The Augusta Victoria in East Jerusalem is vital in the care of cancer patients for the Palestinian Territories. But an unprecedented lack of funds has pushed him to turn away patients and limit ongoing treatments. Although in the past it has dealt with the chronic instability of the Palestinian Authority, the curb on annual aid from the European Union has put it in such a chokehold that it could force its closure. Behind the blockade, a fight over Palestinian textbooks.
In another situation, the emptiness in a cancer care room could be good news. But for the Augusta Victoria Hospital (AVH) in East Jerusalem, it is synonymous with a reminiscent financial crisis, although with an unprecedented touch: for the first time, it forces it to reduce treatments and puts the lives of hundreds of people at risk.
Located on the Mount of Olives, the medical center – operated by the Lutheran World Federation (LWF) since 1950 – is a reference in cancer care for the Palestinian Territories.
His unit is the only option for cancer patients in the Gaza Strip and the best alternative for mourners in the occupied West Bank. However, due to this lack of funds, since September 2021, the sanatorium has been forced to reject 500 new patients, while in parallel the more than 600 with ongoing treatment have suffered delays or interruptions due to lack of medication.
Usually the day care center receives between 80 and 90 Palestinian patients. Now the place looks far from full. “On a daily basis, about 40% of our patients cannot come to the hospital to receive their treatments on time, as planned,” Dr. Yousef Hamamreh, head of oncology at the hospital, told France 24.
The doctor adds that “this has been common in the last six months.”
As we anticipated, economic problems are not something new for the Augusta Victoria. Like the other five hospitals in the East Jerusalem Network, it always suffers from the chronic financial instability of the Palestinian National Authority (PNA), which owes the AVH alone more than $70 million in debt.
In other things, this translates into unpaid treatment for patients referred by the Palestinian Ministry of Health.
The current crisis has the added impact of the Covid-19 pandemic and the lack of assistance from the United States during the four years of the Donald Trump Administration, support that was resumed in 2021. But the coup de grâce has been given a month-long blockade of the European Union’s (EU) annual contribution.
Aid to the hospital, hostage to a political dispute in Brussels
The European Union is the largest single donor to the Palestinian National Authority and channels its contributions through the PEGASE direct funding mechanism. In November 2021, it was expected to release the annual contribution of 214 million euros, of which around 13 are destined for hospitals in East Jerusalem.
However, the funds remain paralyzed in Brussels, pending the final decision of the European Commission. The visible face of the blockade is the Neighborhood Commissioner, the Hungarian Oliver Varhelyi, who leads the demand for reforms in the textbooks of Palestinian schools, on which Europe debates whether they promote anti-Israel sentiments or in favor of violence.
The delivery of the money is, today, conditioned to these possible modifications.
Ireland has been at the forefront of warnings about the importance of giving aid the green light. Along with 14 other member states, she asked the Hungarian official in a letter to unblock the situation, on which she questioned his attitude.
Days ago, before a meeting of European foreign ministers, Irish Foreign Minister Simon Coveney expressed his “frustration” at the blockade and noted that “all the ministers except one requested the disbursement of the funds.” Still, the file lies on a desk in Brussels.
Thousands of kilometers away, the consequences are being paid by hundreds of Palestinian cancer patients, for whom the urgency does not allow them to wait for the resolution of political disputes. They even consider paying out of pocket for treatments. Something economically impossible and, as Hamamreh defends, something that goes against their “right” to be cared for.
“The consequences are very bad. It is very simple, it is affecting people’s lives. When you are not treated on time, when you have interruptions in your treatment, there is a greater risk of dying of cancer than of being cured,” synthesizes France 24 Dr. Fadi Atrash, CEO of Augusta Victoria.
This oncologist is alternating the gown with the suit to lead the search for funds to keep the hospital running. In recent weeks, the UN Office for the Coordination of Humanitarian Affairs (OCHA) and the German government have pledged to provide $500,000 each for the purchase of oncology drugs. They are contributions that, according to Atrash, “help, but in the long term they are not enough.”
“We need regular payments to return and we are trying to take our voice to the European Commission to tell them that blocking this money is hurting our hospital, our patients. It is about human lives, not politics,” warns the doctor, to the time he sends out a message with an ultimatum tone: “By the end of June, I think that if there is no clear plan, if we reach that time without money, if we do not have any support, we will not be able to function at all.
“We are the only future for Gaza patients”
The relevance of the Augusta Victoria Hospital can be understood in two services: it is the only one that offers pediatric renal dialysis in the West Bank and it is the only one that Israel has allowed to provide radiotherapy for cancer patients. For a long time, the Israeli authorities have prohibited the presence of radioactive materials in the Palestinian Territories under a war argument.
Thus, of all his patients, 40% come from the Gaza Strip, who “if they don’t come here, they have no alternatives,” says Fadi Atrash.
“We are the only future for patients in Gaza… Even the people of the West Bank have few alternatives. But here we present a comprehensive treatment. We have radiotherapy, chemotherapy, immunotherapy, palliative care. All these aspects are offered here in our hospital and that makes it unique. Its service, its quality and also its location in East Jerusalem.”
Too many difficulties for people who, in addition, must face the obstacles of crossing the ‘checkpoints’ of the Israeli forces or fighting to obtain travel permits from the Hebrew Government.
“We would lose a lot if this hospital disappeared,” confesses a woman from Hebron, for whom the proximity to the hospital “is very important” since the city of Ramallah is further away. “I tried other hospitals, but I didn’t find the care here. It’s much better,” she adds in dialogue with France 24.
She does not escape the current situation: she has been waiting for her medications for a month and a half and assumes that she will have to find money to pay for them on her own. “Our health situation is deteriorating every day, our condition is getting worse and worse and we are going backwards,” she lamented.
Almost two months of waiting also adds a 39-year-old woman, mother of four children and victim of locally advanced breast cancer. She needs a particular biological agent that would raise her chances of being cured to 70 or 80 percent. If she does not receive such treatment, she will have to undergo surgery.
His calm face hides a great concern: “I can’t sleep at night.” And, despite this, she sends a wish that is at the same time a demand: that other women do not have to live the same situation.
Calls, frustration, depression: the sufferings of doctors
This economic and political crisis – not only because of Brussels, but also because of the Palestinian National Authority – takes doctors away from their main mission and leads them to take on difficult tasks, such as contacting patients by phone who do not have treatments available to them.
Several colored post-its with the name of the patient and his medication, which is not available, hang from a board at the oncology reception. Nearly 50 in a single week, and counting.
Dr. Yousef Hamamreh grabs another list and shows the crosses. He explains that, every day, they prepare the care lists for the following day and cross out the names of those who do not have their drugs available. That is followed by a round of calls to give the sad information. “When patients see the hospital number, they know what’s going on,” the doctor tells us. “And every time they ask the same thing: ‘Okay, they don’t have it today, but when should I go to the hospital? What day? Give me an appointment.’ But the problem is that I can’t tell them when it will be.”
“This is very frustrating, not only for me, but for all my doctors. Sometimes, we fall into depression,” reveals Fadi Atrash, who admits that “sometimes I avoid contact with my patients because I can’t tell them: ‘I can’t pay your treatment.’ As a doctor I have the skills to give my patients the best care, but without medication, without resources, without money, I can’t.”
Yousef Hamamreh adds that the reactions of the patients are diverse: “Some wait for our call for new appointments, others get depressed, their families get depressed, even the oncologist gets depressed because he cannot offer them appropriate treatment on time.”
For the head of the oncology unit, the most difficult thing is to break people’s trust in the health system, but he understands that “I don’t know if I can promise my patients three or four times without giving them results. Cancer patients are not normal patients. They cannot expect my promises or other promises,” he says.
Facing an increasingly deteriorating panorama, Hamamreh admits that “now we are looking for hope, only hope.” This could be fueled if, thousands of miles away, in an office in Brussels, key funds to keep the cancer center alive are released. Because her death would also mean that of hundreds of patients.
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