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

Ignore this plea for help at your peril – Afghan women in jeopardy

Soon to become ‘yesterday’s war’ the West’s intervention in Afghanistan will leave half its population fearful and in jeopardy. Already laws to protect women are being challenged or unravelling.

Afghan Women’s Support Forum – for further background


An Urgent Cry for International Support to Rescue Afghan Women’s Rights

If you do not help us today, we will never be able to appeal to you for support again. This may be the final battle that we could ever wage for democracy, peace and human rights in this country.

We are now in the middle of a fierce battle to defend our rights as women and as human beings. Our rights are being ferociously cannibalized today by the Legislative and Executive Branches of government – the very institutions of democracy that you helped established through the taxes of your people during the past decade.

The main protective shield of Afghan women’s rights, the Law on the Elimination of Violence against Women which you helped us enact in August 2009, is currently under serious threats of being repealed because of pressures from fundamentalists outside and inside the Afghan government. Our lame duck President has declared that he had received enough of embarrassment already in supporting women’s rights and will not help us in any way.

We have no other recourse anymore. We will not wage armed struggle because, having been a victim of violence for so long, we believe in peaceful ways of defending our freedom and rights.

The international community promised that the rights of women will not be sacrificed in the altar of peace. We need a fulfillment of that promise in these very times. We appeal for international support in this final struggle to halt the repeal/amendment of the Law on Elimination of Violence against Women and other Constitutional policies on gender equality and women’s rights.  We believe that you could pressure the fundamentalists in our government to stop their assault to women’s rights policies under the threat of a potential aid and economic embargo from your end.

We, therefore, come to you on bended knees to please use your diplomatic and economic influence to support us in this precious battle. Losing the Law on the Elimination of Violence against Women meant losing everything for us.  Don’t let your investments go down the drain. Don’t let the rights of women in this part of the world perish silently in the hands of the enemies of democracy.  In our most desperate moment, we count on you in the name of sisterhood, human rights, peace and democracy. We come to you with hope, and hope never fails.


NATO’s grim legacy to Afghanistan

Good night Kabul . . .

Those of us who have spent time in Afghanistan – specifically with members of its  Army (ANA) and Police Force (ANP)  – will not be surprised by Ben Anderson’s pessimistic documentary about NATO’s legacy. He finds “a drug addled police force that kidnaps locals and sells its weapons”.

Ben writes, “Handing over security operations in Afghanistan to the Afghans is “proceeding very well”, Philip Hammond, the defence secretary, said on a recent visit to Helmand. “The Afghans are developing capabilities faster than we expected.” He was echoing the unbridled optimism of many British and American officials.

Having just returned from five weeks in Sangin — the most violent district in Afghanistan’s most violent province — I cannot see any reason for such optimism.

The police in particular are behaving so badly that it would not be a surprise to see local people welcoming a return of the Taliban, seeing them as a bulwark against spectacular corruption and violence, just as they did when the Taliban first swept to power.

The police, often illiterate and drug-addicted, use child soldiers, kidnap civilians, fire indiscriminately and sell the weapons and fuel that we have paid for. Police commanders routinely abduct and sexually abuse young boys.

That this is happening in Sangin is particularly galling when so many have died there — 109 British troops and many more Afghan civilians — so that the Afghan government can operate in areas previously controlled by the Taliban.

Today the patrol bases that coalition troops fought so hard to establish have largely been abandoned. The 500 US marines in Sangin stay on the relatively safe forward operating base. Most spend their time lifting weights and counting down the days until they can come home. For them the war is already over.

Only two teams of 18 US marines leave the main base to “advise” the Afghan army and police. The police advisory team covers 34 patrol bases: its members visit each base once every three weeks on average. Some visits last about 20 minutes, some 4-5 hours. Either way, the teams are advising, not training. “As an adviser you’re a dog with a lot of bark and not a lot of bite,” says Major Bill Steuber, who is in charge of the police advisory team. “If we were to shut down all of their corruption schemes you would render them ineffective.”

Steuber is a bear of a man, square-jawed and with the sides of his head shaved almost bald. He seems incapable of lying or even using euphemisms. When he explains what he has to contend with every day, he flinches at the sound of his own words. “It [the police corruption] is vast, everything from skimming ammunition off their supplies to skimming fuel off their shipments. There’s false imprisonment — they’ll take people: during an engagement they’ll just wrap everyone up; then they’ll wait for the families to come in and pay them money to release them.”

He also says the police regularly sell ammunition and weapons in the local bazaar, including rocket-propelled grenades. So, weapons we have paid for could well be ending up in the hands of the Taliban.

While Steuber attempts to influence the police leadership, his men check on the patrol bases dotted all over Sangin. At one the marines spell out the new reality to a police commander: “You have to learn to operate as if we weren’t here,” says Lieutenant Sharp. “You have to learn to walk out on your own.” The two men sit on a rug in the middle of the police base. Behind them is a huge marijuana plant. Nearby two policemen lean on each other, sometimes snoozing, barely aware of what’s going on around them.

The police commander wants the marines to raid a factory making improvised explosive devices and he is annoyed that they won’t do it. “If you don’t help us then we’d be crazy to patrol and kill ourselves and see our friends killed,” he snaps. “You came here for our Afghanistan, to build it for us. But the way in which you are building it is to ignore the enemy and the IEDs I show you.”

He also complains that he has only 10 AK-47s for 20 men and one useless PKM machinegun without a barrel. He eventually agrees to come up with a plan to raid the IED factory within five days. Two days later the marines are told he has taken unannounced leave.

At a checkpoint the marines tell the police to fill some sandbags to fortify their base. Some of the policemen are so high they can’t stand up straight. Snot drips from the nose of one; he swats it away and then looks at his hand, trying to work out what it is. I’d seen one of them smoking a large joint when we arrived, but I’m sure these men are on heroin. They eventually get bored with filling sandbags and pull over some civilians to finish the work.

Then someone fires three shots at the nearby watchtower. Two policemen, who are on the roof of the watchtower rather than in it, fire back, even though they haven’t seen the shooter and there are civilians nearby. A huge marine sergeant-major is soon towering over the elf-like deputy commander, asking: “What are you shooting at?”

“Taliban,” says the policeman, through the marines’ translator, “in those gardens.” He is pointing, but also laughing. He starts making childlike shooting noises, jabbing his finger up at the marine as if it were a pistol.

“Show me the Taliban!” yells the marine. “Professionals don’t do that. Professionals make sure they know their target and what lies beyond their target.”

The policeman clearly does not understand the problem. “It doesn’t matter. It doesn’t make any difference,” he says. “The civilians are also Taliban.”

The marine continues trying to teach him: “Professionals don’t just shoot out into the crowd. You’re supposed to be professionals.” The translator has stopped translating because it is clearly pointless.

A few weeks later one of the policemen from the same base was shot in the back. The US medics who saved him found a bag of heroin in his pocket.

There are much bigger problems. Every base has at least one “chai boy”, who usually looks between 11 and 15 years old. They serve tea and sometimes wear uniforms but this may be to hide the real reason for their presence. Police commanders often see it as their right to abduct a local boy from his family and keep him as a servant and a sex slave. Steuber nods towards a commander who has entered the police headquarters car park. “You’ve got a patrol base commander who we know is kidnapping boys and sexually molesting them.”

The problem is widespread. In the past five weeks four boys have been shot while trying to escape police commanders, three of them fatally. One boy was shot in the face. “Try working with child molesters, working with people who are robbing people, murdering them. It wears on you after a while,” Steuber said.

After the fourth boy was shot, Steuber confronted the deputy police chief and urged him to act. The deputy chief admitted his officers were abusing boys, but claimed the boys went to the patrol bases willingly. He eventually agreed to carry out Steuber’s plan — turning up at patrol bases at dawn and arresting the commanders who kept young boys. But two hours later he cancelled the operation and, to this day, the chai boys have not been freed. These incidents are common and the Afghans know it.

General John Allen, the outgoing commander of Nato forces in Afghanistan, was even more upbeat than Hammond in describing what we are leaving behind: “Afghan forces defending Afghan people and enabling the government of this country to serve its citizens. This is victory. This is what winning looks like and we should not shrink from using these words.”

The Afghan government says it is fighting corruption and that the police and army are ready and willing to take full responsibility for the security of their country.

What we are actually leaving behind is an uncertain and terrifying future for the Afghans. The trip to Sangin was my ninth in the past six years. It was also the most worrying because it was the clearest glimpse I have had of what that future looks like.

It is difficult to avoid the conclusion that we are leaving not because we have achieved our goals, but because we have given up on them.”

Ben Anderson’s film, Mission Accomplished? Secrets of Helmand, will be broadcast on Monday 25th February – BBC1, Panorama  at 8.30pm.