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An international solidarity fund should be established to support more than 10,000 cancer patients in Gaza who have seen life-saving diagnosis and treatment eliminated in the destruction of hospitals across the enclave.
The call was made at the World Cancer Congress in Geneva by medics on the front line of cancer care in Gaza.
Humanitarian leaders also rallied for international support for patients in the same way those in Ukraine were offered help during the Russian invasion.
director of the Gaza Cancer Centre
In response to a plea for bridge funding, the Union for International Cancer Control (UICC), established emergency financing to support cancer organisations struggling to treat patients affected by the Ukraine conflict.
While some cancer patients in Gaza have been transferred to neighbouring countries for treatment, the remaining patients are cut off from life-saving care and unable to seek treatment elsewhere due to Israeli blockades.
“As the Ukraine war unfolded, we saw a refreshing new way of unprecedented solidarity in global form,” said Princess Dina Mired of Jordan, the first Arab woman to lead the global cancer-fighting organisation UICC in 2018 and health activist at the King Hussein Cancer Foundation.
“UN agencies and international law organisations aligned as one, calling for respect of the Geneva Conventions and non-targeting of civilians. Hospitals in adjoining countries were collaborating beautifully to save cancer patients.
“During the genocide in Gaza, I was devastated and shocked when the whole humanitarian infrastructure were not only erased but raised to the ground in one blow. We were thrown back to the dark ages, with the basic tenets of emergency care during conflict completely denied to a civilian population of 2 million people.
“Health facilities whether owned by Palestinians in Gaza or the UN’s supposedly protected facilities were all targeted as collateral damage. Even the Red Cross and the Red Crescent did not escape the onslaught – the Geneva Conventions was dead and buried under the rubble.”
Centres in ruins
As Gaza came under attack from Israeli air strikes, the health sector was decimated, leaving a gaping hole in Gaza’s ability to treat its most infirm cancer patients. Working in the ruins of clinics and hospitals severely damaged by Israel’s military operation, doctors struggled to treat the thousands of patients now facing a death sentence from treatable, survivable conditions.
With permits required to leave Gaza, it has been a long-running struggle for cancer patients to leave for treatment elsewhere. The opening of the first specialised cancer hospital with 100 beds in late 2018, the Turkish-Palestinian Friendship Hospital, helped alleviate some of the burden.
In 2019, the Palestinian Children's Relief Fund (PCRF) opened the first and only paediatric cancer department.
Both investments signalled the start of an organised, emerging cancer care that promised to improve patient outcomes. Since the start of war, there is no longer any radiotherapy treatment available in Gaza, Princess Dina said.
“We were reduced to calling for the availability of anaesthesia and medical alcohol, so surgeons did not have to disinfect patients with vinegar or amputate children's limbs without anaesthesia,” she said. “If you were one of the lucky few cancer patients sitting on a hospital bed, you knew deep down the IV inserted into your veins would not deliver any more chemotherapy drugs.
“There were no painkillers, and you also did not know whether your expert oncologist would come in the next day, whether arrested, kidnapped or murdered. These services completely left with hospitals being destroyed and the ones standing turning into makeshift shelters for thousands of people, whether injured or not.
“Cancer had a field day – it loves war which bodes badly for the explosion of advanced cancer cases in years to come. We collectively call for real solidarity in order to influence global policy, to rebuild the whole health ecosystem.”
Late diagnosis
Breast cancer stands as the most prevalent cancer in Palestine, with survival rates estimated to be as low as 40 per cent. In western countries – where access to treatment and diagnosis is widely available – survival beyond five years is as high as 90 per cent.
Augusta Victoria Hospital is the only Comprehensive Cancer Centre in Palestine. According to hospital data, more than 60 per cent of breast cancer patients are diagnosed at late stages.
Cancer is the second leading cause of death in Palestine, preceded by cardiovascular diseases, with 60 per cent of new cancer cases diagnosed between age 15 and 64.
“Hospitals suffer from regular shortages in chemotherapy, while radiotherapy has been denied,” said Dr Ru’a Rimawi, a Palestinian physician and researcher who has assessed the effect of war on cancer patients, and broader healthcare.
“Most cancer patients require radiotherapy at a certain stage in their lives, which means most have to be referred to East Jerusalem for treatment. The access rate is one machine per one million inhabitants, and bone marrow transplantation is still unavailable.
“Patients need cell transplants, so bone marrow transplantation must be referred to other countries.
“Approximately 100 patients per day travelled from Gaza to the West Bank and Jerusalem for radiotherapy, chemotherapy or surgery.”
Permits
Patients living in the West Bank and Gaza who are referred for diagnosis and treatment require medical permits, a complicated and lengthy process. The permit application process starts with making the medical decision, then obtaining medical approval, financial approval, getting the appointment date and then a payment process.
If people are fortunate to get a permit to cross the checkpoints, the process takes between 33 and 121 days. According to WHO data presented by the Dana-Farber Cancer Institute, in 2022, 20,295 permit applications were issued for Palestinian patients in Gaza, of those 33 per cent were denied or delayed.
Of those applying for permits, 29 per cent were children who needed to be accompanied by a parent or guardian, with 62 per cent of companion permits rejected, leaving about a quarter of children to travel to a health centre for treatment on their own.
“Imagine the delays in diagnosis and treatment,” said Dr Rimawi, who recalled Israeli soldiers airing their weapons at her as she crossed the divide during her clinical training.
“Cancer patients facing delays and denials in their permit applications are five times less likely to survive their disease. This is systematic discrimination, a death sentence.”
“Imagine a child facing cancer going through the treatment journey, going to the hospital with no mum or dad, with no one. These children deserve better.”
The 180-bed Gaza Cancer Centre was one hospital severely damaged or destroyed by bombing raids since the conflict began. It served 450 daily outpatients and was well equipped with an 8-bed ICT unit, blood bank, pharmacy, CT and MRI scanners and four fully equipped operating theatres.
Before the war, cancer incidence in Gaza was about 93.1 cases per 100,000 people. Breast cancer was the most common, accounting for 19.2 per cent of all cancers in the enclave, while colorectal cancer made up 13.2 per cent of all male cancers. The mortality rate was 34.5 per 100,000 people.
Dr Sobhi Skaik, director of the Gaza Cancer Centre, who was unable to secure a visa to visit the Geneva conference, spoke by video link from Cairo.
“Damages happened to the hospital when it was targeted directly twice in 24 hours,” he said.
“The patients were very scared and threatened, they couldn’t stay in their rooms, so they were coming into the corridors. We tried to take care of them as much as we could. It was a frightening situation and we all suffered with our patients.
“For cancer patients in Gaza, there is no basic infrastructure, just as in some smaller clinics where we can prepare for chemotherapy. Nearly all of our patients will be treated abroad, as nobody knows where is safe and there are no adequate facilities.”
Missing
The Ministry of Health said more than 41,200 people have been killed in the war in Gaza with more than half thought to be women and children. A further 10,000 people missing.
“Gaza’s cancer patients are in a real crisis, supporting demolished health systems would help the cancer patients,” said Dr Skaik. “During conflicts, there must be widespread protocols with some sort of solidarity fund for Gaza, like the UICC fund for Ukraine.”
The UICC has several member organisations in the region.
The Israel Cancer Association (Givatayim), the Flute of Light (Netanya), Aid and Hope Program for Cancer Patient Care (Gaza); Alhayat Association for Cancer Control (Ramallah), Augusta Victoria Hospital (Jerusalem), Istishari Arab Hospital (Ramallah), Palestinian Oncology Society (Ramallah), and Patient's Friend's Society (Jerusalem).
A UICC official said it would consider any request to set up a solidarity fund for Gaza, as had been done for Ukraine.
“UICC has not received a request from members in the region to set up a Solidarity Fund, but would certainly discuss it with them if it did,” the official said. “UICC is concerned that every effort is made for people suffering from cancer and other diseases and that they have access to care regardless of where they live.
“This is why UICC has cancer care in conflict zones on the agenda of the congress. In line with humanitarian law, UICC wants health care to be upheld during conflict and hospitals to be safe zones for patients and health workers.”
Rebuild costs
Dr Leslie Lehman, a paediatric oncologist who is collaborating with the Abu Dhabi Stem Cell Institute, said rebuilding health systems equipped to support cancer patients required considerable resources.
“You need a huge infrastructure, with medicines, radiotherapy and blood products,” she said. “When patients from Gaza go to other places, they don't have their records and you can't treat someone unless you know exactly what treatment they have already had.
“While it is wonderful for other countries to accept these patients and try to continue the care, it's not the same as people aren't allowed to come with their families. Children are this magical symbol of innocence. We can fix them and they're going to go on to have a full life and realise their potential.
“But our children and our grandchildren will ask us how we let this happen. Hopefully, we can do something about that.”
