While media headlines this year captured the destruction in Gaza following the Israel-Gaza hostilities and the humanitarian impact of war, less is known about the daily battles faced by cancer patients in Gaza. This blog intends to specifically describe the persisting challenges in accessing care, that mounted during the COVID-19 pandemic, which are seldom highlighted in media reports. We hope and encourage that the global health community will grow more cognizant and take action to protect Palestinians’ right to health.
Cancer patients worldwide faced increased difficulties in accessing treatment during the COVID-19 pandemic, but for Palestinians with cancer living in the Gaza strip, additional restrictions on their movement, imposed by the Israeli authorities, have dramatically limited their access to medical treatment in 2020. This has now been a trend continuing into 2021, especially since the latest round of the Israel-Gaza hostilities in May 2021.
Many cancer diagnosis and treatment tools are unavailable in Gaza, including PET CT and radiotherapy, largely as a result of Israel’s years long blockade on Gaza, which prevents the import of items listed as “dual use items”. Cancer patients must therefore travel elsewhere for medical care, mainly to Palestinian hospitals in East Jerusalem and the West Bank. To leave Gaza, they must undergo a lengthy labyrinthian process that includes securing a medical exit permit from the Israeli military. Physicians for Human Rights Israel (PHRI) — the human rights organization where the authors work — assists Palestinian patients from Gaza in accessing medical care, which includes appeals to Israeli authorities. In 2020, PHRI assisted 113 cancer patients in accessing tertiary care, succeeding to reverse 81 denials of timely medical exit permits by the army.
In recent years, the Israeli medical exit permit system has been increasingly restrictive, with the WHO documenting that only 61% of patients applying for a permit received one in time for their appointment in 2018, compared with 92% in 2012. Since 2020, these ongoing challenges facing patients were compounded after the arrival of the COVID-19 pandemic to the occupied Palestinian territory (oPt).
The fragmented Palestinian health system (suffering from de-development after 13 years of blockade, over 50 years of occupation and dealing with chronic shortages in healthcare equipment and medications), was forced to put in place many restrictions once COVID-19 cases were detected in the densely-populated Gaza strip.
Palestinian cancer patients in 2020 were placed in a near impossible situation: having to choose between exiting Gaza and risking COVID-19 infection along the way, as well as undergoing a lengthy quarantine in sub-optimal conditions (and then re-applying to exit Gaza to continue treatment), or staying and forgoing the relevant medical treatment.
In May 2020, patients navigating this system faced further hurdles once the pre-existing coordination mechanism between the Palestinian authority and Israel broke down, after Israel announced its plans to unilaterally and illegally annex the West Bank.
Not only were patients unable to apply through the usual official Palestinian partners but the Israeli authorities continued to demand that they still undergo a complicated bureaucratic maze to access medical permits. Civil society organizations — which helped patients who tried to access medical treatment, including cancer care — were overwhelmed by requests. Further bureaucratic challenges became apparent during this time, including the demand by the Israeli authorities that breast cancer patients submit biopsy test results. The rationale for these additional and intimate documents is unclear, as it comes after patients already had hospital appointments waiting for them outside of Gaza.
Minors with cancer — a significant grouping, as almost a third of cancer patients are minors — faced unique difficulties, as Israel continually prevented their parents from accompanying them to medical treatment away from home. In 2020, 32 families of children with cancer turned to PHRI after the parents were denied permits to accompany their children to treatments outside Gaza. Parents therefore had to either choose to send children to hospitals with elderly relatives, whose chances to secure permits are higher, or even with strangers, or to re-apply for a permit in the hope of receiving it, which delayed access to timely oncology treatment. Separating children from their parents has a profound health impact and has been widely criticized. In 2020, 2 out of every 5 children who left the Gaza Strip did so without their parents at their side, according to the Israeli military.
Restrictions on access to healthcare have persisted in 2021. During the Israel-Gaza hostilities in May, the Erez crossing, through which cancer patients from Gaza must pass, was closed. Even after the hostilities ended, Israel arbitrarily continued to limit access only for patients in life threatening situations, and excluded cancer patients from this criterion. One Palestinian cancer patient died after being refused a permit, and Israel only amended its policy after PHRI submitted a petition to the Supreme Court.
As an occupying power who controls much of Palestinian life, Israel has a legal obligation towards ensuring Palestinians’ right to health. That includes ensuring a safe, speedy and open passage to all patients. Simultaneously, oncologists and global health experts in Israel and beyond hold a responsibility to safeguard the right to health. As such, advocating for access to medical treatment for patients from the oPt, including through directly challenging and lobbying the Israeli authorities, amongst them the Ministry of Health and Ministry of Defense, is vital for the fight against the violations of Palestinians’ right to health. Most crucially, a new policy is required, one that abolishes the existing system and allows medical patients to access healthcare outside of Gaza without barriers and delays.
About the authors: Haneen Kinani was PHRI’s freedom of movement and projects coordinator from 2019-2021, coordinating health permit requests for patients from oPt
Dana Moss is the international advocacy coordination at Physicians for Human Rights Israel
Ghada Majadle is the director of the oPt department at PHRI
Conflict of interest: We declare no competing interests.
Handling Editor: Neha Faruqui