Umaimah Zamalat assumed her papers were in order.
But when she got to the Erez checkpoint at the boundary between Gaza and Israel, ready to go for a second treatment, she was stopped.
“My permit allows me to travel to Jerusalem until I finish four [radiation therapy] sessions. But when I tried to cross Erez for my second session they told me I am no longer allowed,” Zamalat told The Electronic Intifada.
The Israeli military authorities at Erez gave no explanation when they turned her back. Patients from Gaza are not allowed to stay in Jerusalem or Israeli hospitals for the duration of their treatment and must return between sessions. This leaves them at risk of sudden, unexplained and apparently inexplicable permit revocations.
That, in turn, has inevitable consequences on patients’ health.
“I am extremely worried. Doctors told me that my case is very sensitive to delays,” Zamalat said.
Zamalat has reapplied to get another permit to complete her radiation therapy. But she holds out very little hope.
“Our problem is not just being cancer patients. It is with the bitterness of an occupation that we feel in every tiny detail of our lives, even in our illnesses,” she said.
Health care professionals in Gaza have documented a disturbing rise in incidences of cancer in the impoverished strip of land.
Dr. Mohammed Abu Shaban is a Palestinian oncologist who works at different hospitals in Gaza. Over the last two years, he said, citing statistics from the Gaza ministry of health, the number of cancer diagnoses reached some 14,600.
“Every month, we see at least 120 new cancer patients in Gaza,” the doctor told The Electronic Intifada.
Abu Shaban alleged a direct relationship between the increase in the number of patients with cancer and the three wars launched on Gaza over the last eight years. Doctors in Gaza and foreign health professionals have long suspected that Israel has used new forms of weaponry over Gaza, including Dense Inert Metal Explosives (DIME) or ammunition laced with radioactive material.
“Israeli forces have used illegal weapons with lethal radioactive materials that transfer to the soil,” Abu Shaban said. “People who live next to areas that have been shelled risk being exposed to these materials. That enhances the risk of cancer for these people.”
Leukemia is the most pervasive cancer in Gaza, according to the doctor. Abu Shaban estimates that some 25 percent of cancer-related deaths among children are due to the condition.
In addition to the difficulty of gaining access to treatment is the cost. With poverty and unemployment rates both near 40 percent, Palestinians in Gaza rely on government assistance.
“People cannot afford the exorbitant prices of health care services,” Abu Shaban said. “We are in acute need of more funds to cover extra expenses for our patients.”
Rafah not an option
Amina Ahmad’s condition dramatically deteriorated eight months ago. Diagnosed with lung cancer in 2012, the 46-year-old from Gaza City applied for referral to one of the specialized hospitals in the West Bank or inside Israel six months ago.
But she needs the permit.
“I have my medical reports and all the necessary papers to enable me to move to the West Bank as an urgent humanitarian case. But I have not gotten Israeli approval yet,” Ahmad said.
A delay in obtaining a permit to enter Israel can have dire consequences. If appointments are missed, patients will have to go through the whole application process again. “We are left to die in silence,” Ahmad said.
The situation would be different if the Rafah crossing to Egypt was open, she said. Egypt offers care that Gaza hospitals cannot and, if nothing else, she said, at least she would not be hostage to “the whims of the Israelis.” But Egypt has kept the crossing closed, with only a few dozen days of partial opening, since late 2014.
Under the blockade, said Dr. Ahmed El Shorafa, head of the tumor clinic at the European Hospital in Rafah, the situation can only be described as “catastrophic.”
Gaza suffers a serious shortage of medicine, medical supplies and equipment as well as trained and specialized personnel. “We use the same machines and the same protocols as we did 14 years ago. We have not been able to develop anything,” El Shorafa said.
As a direct result, Gaza’s hospitals are unable to offer radiation or chemotherapy treatments — hence the need for the many referrals to West Bank or Israeli hospitals.
Fear and anger
“What we have observed in the last five years is that the annual referrals of Gaza patients have only risen by only 1.3 percent despite a significant increase in the number of patients,” El Shorafa said. “The very restricted movement has reduced the options open to Gaza patients for specialized care.”
In the first 10 months of 2015, the administrative arm of the Israeli military occupation administration — the body known as the Coordination of Government Activities in the Territories, or COGAT — denied 1,035 Palestinians in Gaza permission to exit so that they could receive necessary medical treatment in the occupied West Bank, Israel or Jordan.
This represents almost twice as many denials as were issued the entire previous year.
Six-year-old Sahar Abd al-Aal was diagnosed with thyroid cancer. She is currently undergoing radiation treatment at the al-Rantisi pediatric hospital in Gaza City. Hafiza, her mother, waited anxiously for her doctors’ verdict on treatment going forward.
“My daughter has to undergo the last session before doctors assess her case and whether she will need to be transferred,” Hafiza said.
“I am afraid that my daughter will have to be transferred and the Israelis will not allow us,” she added.
One of the protesters, Rawan Lubad, has lived with breast cancer for 10 years. The 61-year-old is in constant pain. She has twice applied to get a permit for referral. She was twice denied.
“I am dying here. I feel that I have been sentenced to death,” she said.
Isra Saleh el-Namey is a journalist from Gaza.