Huda is a nurse in the cancer outpatient department at Al Rantisi Hospital in Gaza City. She has been working with cancer patients for 15 years. 

The work is not easy and cancer departments in Gaza face severe shortages of drugs and supplies, as well as lack of equipment. In November 2019, almost half (48%) of essential drugs stocks were at zero stock in Gaza’s Central Drugs Store. For chemotherapy drugs, the situation is even worse with 63% of essential drugs at zero stock.

Huda comments, “In addition to suffering the effects of cancer, patients suffer a lack of services, shortages of drugs and denial of their permits to reach services outside Gaza. We don’t have enough psychological support services or intensive care beds. When a woman has an appointment to get chemotherapy and the drug isn’t available, she’s disappointed and upset. It affects us as caregivers as well. Patients referred for care out of Gaza are also denied permits to exit. We feel frustrated and helpless to watch as a patient’s health deteriorates. Chemotherapy drugs require a specific schedule according to the treatment plan and delays mean worse outcomes for patients.»

Cancer patients require care outside the clinic, and Huda shares her personal number so that they have someone to turn to in moments of need or crisis. She contacts local societies to link patients into the mental health and psychosocial support services that are available. 

Huda has her own personal experience of cancer, after her husband was diagnosed with testicular cancer over ten years ago. Her personal experience has given her insights into the need for strengthening psychological support for cancer patients and their families. “We were very shocked, but I tried to support my husband and to fight the battle with him. I’ve lived what it means to have a relative fighting cancer and I know the suffering patients go through during their journeys to get treatment. Especially when they have to reach health services outside Gaza.”

Huda is 38-years-old and has three children. She lives with her husband and children in Gaza City. She reflects on the crisis facing the health sector in Gaza, “We are living in a very hard situation. I always dream that cancer patients will have a specialized hospital here and that all the services they need will be available. Patients and health workers deserve a better environment. We deserve our rights.”

Related links: 

WHO monthly reports on referral of patients from the Gaza Strip, November 2019 

WHO obstetrician and gynaecologist Dr Nashwa Skaik, who leads the pioneering Early Essential Newborn Care project which assists with 75 per cent of all births in Gaza, has been awarded WHO Director-General’s Award of Excellence for her work. Credit: WHO22 December 2019, Gaza – “Families and in particular, mothers and infants, are the essence of any society and they should never be neglected. I am immensely honoured and grateful for this recognition, which is a true reflection of the global and regional efforts to improve mother and newborn health in all settings. This reward is a huge boost to myself and the team in our office,” Dr Nashwa Skaik, WHO’s obstetrician and gynaecologist in Gaza, reflects after receiving the WHO Director-General’s Award of Excellence for her work managing a pioneering maternal and newborn health care project in the Gaza Strip to prevent and treat the key causes of newborn mortality and diseases. 

In Palestine, babies aged less than one month old account for 50 per cent of deaths in children under five. Half of these deaths in babies occur in the first day of life, mainly from complications related to prematurity, birth asphyxia and infection.

Based on international evidence, Dr Nashwa and  colleagues at WHO, rolled out the Early Essential Newborn Care project in 2017 with the Ministry of Health in Gaza to ensure that quality essential care is provided during critical moments around birth, in addition to care for premature, low-birthweight and sick babies.

The project has strengthened the Ministry of Health’s system from the bottom up, by coaching local clinical staff with a package of simple and cost-effective evidence-based interventions during childbirth and immediately after, and focusing on the elimination of harmful and outdated practices in the first 24 hours of life. This includes reshaping policy and guidelines, managing supplies and staff, and providing health information.

The project now covers 75 per cent of all births in Gaza in maternity and neonatal units in four targeted hospitals and widespread adoption has resulted in significant improvements since 2017 in key areas including the following.

Early and exclusive breastfeeding: take up improved from 21% to 52.5% from 2017 to 2019. These practices, where infants receive breastmilk within one hour of birth and where they only receive breastmilk without additional food or drink, are known to lower newborn deaths by 22%. Breastfeeding protects the baby from common childhood illnesses such as diarrhoea and pneumonia and may also have longer-term health benefits, such as reducing the risk of overweight and obesity in childhood and adolescence.

Babies receiving sustained skin-to-skin contact: this increased from 0% to 35% from 2017 to 2019. This practice, where a baby is laid directly on their mother’s bare chest shortly after birth, is essential for preventing temperature loss and diseases that lead to infection and death. Among infants who received this care, there is a reduction in newborn admission to intensive care due to respiratory problems by 5% in Gaza. In addition, it helps parents bond with their babies and supports better physical and developmental outcomes for the baby.

Dr Skaik said she treasures the opportunities she gets at WHO:

“They are like no other place. I enjoy my everyday work with the team and the space I am given to be more creative and innovative. We try our best to deliver high quality and unique care to all mothers and babies in Gaza, which ensures that they thrive and survive despite the difficult circumstances.”

The WHO team congratulates Dr Skaik and her colleagues for their dedication and achievements in improving the lives of mothers and babies in Gaza.

Sabreen is a 28-year-old first responder and team leader of the Nabed Al-Hayat team, working east of Rafah in the south of the Gaza Strip. Sabreen established the independent team on 6 April 2018, soon after the beginning of Gaza’s Great March of Return. Her team of 13 at the start of demonstrations included Abdullah al-Qutati, who was shot and killed on 10 August while working to provide help to those injured. Today, the team comprises 12 first responders, though different team members have had to take leaves of absence from volunteering due to injuries sustained while working to deliver healthcare. The team works closely with the Ministry of Health field medical point.

On 27 September 2019, Sabreen was treating a child who had suffered gas inhalation close to the Gaza fence. While receiving care, the child was shot with live ammunition in his back, which penetrated into his abdomen. Sabreen remembers, “At first, I collapsed with grief and started crying. Then I straight away resumed providing first aid to him [the child] until he was transferred to the medical point. We were about 100 meters from the fence… He was under my care and I couldn›t believe they would shoot a child while a paramedic was treating him. After that, a journalist standing near me had a call from the Israeli side to convey a message to me that I should leave the place and that they would shoot warning bullets to our side. While leaving, they shot about ten bullets around me.” The child, 13 years old, was transferred to the European Gaza Hospital and admitted to the intensive care unit after surgery. 

Approximately 20 minutes after the child was shot, at around 6:10pm, Sabreen saw four injured persons close to the fence in need of assistance. She went forward to help and had begun to treat one of the persons when she was shot with live ammunition. The bullet went through her right forearm, severing a nerve in her hand, and into her abdomen. She had heavy bleeding from her liver and was rushed to hospital. At hospital, Sabreen was taken straight to the operating theatre to stop the bleeding. After the surgery, the doctors told her family that the bullet had lodged next to her spine and that intervening to remove it would risk additional health problems. Sabreen stayed at the hospital for four days under observation before she was discharged.

Since her injury, Sabreen has become dependent on her husband and mother to move around. She can only stand with difficulty and needs to walk slowly, requiring help for most of her daily tasks. She suffers numbness in both her legs and has also lost some movements and feeling in her right hand.

Sabreen says, “It’s not my first injury. I was shot in my head with live ammunition a few months ago which affected my sight… I feel I am targeted as a paramedic and in Gaza we have never been truly protected. In spite of all the risks, I choose to be a first responder at the fence. I believe it is our responsibility to treat those who need our help and our skills.”

Sabreen is married with a 7-year-old daughter who is at primary school. “After my injury, I haven’t been able to properly care for my daughter. Now my husband or my mother have to care for her. Sometimes my daughter has had to miss school when her father is at work. Really, it is so hard for me as a mother to be unable to care for my daughter as I want to. I never felt as disabled as when I was unable to help her.”

Sabreen sustained the 44th and 45th live ammunition injuries among health workers in the Gaza Strip since the start of the Great March of Return. From 30 March 2018 to 30 September 2019, three health workers have been killed and 832 injured in 550 recorded incidents against health staff and facilities in the Gaza Strip.