War: the real ‘cancer’ of mankind

Reproduced by kind permission of The Courant.

 June 5th marks the 50th anniversary of the Israeli occupation of the West Bank and Gaza. On June 14th Palestinians in Gaza will have been in lockdown for 10 years, a period punctuated by three punishing military offensives. It’s 16 years since British troops were deployed to Afghanistan, and three since they officially left a still dangerous and unstable country.

 Palestinians and Afghans have been so frequently linked to violence, conflict and aid appeals that they have lost their identity as people with ‘normal’ needs; needs like education, freedom of movement, food, shelter and healthcare.

Pain can shrink a universe. To someone struggling with cancer the fact that their nation is in political turmoil or their leader about to be toppled is almost an irrelevance.

But only ‘almost’, because war and the tectonic plates of political repositioning have a direct effect on every aspect of family life – and at the heart of every family is a woman.

‘Brexit’ may have prompted families in the UK to speculate about how leaving the EU might impact on health spending, but no Western woman expects to face a future in which breast cancer treatment is either unavailable or punishingly hard to access.

Towards the end of 2016 I joined a low profile, self-funded ‘tour’ for individuals who wanted to see for themselves how citizens of the Jewish State and their neighbours in the Palestinian Territories co-existed. During that visit news reached the party that Donald J Trump had won the American election and iconic singer-songwriter Leonard Cohen had died. Cohen’s legacy was a poignant valedictory album prophetically called ‘You want it darker’. For those living in the ‘Occupied Palestinian Territories’ that darkness had been gathering for a long time. For some it began 70 years ago and on May 15th the Nakba was commemorated – i.e. the ‘catastrophe’ that resulted in more than 750,000 Palestinians being dispossessed when the State of Israel was formed.

Erez Crossing from Palestine to Israel

Donald Trump’s proposal to build a wall to keep Mexicans out of the USA provoked shockwaves of horror and international condemnation. Yet Israel has been building walls for years, not to staunch a flow of economic migrants, but to keep Palestinians out of their own country. Behind the walls are roads that Palestinians can’t use and settlements that they can’t live in.

Nearly 4,000km east of Jerusalem, the residents of Kabul also face barriers. Maybe not the kind that physically criss-cross the West Bank or restrict access in and out of Gaza, but they are equally impenetrable.

American journalist Sidney J Harris described war as ‘the cancer of mankind’ – a malignant and destructive force that changes the conventions of life. Nowhere is that more evident than in these two countries.

Palestine and Afghanistan are not unique; visit any failed state, war or post-conflict zone and you will find disruption. Good infrastructure, freedom of movement, communication networks and a degree of wealth are pre-requisites of any ‘healthy’ society and the first to suffer in times of war.

The Erez crossing from Gaza to Israel is a bleak, soulless place. Intimidating to all travellers it represents a singular obstacle to those seeking medical treatment. It is accessible only to Israeli-issued permit holders, primarily medical and other humanitarian cases, aid workers and merchants. Many of those who pass through the long corridors of concrete and wire that deliver them to the scrutiny of security checkpoints need vital treatment for cancer. According to the World Health Organisation’s (WHO) Access Report for March 2017, 45% of patients seeking to leave Gaza for healthcare had their appeals for permits denied or delayed.In 2016, the average rate of permits granted was just 64%.

Erez Crossing from Israel to Gaza

At the Qulandia crossing, between the West Bank and Israel, women seeking radiotherapy also have to wait – often standing in the heat and dust for hours feeling sick, frightened and anxious. Currently this critical treatment is only available to them at Jerusalem’s Augusta Victoria Hospital.

Mainstream news outlets focus on the kinetic aspects of Israel’s relationship with its Palestinian neighbours. The morality of bombs, air strikes, blockades and the inevitable ‘collateral damage’ is a subject that exercises Middle East pundits with Pavlovian regularity. The 2016 Haifa blaze was global news, but deaths due to more prosaic causes are not so well profiled.

Oslo Accords notwithstanding, neighbouring Israeli and Palestinian communities live in parallel universes. Divided physically by intimidating concrete walls and forced to use different roads, their daily experiences of life couldn’t be more different. Those living in Gaza have faced virtual lockdown since 2007 when Israel imposed a land, sea and air blockade on the strip; many inhabitants regard it as an open prison. Their counterparts in the West Bank have more mobility, but their movements are curtailed by checkpoints, random ID inspections and much-disputed seizures of land, property and water sources. There is no airport in Palestine (the West Bank, or Gaza).

As for the ‘mutual dignity’ promised by the 1993 Oslo agreement, it is hard to imagine anything less dignified than the sight of human beings queuing like cattle at checkpoints manned by unsmiling young guards whose ‘security’ role frequently causes sick women to miss hospital appointments or go home in despair.

Often separated from their West Bank neighbours by just a few kilometres Israeli women are almost twice as likely to survive breast cancer as their Palestinian counterparts.

“Medical Aid for Palestine (MAP), one of the charities contributing to the support of a not-for-profit Cancer Centre in Ramallah and a West Bank university, has tried to remedy this. The charity supports the Dunya Centre (to the tune of £88,000 per annum) and has invested in Bethlehem University so that it can offer a Higher Diploma course for nurses in Oncology and Palliative Care. A spokesman said, “Our initial £121,000 covers the first two cohorts (1.5 academic years), with another £152,000 pledged to cover a further three cohorts subject to a positive evaluation.”

 The Dunya Centre

The Dunya Centre is a beacon of hope in this depressing scenario. Founded in 2011 it is the only place in the West Bank that offers Palestinian women (and men) the comprehensive early diagnostic technology for breast cancer that can save invasive surgery and, in many cases, lives.

After qualifying as a doctor in Moscow its Director, Dr. Nufuz Maslamani, returned to Palestine to practice. She too has to negotiate the Qulandia crossing daily to get to work, but is upbeat about what the clinic is achieving. “Every woman who comes here is given a breast examination. We teach her how to do self-examination. If she does this each month she can detect 70% of the changes that indicate breast cancer. We work to international protocols, if a woman is more than 40 we start with a mammogram and then after that, ultrasound but if the woman is less than 40 we start with ultrasound and a physical exam.”

The Dunya Centre offers clinical examination, mammography, breast ultrasound and PAP/cervical smear tests. It has a cytology lab and is able to conduct a variety of investigations. “Six of our patients have been men,” says Dr. Maslamani.

Dr Nufuz Maslamani and members of her team at Ramallah’s Dunya Cancer Clinic

While we speak a member of staff brings in some hair ‘donated’ by a supporter. It will be used to make one of the wigs that the centre makes available to women who have lost their hair as a result of treatment. The clinic also offers psychological support for cancer patients and their families and uses its ‘Survivors Group’ as a force multiplier to reach members of the community fearful or mistrustful of its services.

One Israeli hospital employee has a unique overview but is understandably unwilling to be named. “Certain kinds of treatment are just not available in the West Bank; they don’t have a child dialysis facility for example and they (children) have to travel many kilometres to get their treatment three times a week.

 “In Gaza however, things are terrible. If they need a blood transfusion for example, it can be done, but certain blood types need to be processed to get rid of antibodies. Well, that facility does not exist in Gaza. You can do the transfusion but you are probably killing the patient.”

Afghanistan’s cancer sufferers are not separated from treatment by such visible barriers but by lack of money, and accessible facilities. Like their Palestinian counterparts their situation is a legacy of conflict.

 Afghan breast cancer surgeon Dr. Zarghuna Taraki, whose UK patients at University College Hospital London have access to excellent treatment, said, “Cancer is a dark area in Afghanistan – not only breast cancer but all cancer – there is certainly no comprehensive awareness campaign. I was talking to some ladies back home and they asked me questions such as ‘Is it possible that a breast can develop a disease?’

“Most women in Afghanistan look to other women, their friends and families, for information. In the villages especially I don’t think they have any knowledge about the meaning of breast lumps or breast cancer – so they die without ever knowing the reason. This is very sad but it also makes it harder to learn how widespread breast cancer is when causes of death are unknown.”

The WHO estimates that nearly 20,000 cases of cancers are diagnosed in Afghanistan each year. Breast cancer is the most common, accounting for approximately 15% of all cases. It is the leading cause of death in women.

Of course, Palestinians and Afghans are not the only people denied the healthcare that we in the UK take for granted – every country where ‘the cancer of mankind’ has left its mark can point to families destroyed by un-necessary deaths.

But it’s not all bad news. Just as the Dunya Clinic brings hope to Palestinian women, so too does the embryonic Cancer Department in Kabul.

 In November 2014 when the then MP Dr. Shinkai Karokhail, now Afghan Ambassador to Ottawa, returned home after spending almost a year overseas being treated for breast cancer that was misdiagnosed in Afghanistan, she and HE The First Lady, Mrs. Rula Ghani, began advocating for improvement and better cancer prevention and control in their country. They brought together the nation’s cancer professionals under one umbrella – the Afghanistan Cancer Foundation (ACF).

In addition to cancer awareness campaigns, ACF convinced the Ministry of Public Health and the only medical oncologist in the country to set up an outpatient department (OPD) followed by the opening of a 23-bed Inpatient Department (IPD) in Jumhuriat Hospital. Between August 2015 and April 2017, more than 9,500 patients were provided with cancer diagnosis and treatment services there.

Still finding its feet the Cancer Department, affiliated with the National Cancer Control Program, is desperate for support as its coordinator at the Ministry of Public Health, Dr. Maihan Abdullah  explains: “Support and advocacy for cancer prevention and control here is badly needed. With each passing day the number of patients visiting the Cancer Department is increasing. Patients coming from rural areas have to wait for days to be admitted. The most urgent need is infrastructure/buildings that could accommodate the increasing demand for cancer care services. The second most important need is for the establishment of a pathology unit for which we need human and financial resources. The third most important need is for radiotherapy.”

He knows that political and financial support is crucial, but equally vital is expertise. “We need to recruit non-Afghan experts but many are reluctant to come to Afghanistan without the support of their governments.”

See also: http://www.ukprogressive.co.uk/afghanistans-first-lady-backs-battle-against-silent-killer/article39912.html