Cancer in Gaza: a game of roulette

Hanin Alyan Elholy | 18-05-2017

Women in Gaza protest the poor treatment available for breast cancer

Gaza’s National Centre for Monitoring Cancer reported at the beginning of 2016 that there were more than 14,600 cancer patients in Gaza. That’s not that unusual for a population of 2 million. But consider this: While breast cancer is one of the most treatable forms of the disease, five-year survival rates in Gaza are as low as 30 percent, compared with around 85 percent in England and 86 percent in Israel. 

One of the reasons is the lack of medications and treatments like radiotherapy, which is required by about two-thirds of cancer patients. Gaza also has only two functioning mammography machines and no MRI equipment. Another reason is how difficult it is for people with serious diseases to leave Gaza for the treatment they need elsewhere. Palestinians in Gaza have only two ways to leave: the Rafah crossing into Egypt or the Erez gateway into Israel. 

Individuals who try to travel through Rafah must register in advance with the Passenger Registration Office of the Gaza Ministry of Interior, which allocates a limited number of visas for patients. Prior to each opening of the crossing, the Ministry of Interior posts on its website the lists of patients cleared for travel by Egypt. World Health Organization (WHO) figures for January through October 2016 show that 20,000 patients filed applications to travel to Egypt, but only 1,023 of them actually travelled during the 25 days the crossing operated.
Exiting Gaza through though Erez for treatment in the West Bank (including East Jerusalem) or Israel is an even longer and more arduous process—and the delays can be deadly. First, patients must receive approval for a medical transfer by a medical committee in Gaza. Then they must secure agreement by the Palestinian Authority in Ramallah to cover the cost of treatment; the PA also decides which institution to which to refer them. In most cases, guarantee of funding is first provided for West Bank hospitals, which are less costly. Only later, if required, are patients referred to Israeli hospitals. Once these approvals are given, patients must file for an Israeli entry permit via the PA’s Ministry of Civil Affairs. Israeli entry permits are granted only after stringent security screening of both patients and whoever is accompanying them. Decisions on whether to deny or approve application are communicated arbitrarily; no reasons are stated for denials. In October 2016, only 44 percent of applications were approved.
You could say Israel (and increasingly, Egypt) is the real “cancer” for the people of Gaza. 

Here are two of the women behind those numbers.
 
Ayah Abdulrahman 

The first time her sky-like eyes charmed me was when I watched TEDx Shujaiya 2015. Ayah Abdulrahman gave an inspiring talk on her battle with cancer. Her victory eight years after diagnosis seemed offer a broader hope that other seemingly unbeatable odds could be defeated—including our decades-long occupation. 

The 28-year-old artist had participated in more than 70 exhibitions and her paintings shown in countries from Sweden to Algeria. But then one day, when she was checking to see if she was pregnant, doctors discovered a tumor on her ovary. Although they said at first that it was nothing to worry about, the tumor turned out to be cancerous. Her life would never be the same again.

Ayah’s physicians quickly concluded she needed to travel out of Gaza for treatment. However, due to her serious condition, both Egypt and Jordan refused to accept her. Instead, she was sent to occupied Palestine (Israel). 

“When I was in the (Israeli) hospital, I felt there was something missing, something stolen from me. My homeland wasn’t truly mine,” she recalls.

Aya painted a young cancer patient, first without hair (right) and then
as he appears in his dreams.

Nevertheless, Ayah stubbornly viewed her cancer like the flu, an illness that would continue temporarily and from which she would recover. She convinced herself of the certainty of healing. And although she at first felt isolated by her illness, that changed when she visited a hospital that specializes in cancer. Ayah immediately felt this was where she belonged. There, she was as normal as anyone else, with patients chatting about chemotherapy and the frustration of wires connecting to their bodies. And every one of the young patients was eager to return to playing with their friends, running with the wind blowing in their hair and completing their education. They just wanted to smell liberty again. 

"Being among the children with cancer was a kind of therapy for me,” she says. “When they were happy I was happy. And when one of them died, I was down in the dumps.” 

Ayah was different from other cancer patients, who often drowned in oceans of depression and hid in the darkness away from other people. Instead, she not only challenged her cancer with her smile, she also spread laughter to every pale face she met.  And …she painted the walls of her floor with pictures that created a bit of brightness. 

That same spirit inspired her artwork from a young age. Ayah’s talent became obvious when she was in kindergarten. On her first day, Ayah's teacher stood by the door at the end of the day, waiting for her mother to arrive. "Your daughter is an artist with a capital A," she announced. 

“This was the beginning of my creative journey and the real birth of my soul,” recalls Ayah. “When I entered university, I promised myself I’d become a distinguished artist, and here I am.” 

A true Renaissance woman, Ayah followed in her father’s footsteps and became a teacher (in her case, in kindergarten), and uses both art and drama in her work with children. 

"Children are my inspiration,” she says, adding that the real cancer affecting the lives of too many is the Israeli occupation that robs children of their dreams. “We all love life, but in Gaza, there is something that prevents us from living it the way we should.”
 
Author’s note: When I first began writing this story, Ayah was a victory who gave us all hope. In a way, her fight symbolized our fight to be free. Her courageous story was like a bridge to the end of the tunnel for anyone who is depressed and struggling. Then I learned that her cancer has come back, spreading into her kidneys, spine and pelvis. She returned to Israel once more and is now on a new medication regimen. She is still fighting with the same positive spirit, and, inshallah, her name will become reality: “miracle.”

Sameeha Elwan

Sameeha, 29, is originally from Gaza. She earned her master’s degree in comparative literature from the UK’s Durham University and now is working on her Ph.D. in Australia. Her husband, Ayman, also is from Gaza and they have a young son. It would seem she has achieved all that most Gazans dream of. But then her mother became seriously ill from cancer. One of the “curses” of being Gazan is that getting in or out is fraught with uncertainty and risk. Once you leave you are afraid to try to return, uncertain if you’ll end up imprisoned.

Sameeha, her husband Ayman and her son

Seven years ago, prior to Sameeha’s departure from Gaza, her mother was diagnosed with breast cancer. Israel refused her request to enter for further evaluation and the crossing into Egypt was closed, so she resorted to one of the underground tunnels, bending over to creep through the mud. 

“The tunnels aren’t easy for young men; how do you think it was for an older woman with cancer?” recalls Sameeha. 

Fortunately, the cancer cells weren’t growing rapidly and the doctors assured the family it had been caught in time.  Thus, her mother strongly urged Sameeha to travel abroad to complete her studies. Like other Palestinian women, her mother was a model of sacrifice and patience. In 2011, Sameeha left, but kept in constant touch by Skype. 

Then came 2014, the year of both Israel’s deadly war on Gaza and the spread of her mother’s cancer. When her mother finally started chemotherapy, she asked to talk by audio only. She didn't want her daughter to be see her condition; she wanted Sameeha to focus on her studying and her child. 

Her mother needed an MRI scan to determine her response to the medication, but she could not get permission to travel outside. Her condition worsened and the cancer metastasized to her bones—particularly the inner medulla, which is responsible for creating red blood cells.

“We were running in a vicious circle, trying to get an appointment in an Israeli hospital and a permit to enter Israel for treatment,” Sameeha recalls. “The cancer became more aggressive, and the obstacles the Zionist government put in front of us doubled her pain, combining the physical pain with psychological anxiety.” 

Finally, her mother was allowed to travel for a week to the West Bank, where she got the needed scans and radiotherapy. But her condition continued to decline.

"Sameeha, I want you back."

Sameeha's mother and her son

For the first time, at the beginning of 2017, Sameeha's mother asked her to come home. Sameeha knew there was something significant in her mother's call—as if she wanted to commit her to memory. Sameeha put her head in her hands. 

"I couldn't say I can't come back and I wanted to see her, to be with her, knowing I would never forgive myself if I never tried," she says. 

For security reasons, Sameeha does not feel free to explain how she made it back through Erez. But there were many obstacles and fearful moments. "It was humiliating at every step, and particularly insecure and frightening since I had my 2-year-old child with me. But, I finally made it back in Gaza!” 

Sameeha now understood why her mother refused to turn on her camera while communicating with her. "After only three years, she looked so different from the mother I remembered. The strong tall woman was replaced by a fragile figure," she sighs.

Her mother’s face was ghostly pale face and she’d lost more than10 kg (22 pounds). But when she was able to hug Sameeha and her first grandson, Tamim, she felt instantly better. The reunited mother and daughter celebrated his second birthday together.   

The following weeks were like a dream, but they were shadowed always by the coming end, since almost from the beginning, Sameeha had to work on getting a permit to return to her new home and husband. “On top of all the procedures needed to exit, I had to apply for an ID number for Tamim,” explains Sameeha. “We had no idea how long it would take. There wasn’t a single day since I came to Gaza that I wasn’t consumed with paperwork and worrying about when and how I would be able to leave. I find it so unfair that after all I had to do to be there with my mom, I was not totally able to be with her—that I was a concern for her as well as a comfort. But I will never hate Gaza, because it made me what I am.”     

Finally, two months after arriving, Sameeha left. Her mother is still alive, although for how long, no one knows. 

Posted: May 9, 2017

Mentor: Greta Berlin


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