Coronavirus and politics trap Gaza's cancer patients

For a young mother who lives in the Gaza Strip, the events of the last three months have been desperate. Walla Al Zureidi is 31 and has breast cancer. She needs treatment that is not available in the closed-off territory.

"We don't know whether I will get treatment. Without it, there is a risk to my life," she says on the phone from Gaza. After undergoing a mastectomy, she was set to make an appointment for radiotherapy in June at a hospital in East Jerusalem. 

But the travel restrictions introduced to contain the coronavirus pandemic and the Palestinian Authority's (PA) decision in May to suspend civil and security coordination with Israel — a protest against Israel's plans to annex parts of the occupied West Bank — have left her stranded.

For Gazans like Al Zureidi, an already complicated situation has become even more uncertain. She no longer knows how she should apply for a permit to exit the Gaza Strip through the Israeli-controlled Erez Crossing.

"We didn't know whether we were allowed to leave Gaza. Some say no one can get out. On the news, they say that there are people leaving through Erez, but we don't know where to apply."

Israeli and Palestinian bureaucracy made worse

For the past 13 years, Israel has tightly controlled the movement of people and goods through its crossing points with the Hamas-ruled Gaza Strip.

Obtaining an Israeli permit to exit Gaza has typically been a difficult bureaucratic process. Israel only allows people in certain categories such as severe medical cases, traders, students, and other humanitarian cases to submit an application.

Gazans used to apply with a medical referral at the local office of the Civil Affairs Committee, a body run by the PA from Ramallah, which channeled all permit applications to the Israeli Coordinator of Government Activities in the Territories (COGAT). In late May this process was stopped.

The halt motivated other cancer patients like Alia Agha from Rafah, in the south of Gaza, to seek alternatives. "Not only does a patient suffer from this disease, but they also suffer to get treatment," says Alia.

Aid organizations in tough situation

Like others, she eventually turned to human rights and other aid organizations in Gaza and in Israel for help, even though those organizations usually follow up on cases rather than directly submit permit applications to the Israeli authorities.

"In June, we dealt with 104 [mainly urgent] cases, normally we only handle 30 cases. It's a huge number for us. We don't have that capacity," says Ghada Majadle from Physicians for Human Rights (PHR), an Israeli non-governmental organization (NGO).

"Human rights organizations should not replace an official body doing the coordination," she added, saying that a solution needs to be found for the underlying political problem.

The Al Mezan Center for Human Rights, a Palestinian NGO in Gaza, also followed up on permit applications but later stopped so as not to be seen "as an alternative to the Palestinian Authority," said Deputy Director Samir Zaqqout.

Cancer patients need rapid treatment

Time is of the essence for those with urgent illnesses like cancer. "If they don't get their radiotherapy on time, they risk that their cancer might come back," says a specialist surgeon who usually treats patients from Gaza in an East Jerusalem hospital.

The doctor, who requested anonymity, is concerned about not seeing his patients return for therapy. Exits of patients and their companions from Gaza have plummeted from over 2,900 in February to under 200 in June. That is according to Gisha, an Israeli human rights NGO that monitors operations at the crossing.

The spike in COVID-19 cases in the occupied West Bank and Israel, as well as the 21-day quarantine imposed by the Hamas authorities on people returning to Gaza, has further put some people off applying for a permit in the first place. 

Push to lift some travel restrictions

In Ramallah, the PA acknowledges the newly added hardship, but does not seem to offer a sustainable solution. "It caused suffering for cancer patients and other patients," says Ibrahim Milhim, a government spokesperson in Ramallah via a Whatsapp message, adding that, "We asked the International Red Cross and UN organizations to intervene to allow these patients to reach hospitals in the West Bank, Jerusalem and Israel."

The UN is currently working on a system to step in as facilitator between the Israeli side and the PA, says Jamie McGoldrick, the UN's humanitarian coordinator in Jerusalem.

"We are working with the parties to come up [with a system] whereby the UN can be the go-between to allow patients to come out from Gaza as before and working with the existing systems."

This, however, would only apply to life-saving cases where patients need treatment in the West Bank and elsewhere, he added. In the long term, all sides should work on providing comprehensive cancer treatment inside Gaza.

For its part, COGAT has set up an application form on its website and may accept direct applications for some humanitarian cases. But it remains unclear what happens with non-medical applications like students, laborers, social cases, or those returning home to Gaza, who also need a permit to go back in. COGAT has not responded to a request for more details.

In a letter on Sunday, five Israeli human rights organizations — including PHR and Gisha — urged COGAT, Israel's Defense Ministry and the Israeli attorney general "to lift restrictions and to enable Palestinians to travel outside of Gaza through the Erez crossing beyond urgent medical cases and regardless of Palestinian coordination bodies."

Alia Agha hopes that her permit will come through by the end of July. "I don't want to to leave Gaza, I want to stay with my family, but I have no choice but to go for treatment outside."

Hazem Balousha contributed to this report from Gaza.

This article has been updated to reflect that the Al Mezan Center for Human Rights checked on its permit applications.