for Human Rights (PHR) in the occupied Palestinian territories. “A lot the facilities have been damaged or destroyed.”
Israeli forces did not spare Gaza’s health sector in the invasion. The windows were blown out of the Al Nasser pediatric centre. Israeli tanks shelled Al Quds hospital’s administrative building as a phosphorous shell incinerated the top two floors: the staff restaurant, the largest meeting hall in Gaza, the childrens’ playroom, and the medical supplies warehouse were wiped out while the socio-cultural centre and ambulance station sustained damage. Artillery fire struck the walls, water mains and electrical system of the Gaza-European Hospital, and multiple detonations rocked both Al Awda and Al Dorah emergency rooms. Despite International Committee of the Red Cross pleas for Israel to stop pummeling the medical facility Al Wafa, it’s new building was destroyed.
The 15 hospitals and 41 medical clinics damaged in Operation Cast Lead remain broken today. Their restoration materials are kept out of Gaza by Israel’s occupation, according to PHR. The blockade and siege of Gaza has led to a system-wide lack of such basics as construction material, medicine, equipment, and electricity.
Nasma’s parents needed to get her out of their devastated, besieged homeland. They applied for and received permission from the Gaza District Coordination Office (DCO) for Nasma to enter Israel for medical tests at Jerusalem’s Al Muqasid hospital. But her father Nija did not. The responsibility of caring for and carrying the sick infant fell on the shoulders of her nine-month pregnant mother. Nija is still angry about the designation that forced his wife, alone, heavy with child, and cradling their sick daughter, across the Beit Hanoon/Erez border into Israel on June 4 for blood samples. The news wasn’t good.
LEAVING HOME FOR HELP
“Her lymph glands showed she had a bad type of cancer,” Nija said of the diagnosis.
The doctors there knew they couldn’t help her, and Nasma was transferred to a third hospital, Al Muta’l, where doctors said her sickness was in an advance stage and exceeded their abilities. Again, Nasma and her pregnant mother entered a new hospital, this time in Tel Aviv. Here Nisma’s family received bad and good news. Their daughter was suffering from a “very dangers and very sophisticated” cancer - but now she had a baby sister. Her mother gave birth in the iconic metropolis of her people’s occupiers to a healthy child who would outlive her.
The authorities quickly revoked Nasma’s mothers access to Israel: she returned to Gaza with the new child. Nija replaced her in Tel Aviv and stood vigil while Nasma had surgery. New blood tests revealed she had B-cell lymphoma - a disease that, if found and treated early, can be cured. Rarely can Gazan doctors do so, kept from medicines, equipment and modern techniques.
“Early detection of diseases in Gaza - especially in cases like cancer when its critical - is very, very low,” Katz said. “These problems we are encountering again and again.”
“There most significant problem is a problem of diagnosis and medical skills because of the situation,” Katz said. Students cannot train to become doctors, and doctors cannot study new medical practices. “The Gazan medical community is disconnected from the world medical community and this will take many, many years to solve.”
However, even if Nasma’s lymphoma - a cancer which turns B-cells in the blood malignant - had been detected, she still would have had to leave Gaza.
CANCER UNDER SIEGE
“Cancer patients in Gaza have serious problems,” Katz said. Cancer treatments involve radiological devices - which aren’t allowed by the Israeli siege into Gaza because their radioactive pieces could be weaponised. “Radioactive materials are not allowed at all into Gaza, and so any cancer patient must leave for treatment because they can’t have radiology treatment in Gaza. It’s important they leave on time.”
Over 1,000 sick Gazans are referred to hospitals inside Israel, the West Bank or Jordan every month, according to current monthly WHO reports. To receive proper care afforded by adequately staffed, powered, stocked and equipped hospitals, each needs to apply through a complex procedure involving Hamas, the PA and Israel. Knowing treatment is needed and available, but not knowing when, or if, access to it will be granted, takes a heavy psychological toll.
Since the flotilla attacks Israel has issued fewer potentially life-saving permits, according to PHR. Thirty-two patients have died waiting to access the hospitals they were referred to, according to the WHO.
Five organizations must vet all patients seeking a treatment outside Gaza in “a very long and exhausting procedure,” Katz said. Nasma’s family petitioned their hospital, Hamas, the Palestinian Authority, a liaison committee, the DCO and finally Israel’s intelligence service. Cleared by Shein Beit, the DCO passed along her file to the liaison committee who told the family Nasma could go abroad for help.
“In anyone one of these there could be a delay or something could happen,” Katz said, noting Israeli security checks hinder applications alongside infighting between the Palestinian National Authority and Hamas. “In urgent cases they are supposed to work quicker, but as you can see, sometimes its too long.”
Physical and political divides between Hamas and Fatah, Ismail Haniyeh and Abu Manzen, Gaza and Ramallah, keep Palestinians from reaching treatment abroad. Medications to Gaza enter through the PA Ministry of Health in Ramallah, where a management system, complex by nature, divides medicines and equipment. The cooperation necessary in such a multi-faceted system doesn’t happen between Hamas and the PA: neither can visit the other.
THE FINAL EXIT
On June 28, 2010, Nasma and Nija returned to Gaza. After ten days, she was accepted to the Ramdam hospital in Haifa where on June 7, she underwent chemical treatment. She had to return to Gaza before again resuming chemical treatment in Haifa for two months. Then Nasma began therapy at her sixth hospital, Ha-Emek in Afula. The PA Ministry of Health denied Nasma entry on September 28 but allowed her return on October 4.
Back in Gaza city on October 6, Dr. Mohammad Abu Sha’aban told the Israelis Nasma needed to resume Afula’s treatment. Nasma spent her second birthday, cancer coursing through her, waiting for permission to receive adequate medical treatment. No word came from the Israelis for a week, and a desperate family called Physicians for Human Rights on October 13, who successfully got exit permission for Nasma and her father the next day.
But it was too late. Dr. Abu Sha’aban said the baby girl was too weak to be moved and her family watched her deteriorate for two days until her death on October 16, 2010.
“The problem wasn’t that Nasma was denied exit,” Katz said. “The reason why she couldn’t leave was essentially bureaucracy.”
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