Fighting breast cancer in the Gaza Strip
AgenciesAn Anglican Overseas Aid-supported project at Gaza's Al Ahli Arab Hospital has been helping women through the ordeals of breast cancer. TMA's Chris Shearer saw first hand how the project has been changing lives.
By Chris Shearer
July 8 2019
Medical Director of Ahli Arab Hospital Dr Maher Ayyad (left) reviews a mammogram with a colleague.
Gaza has been called “the world’s largest open-air prison”. Israeli army snipers keep a constant eye over no man’s land from watchtowers above the concrete security walls. Behind them, a few kilometres back, a long row of Israeli Defence Force tanks hold a hilltop position, their guns pointed towards the Mediterranean. Visitors, mostly foreign aid workers and press, are required to secure entry permits from both sides of the border, undergo rigorous security screenings and smile through the occasional interrogation.
Beyond the wall, Gaza City itself is a chaotic conglomeration of features one might expect to see in one of the world’s most troubled places. Car horns honk and wail in a near-constant cacophony as you creep through traffic, looking out at concrete buildings worn by time and, occasionally, torn open or flattened by air strikes. Faded murals beseech the inhabitants with political messages. Shopkeepers, tinkerers and hawkers peddle what they can in a place strangled by the Israeli and Egyptian economic blockade. Even in a moment of calm, there’s a sense that this place could erupt into violence at any time, as it has so many times before.
But beneath the geopolitical quagmire that has come to define it is another insidious threat, one that targets Gaza’s mothers and daughters, its sisters and wives: breast cancer.
For Australian women, the chance of living five years past a breast cancer diagnosis is 90 per cent. In Gaza, it’s just 65 per cent, says the World Health Organisation. According to a report in the Journal of Global Oncology, awareness of symptoms, risk factors and screening programs is “suboptimal” among women in Gaza. Self-screening and regular mammograms have also not been a part of the culture for various reasons, ranging from fear of stigma to embarrassment. Despite breast cancer being the most common form of cancer among Gaza’s women, accounting for nearly a third of all reported cases, 64.2 per cent of women rarely or never self-screened or had mammograms.
It’s a situation the “Women’s Health, Women’s Rights” project at Gaza City’s Al Ahli Arab Hospital is trying to rectify. Supported by Anglican Overseas Aid through the Australian Government’s Australian NGO Cooperation Program, the project aims to help women detect, diagnose and treat breast cancer early while minimising the wider psychosocial impact and creating a positive change in the knowledge, attitudes and behaviours around the disease.
Operating as a humanitarian organisation of the Episcopal Church in Jerusalem and the Middle East, the hospital treats all who come to it, regardless of race or faith. But reaching the remote, the poor, or those who simply don’t know about the program is a challenge. The Director General of Al Ahli Arab Hospital, Suhailia Tarazi, says the key to this project has been partnering with community-based organisations (CBOs).
“The health system in Gaza is nearly collapsing,” she says. “Because of the deterioration of the economy and increase of poverty, Ahli has expanded its services to go to the community. We’re not waiting for the community to come to Ahli Arab Hospital, but we go to the needy areas and through this program we have more than 25 partnerships with CBOs working in Gaza.”
The CBOs then encourage vulnerable women to come to Al Ahli Arab Hospital for mammograms. Azeeza Salem, head of the Nebras Association for Development, says she sends more than 200 women a year from Gaza’s mid-zone area, with the hospital able to cover the cost of their transportation. “We have [had] good relationships between us and the hospital for a long time,” she says. “[The program] gives poor people a chance, the people living in remote areas, to arrive at Ahli Arab Hospital to given them medical services.”
Mrs Tarazi says in the past 10 years the hospital’s old mammogram machine has taken 65,000 exposures (“thank God it’s still working,” she says with her fingers crossed). Two years ago they were able to purchase a new, digital mammogram machine that has greatly improved their ability to diagnose early-stage breast cancer. As well as the mammograms, she says, every woman is also given training in self-screening for breast cancer and brochures on how to self-screen to take back to their community.
It’s beginning to show results. Medical Director of the hospital, Dr Maher Ayyad, says that they’ve started to discover more cases of cancer as more women have adopted early- and self-screening.
“In Gaza now, every year, we discover about 300 cases of breast cancer, and I’m sure if we did more screening we’d discover more, because we discover sometimes cases that come late. That’s what you as a surgeon don’t like to see, because our treatment will be very difficult,” he says.
“In Gaza we only have chemotherapy, we do surgeries for cancer, but when it comes to radiotherapy, which most patients are in need of, we cannot do it in Gaza, so we have to refer those patients to to either Israel, or Egypt sometimes. So that’s the difficulties we are facing, and the ones who pay the price are the patients.”
Radiotherapy equipment, one of the key tools for fighting cancer, is forbidden in Gaza under the Israeli blockade. “Two million people in Gaza are left without any machine for radiotherapy and the trip to go out of Gaza is very complicated and difficult,” Mrs Tarazi says. “So many patients lost their lives waiting for a permit.”
Indeed, travel into Israel, where most cancer patients are referred, is becoming harder for Palestinians in Gaza. Obtaining permits from the Israeli authorities can take months, and many are denied without explanation. According to the WHO, in 2018 39 per cent of travel permits for medical care were unsuccessful. Two women with breast cancer who spoke to TMA said they hadn’t been able to cross for appropriate treatment, one having been denied permission four times, and the other saying her application hadn’t received a response. Even if a patient secures a permit to leave Gaza, the regular political flare-ups mean border crossings can be closed without warning, throwing treatment plans into chaos.
This extra level of uncertainty in an already distressing situation takes its toll on breast cancer “challengers”, as women diagnosed with the disease like to be known here. Nemah Kassab, who was diagnosed with breast cancer seven years ago, told TMA that for Palestinian women in Gaza, there are no illusions about the pain a diagnosis would bring. “I think all our lives were damaged at that time,” she said. Al Ahli Arab Hospital has been trying to address this mental toll as part of the project by offering psychosocial counselling for women diagnosed with breast cancer, with some sessions for their husbands as well. So far these sessions have proved popular.
“They can express their feelings about their illness, or any other feelings,” said one session facilitator. “It’s helped them to take all these worries out of their bodies and help them exorcise [their feelings].”
About 100 women currently attend these psychosocial therapy sessions, with another 60 on the waiting list. It’s the same old story of shortage in Gaza, one that the Palestinians here are all too familiar with, one that the Al Ahli Arab Hospital contends with every day. But in the face of these challenges, Mrs Tarazi says, you can feel God at work.
“We feel the hands of God [are] above our hands,” she says. “You don’t know how this hospital is working or [keeps] giving. Really, I have no answer except God is leading our way, and He opens for us the way and the means to help those in need.”
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