The Overlooked Burden: Oncology in Gaza and the West Bank

In Gaza and West Bank the humanitarian situation has escalated to catastrophic levels, particularly following the October 7, 2023, attackss. In Gaza, the situation is one of unprecedented destruction and suffering. Tens of thousands have been killed or injured, with over 1.9 million people displaced. The healthcare system is almost entirely non-functional, with hospitals destroyed or barely operational, facing extreme shortages of vital medical supplies, fuel, and personnel.

Famine is a severe and escalating threat, with nearly the entire population facing crisis-level food insecurity, and verified reports of children dying from starvation. Access to clean water, sanitation, and shelter is critically limited, leading to widespread disease outbreaks amidst a relentless bombardment. Cancer care, which was already severely limited with only one specialized hospital, has been particularly impaired; this facility is now closed, forcing patients to go without life-saving chemotherapy, radiotherapy, and other critical treatments, leading to preventable deaths and immense suffering.

The West Bank has also seen a significant deterioration, with increased violence from both Israeli forces and settlers, leading to more Palestinian casualties, injuries, and forced displacement. Movement restrictions are tighter, hindering access to essential services, including healthcare in East Jerusalem and Israel, where critical specialized treatments are often located. Demolitions of homes and infrastructure continue, further destabilizing communities.

For cancer patients in the West Bank, this means increased difficulties in obtaining permits for treatment outside their areas, disruptions to their chemotherapy schedules due to supply shortages, and severe limitations in accessing advanced diagnostic services and radiotherapy, which are largely unavailable locally. The overall situation across the occupied Palestinian territories is marked by immense human suffering, an overwhelmed and fragmented healthcare system, and a severe humanitarian crisis, with cancer care being severely impaired across all stages.

Sorrowful Cancer Statistics in Gaza and the West Bank

The Palestinian Cancer Registry, despite being almost 25 years old, provides elementary statistics, and cases are often underreported, suggesting the true prevalence may be higher than documented. For instance, in Gaza in 2021, the incidence rate was 91.3 cases per 100,000 people, with 1,952 new diagnoses and 610 deaths, while the cumulative burden of cancer cases reached 10,566 by 2020.

Breast cancer is the most common cancer in Palestine, accounting for a significant portion of diagnoses, especially among women. However, the outcomes are starkly different compared to other regions. The five-year breast cancer survival rate among Palestinian women in Gaza and the West Bank is estimated to be as low as 40%, a stark contrast to nearly 90% in countries with robust screening programs.

This low survival rate is directly linked to the high proportion of late-stage diagnoses; over 60% of breast cancer cases in Gaza are detected at stage III or later, double the rate in the United States. This highlights a critical deficiency in prevention and early detection efforts, as there are no effective national programs for common preventable cancers, and mammography screening remains opportunistic and poorly utilized, with only 2% of eligible women receiving mammograms in 2021.

The challenges extend beyond statistics. The healthcare system, described as fragmented and heavily reliant on external actors, struggles to provide comprehensive care. Specialized pathology laboratories, advanced diagnostic facilities, and crucial radiotherapy services are largely absent in West Bank and Gaza hospitals, forcing patients to seek care in East Jerusalem, Israel, or even neighboring countries.

This process is fraught with difficulties, including lengthy and unpredictable Israeli permit applications for patients and their companions, which often result in delays or denials, significantly increasing the likelihood of death from cancer. For example, a survival analysis for Gaza patients referred for cancer therapy from 2008 to 2017 revealed that delays or denials of permits increased the likelihood of death from cancer by 1.5 times. In 2022, 35% of 20,295 permit applications for Palestinian patients in Gaza were for cancer patients, and 33% of these were delayed or denied.

Ghada Abuarqoub (49), suspects that her cancer has spread because of a lack of follow up at Palestinian government hospitals.

Photograph: Sally Hayden 

Source: www.irishtimes.com

Pre-War Challenges and Limitations in Cancer Care

Before the severe escalation of conflict in October 2023, cancer care in the occupied Palestinian territories was already grappling with profound, systemic limitations largely stemming from ongoing occupation and internal fragilities. These long-standing challenges significantly hindered patients’ access to timely and comprehensive treatment.

The healthcare system was characterized by fragmentation and a heavy reliance on external support. Cancer care primarily occurred in small oncology units within West Bank and Gaza hospitals, which notably lacked specialized pathology laboratories and advanced diagnostic facilities. A critical deficit was the complete absence of radiotherapy services in both areas, with the Augusta-Victoria Hospital in East Jerusalem serving as the sole comprehensive cancer center for Palestinians. Advanced hematology and bone marrow transplantation were also unavailable, forcing patients to seek referrals outside the territories.

Moreover, there was a significant emphasis on cancer treatment over prevention and early detection. Despite the preventability of many cancers, national programs for common types like lung, colon, or cervical cancer were largely non-existent. The only active screening program for mammography was opportunistic and poorly utilized, resulting in late-stage diagnoses, particularly for breast cancer in Gaza where over 60% of cases were detected at stage III or later. This contributed to a markedly low five-year breast cancer survival rate of approximately 40% in Gaza and the West Bank.

Access to specialized care outside the immediate territories was a constant struggle. Patients required Israeli medical permits, a process that was consistently lengthy, unpredictable, and often resulted in delays or denials for both patients and their companions. For instance, in 2022, 33% of permit applications for Palestinian patients in Gaza were delayed or denied, with companion applications facing even higher rejection rates at 62%. Such impediments were found to increase the likelihood of death from cancer by 1.5 times. Physical movement barriers, including numerous checkpoints and roadblocks across the West Bank, further compounded these difficulties.

Beyond access, the healthcare system suffered from chronic shortages of essential equipment and medications. Efforts to import vital medical supplies were frequently delayed or denied by Israeli authorities, and radiotherapy machines were unilaterally blocked from entering the West Bank and Gaza, leading to drastically limited access to this critical treatment.

Economic strain also played a significant role; despite substantial budget allocation to cancer treatment, the main Palestinian cancer center occasionally had to turn away patients due to the inability to afford expensive drugs, and the Palestinian Authority defaulted on loans intended for cancer care. Political instability further impacted access, with checkpoint closures disrupting daily patient travel and frequent attacks on healthcare workers and facilities adding to an already dire situation for cancer patients seeking life-saving treatment.

Post-October 7, 2023 Cancer Care

Since October 7, 2023, the already precarious state of cancer care in the occupied Palestinian territories has deteriorated dramatically, reaching catastrophic levels, particularly in Gaza. The pre-existing systemic challenges have been severely exacerbated, creating an unprecedented humanitarian and health crisis.

In Gaza, the landscape of cancer care has been largely obliterated. The Turkish-Palestinian Friendship Hospital, which was the sole specialized cancer treatment facility, has been extensively damaged by Israeli airstrikes and was forced to close due to a lack of fuel and medical supplies. Reports indicate it was eventually blown up, leaving thousands of cancer patients with nowhere to go for treatment. The Palestinian Ministry of Health has stated that intravenous chemotherapy services and medical follow-up for cancer patients have completely ceased in Gaza. This means that an estimated 10,000 cancer patients in Gaza are now deprived of life-saving chemotherapy, radiotherapy (which was already unavailable in Gaza pre-war), and other critical treatments, leading to preventable deaths and immense suffering.

Patients requiring urgent care are facing a “slow death” without medicines, equipment, or hope for treatment inside the Strip. While some international efforts have aimed to evacuate patients, only a small fraction of the estimated 10,000 cancer patients have been allowed to leave Gaza since the conflict began, with severely restricted and complex travel mechanisms. Those who are evacuated often leave without medical records or histories, complicating their continued care. T

he constant bombardment, widespread destruction, and lack of basic necessities like food, water, and sanitation further compound the physical and psychological distress for cancer patients, impacting their ability to cope with their disease and adhere to any available treatment regimens. The healthcare system, already fragile, has collapsed, with most hospitals non-functional and the remaining few operating far beyond capacity with severe shortages of staff, supplies, and basic utilities.

In the West Bank, the situation has also significantly worsened. There has been a marked increase in violence and movement restrictions imposed by Israeli forces. Checkpoints and other physical obstacles have proliferated, further fragmenting the territory and making access to healthcare facilities, particularly those in East Jerusalem or Israel, exceedingly difficult. Reports indicate a substantial decrease in patient and companion permit applications and approvals for medical care outside the West Bank since October 2023. As of May 2024, nearly half of all applications for patients to seek care in East Jerusalem or Israeli health facilities were denied or remained pending. Attacks on healthcare workers and facilities have surged, disrupting service delivery and impeding ambulance access.

The financial crisis faced by the Palestinian Authority, exacerbated by increased withholding of tax revenues, has led to health workers receiving only partial salaries and a critical shortage of essential medications (45% out of stock). This means that for cancer patients in the West Bank, existing challenges such as referral delays, lack of advanced diagnostics, and the absence of local radiotherapy are now exacerbated by intensified movement restrictions, widespread shortages, and a healthcare system under severe strain. The dire situation has led to a significant increase in deaths among cancer patients, both directly from the conflict and indirectly due to lack of access to care.

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A Daily Ordeal

Interviews with advanced cancer patients in the West Bank, as documented by Mitwalli et al. (2023), revealed numerous pre-existing difficulties that have been exacerbated. One male patient, 58 years old, described being denied permits on “security” grounds, stating:

“I do not receive permits from a security point of view (i.e. denied on the basis of ‘security’ by the Israeli military). I tried before and it did not work….I tried to apply for a permit from the Israelis to go to ‘A’ hospital (the Palestinian led East-Jerusalem hospital) for a checkup, the Israeli authorities did not agree, the Israeli interrogator interrogated me and told me I am not allowed.”

Patients also reported interruptions in accessing diagnostic and treatment services due to Israeli delays in providing supplies. One female patient, 50 years old, shared:

    “Now I have to get a nuclear image/scan in Hebron, but the material did not arrive from Israel.”

Another, 46 years old, stated:

“Last week, I didn’t get my chemotherapy treatment. I came, and they (at the hospital) told me that there are no medications, so they postponed my session for two days and gave me two doses to make up for it.”

Beyond these direct impacts of occupation, patients voiced frustrations with the Palestinian health system itself, including the lack of functioning advanced diagnostic services, long waits for appointments, and inconsistent diagnoses that sometimes led them to seek care at their own expense in private hospitals. Surgical delays due to bureaucratic referrals or even physicians’ strikes also forced patients into difficult choices.

The financial and physical burden of transportation was a common complaint, with a 54-year-old male patient from a rural southern town lamenting:

“I come from a southern town with a private taxi, and they take 150 ILS every day…. To be honest, financially you cannot expect to have 400-500 ILS available to come and go, in addition to hospital expenses. You do not have that kind of money.”

Another male patient, 54 years old, recounted the “burdensome and taxing” permit process, which separated him from his son at a checkpoint. These personal accounts underscore the deep and multifaceted struggles faced by cancer patients in the occupied Palestinian territories.

The plight of cancer patients in the occupied Palestinian territories stands as a poignant testament to the devastating intersection of conflict and healthcare deprivation. The systemic barriers that predated the recent escalation have now morphed into a full-blown catastrophe, particularly in Gaza, where the very infrastructure for cancer care has been annihilated. As these narratives powerfully convey, behind every statistic of disrupted treatment or denied access lies an individual facing unimaginable suffering, often in isolation. Addressing this profound crisis demands not only immediate humanitarian intervention but also a fundamental commitment to upholding the universal right to health, ensuring that dignity and access to life-saving care are no longer contingent on geopolitical circumstances.

Resources

Mitwalli, S., Hammoudeh, W., Giacaman, R., & Harding, R. (2023). Access to advanced cancer care services in the West Bank-occupied Palestinian territory. Frontiers in Oncology.

Rimawi, R., Wispelwey, B., & Madani, N. (2024). Roadblocks to Cancer Care in the Occupied Palestinian Territories. Health and Human Rights Journal.

Al-Shamsi, H. O., Abu-Gheida, I. H., Iqbal, F., & Al-Awadhi, A. (Eds.). (2022). Cancer in the Arab World. Published by Springer Nature.