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Jana and palliative care in the Gaza Strip
29 April 2021 - Jana is 4 years old from Jabalia, in the north of Gaza City. She was diagnosed with cancer in 2018 and underwent surgery to have a tumour in her bladder removed in January 2019.
WHO first met Jana in January 2020, when she had been unable for several months to obtain Israeli-issued permit to access radiotherapy treatment at Augusta Victoria Hospital, located in East Jerusalem, a different part of the occupied Palestinian territory. On 16 February 2020, after a four-month delay in her access, Jana and her mother were able to travel to reach health care outside the Gaza Strip.
The outbreak of COVID-19 occurred in the occupied Palestinian territory on 8 March 2020, with the first cases detected in Bethlehem. Since that date, Jana travelled to East Jerusalem for health care twice. From 16 February to 20 May 2020, she completed a course of chemotherapy and radiotherapy at Augusta Victoria Hospital. Jana returned on 29 June for further investigations, and was discharged on 13 July. Since this time, Jana has been followed up for palliative treatment in the Gaza Strip, although drugs shortages, lack of trained staff, and the demands of the emergency response to COVID-19 have all posed a challenge to her receiving the quality of care that she needs. Dr Mahmoud Shbair, a paediatric oncologist at Rantisi Hospital, commented on some of these challenges: “We often give high doses of morphine and fentanyl to patients with advanced cancer, to try to effectively control their pain. But we often run out of painkillers. We need staff training for palliative care, as well as sufficient drugs and the right equipment.”
Jana’s father told WHO, “Doctors in East Jerusalem told us there was nothing more that could be done for Jana. We went to Rantisi Hospital in Gaza on 24 August for follow up and her doctor there said the same. So, we are taking care of Jana at home. We go to Rantisi Hospital from time to time, but things have become difficult with coronavirus. We try to avoid taking her to hospital.” The systems for palliative care are not well developed in the Gaza Strip, where rates of poverty and unemployment also affect the ability of families to purchase even basic painkillers from private pharmacies.
Palliative care aims to improve quality of life for patients and their families and reduce suffering for persons with life-threatening illnesses, with the integration of physical, psychosocial, and spiritual aspects of patient care. Palliative care is an essential part of the right to the highest attainable standard of health, while palliative care medicines – including those needed for proper relief of pain and suffering – feature in the Essential Drugs Lists of WHO and the Palestinian Ministry of Health.
Dr Bushra Lubad is Head of the Intensive Care Unit in Rantisi Paediatric Hospital in the Gaza Stip. She stated, “Palliative care is needed from the initial point of care, it’s not only for patients in terminal stages of illness. It’s also needed for many conditions, not just cancer. We need to take care of children with kidney failure, cystic fibrosis, neurological, and other chronic diseases from all hospital departments.” Her team comprises two doctors, five nurses, a pharmacist, a psychologist, and a volunteer spiritual therapist. They have worked to strengthen palliative care for their patients in the hospital, but protocols for referral to palliative services are not well established and Dr Lubad points to a need for greater awareness, improved capacities, standard guidelines, and better integration of palliative care across the health system. At Rantisi Hospital, the team serves children who are staying as inpatients only and the service is in its early stages, established since September 2019 and working across different departments. “There is no palliative care department or even a room where a doctor or nurse can receive patients for palliative care consultations. An outpatient clinic for palliative care is still a dream!”
The sole psychologist at Rantisi Hospital often has to function as a social worker as well. She explained, “I talk to patients and their families to try to provide psychological support. However, many of them are facing severe hardship and they really need social interventions and assistance. But I don’t have anywhere to refer them to. Many times, we can’t afford basic materials to keep the children amused, like coloring books, crayons, and paper. I can only see the children staying as inpatients, but these children and families need help outside hospital too. The health staff in the hospital suffer psychologically, and they also need someone to take care of them.”
Jana’s ability to walk and play has become limited due to her illness and these days she gets tired quickly. One of the effects of her cancer is that it can stop her from passing urine, which has been happening once or twice each month in recent times. According to Jana’s father, “When this happens, we take her to Rantisi Hospital or to a private clinic. A nurse who lives near us has also come to help sometimes.” The family buys Jana simple pain relief medicines at the local pharmacy and do not receive psychosocial support at home. They continue to hope for a cure for Jana. Her father added, “If we knew of a place they could cure Jana we would do anything, even sell the house. We keep looking for the possibility of referring her outside for help.”
“I will continue to be an advocate for a better health for all Palestinians’’ reflected Dr Rockenschaub at a farewell event before his departure
3 March 2021 - "Dr Rockenschaub and the WHO organization and what they represent were not only our partners, but they worked together with high professionalism. His support and efforts to Palestine’s performance facing COVID-19 outbreak showing the highest levels of responsibility," Prime Minister of the Palestinian Authority Dr Mohammad Shtayyeh has recognized the efforts of WHO’s Head of Office, Dr Gerald Rockenschaub, after almost seven years in the position.
Dr Shtayyeh joined WHO and UN staff, partners and supporters in the West Bank and Gaza Strip to bid farewell to Dr Rockenschaub in ceremonies in the past weeks before he moved to WHO Albania to take up a similar position.
Dr Walid Nammour, secretary-general of the East Jerusalem Hospitals Network also said, "Dr Gerald has greatly contributed to supporting East Jerusalem Hospitals, especially his support to COVID-19 preparedness and his role in consolidating the Palestinian National Institute of Public Health, in their efforts to build a more resilient health system and to strengthen data collection, and the utilization of evidence and best practice by the Ministry of Health. Gerald had a mission in oPt to achieve and not just a job to follow."
WHO Health Emergencies Team Lead, Dr Ayadil Saparbekov, reflected on his integrity, dedication and legacy, “under his leadership WHO has made a significant contribution to improving the health of Palestinians. WHO supported the Ministry of Health in the COVID-19 response including considerably scaling up the testing capacity of the central drug laboratory in Gaza and being one of the first countries in the Eastern Mediterranean Region to mobilize the COVID-19 vaccine through the COVAX AMC Facility.”
Following the Great March of Return demonstrations in Gaza in 2020, Dr Rockenschaub supported the establishment of a Limb Reconstruction Centre to provide permanent health services to those with gunshot wounds who needed specialized and complex limb surgeries to prevent disabilities and amputations.
“I will continue to be an advocate for a better health for all Palestinians, who experience challenging experiences and difficult situations,’’ reflected Dr Rockenschaub at a farewell event before his departure.
Research and practice for health and human rights in the occupied Palestinian territory, October 2020
20 October 2020, Birzeit & Jerusalem – Twenty-five participants from civil society organizations working on health and human rights, in addition to undergraduate and postgraduate students, today completed a 5-day course on Research and Practice in Health and Human Rights.
The course was organized by the Institute of Community and Public Health at Birzeit University, Lancet Palestinian Health Alliance, UNFPA Palestine, and WHO in the occupied Palestinian territory, and examined the application and intersection of health and human rights in theory and practice. The course was strongly interactive, with practical sessions to build understandings and initiatives between sectors to strengthen activities to promote the right to health and a human rights-based approach to health in the occupied Palestinian territory.
In her closing remarks, Professor Rita Giacaman from the Institute of Community and Public Health at Birzeit University and the Lancet Palestinian Health Alliance surmised, “This has been a great experience, telling us that despite this pandemic, we are still able to continue with our lives, learn new things, and cope with the situation. I’d say typically Palestinian, as many of us have been through curfews and exposure to violence previously. But as a people we have a special capacity to endure and resist.”
Mr Ziad Yaish, Deputy Representative for UNFPA Palestine, emphasized “For women and girls, the right to health, and in particular the right to sexual and reproductive health, is a key aspect of being able to live a healthy and fulfilled life. This was confirmed at the International Conference on Population and Development (ICPD) in 1994, and it was reconfirmed again during last year’s Nairobi Summit, which marked 25 years of the ICPD. A hundred and seventy countries including the State of Palestine participated in this summit and made bold commitments to transform the world by ending all maternal deaths, unmet needs for family planning, and gender based violence and harmful practices against women and girls by 2030”.
Finally, Dr Gerald Rockenschaub, Head of WHO office in the occupied Palestinian territory, concluded, “The right to health and barriers to accessing health services in the Palestinian context are a collective concern that require our consolidated efforts. At WHO, the right to health is enshrined in our constitution, which states that health is a fundamental and universal human right. We must maintain principled advocacy and strengthen this through shared knowledge, experiences and practices, to build our collective capacity to address challenges to realizing the right to health for all Palestinians.”
The course was supported by funds from the Swiss Development Cooperation to WHO and core funding from UNFPA.
Further information:
Dr. Ben Bouquet
Technical Officer (Public Health and Human Rights)
WHO oPt
Saja delayed access to the treatment she needs, September 2020
14 September 2020 - Saja is a 9-year-old girl who was diagnosed with acute myeloid leukaemia in May 2019.
She needs a bone marrow transplant, not available in the Gaza Strip, and has not been able to access the treatment she needs since March 2020.
Saja’s mother is from Morocco, and she was diagnosed with acute myeloid leukaemia during a family visit to Rabat, Morocco, in May 2019. Saja received her initial chemotherapy in Rabat, before returning home to Gaza in February 2020 to continue her treatment and undergo bone marrow transplantation in the occupied Palestinian territory.
An initial appointment was scheduled for 22 March 2020 at An-Najah Hospital in Nablus, in the West Bank, but the hospital only offers autologous transplantation (using the patient’s own bone marrow), while Saja needed an allogeneic transplant (with bone marrow from a donor). Saja was rescheduled an appointment at Augusta Victoria Hospital in East Jerusalem, but again the hospital could only offer autologous transplantation. Eventually, on 15 July 2020, Saja received an appointment to attend the King Hussein Cancer Centre in Jordan, however she was unable to exit to Jordan because of the border closure due to the COVID-19 pandemic.
After a delay of around six weeks, Saja was scheduled for an appointment at Tel Hashomer, an Israeli hospital east of Jaffa, for 6 September. However, Israeli authorities advised the family to change her companion since her mother doesn’t have a Palestinian ID. The family appealed the decision in the Israeli civil courts through Physicians for Human Rights Israel, after rearranging her hospital appointment to 15 September. On 14 September, Saja’s appeal was upheld; she was finally able to travel for treatment the next day.
Throughout efforts to refer Saja for bone marrow transplant, she has been receiving chemotherapy at Rantisi Hospital in Gaza City. Her mother, Najlaa, commented, “We are from Rafah, and the journey from Rafah to Gaza takes about an hour. At times we’ve had to attend Rantisi Hospital every other day. It’s exhausting and putting a strain on us physically and financially.”
Saja’s health has been deteriorating in recent months, as she suffered the effects of leukaemia. Admitted to Rantisi Hospital before hearing the result of her appeal, she had needed platelets but faced severe delays with the outbreak of COVID-19 in the Gaza Strip. Even relatives who had been willing to travel to donate platelets for her had not been able to reach the hospital due to the movement restrictions in place.
During the COVID-19 outbreak, just as outside it, no patient should be delayed or prevented from accessing the healthcare they need.
