Sunday, December 16, 2018

Breast cancer in Palestine: less likely to survive because you were born a woman under occupation


By Myriam Purtscher - August 28, 2018
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Section: [Main News] [Features]
Tags: [Health Care]

Breast cancer is one of the most common forms of cancer for women worldwide. Nowadays, when diagnosis is accurately understood and treatment properly undertaken, far more women survive than die from the disease.
 
In the UK, women have an 81 percent chance of survival. In Israel, this number again increases, where 86 percent of women will live five years past initial diagnosis.
 
The picture in the occupied Palestinian Territories however, paints a different picture. Five-year survival rates in some areas of Palestine are as low as 40 percent, making breast cancer the highest cause of cancer deaths for Palestinian women.
 
For more than 50 years, Palestinian women have lived under occupation, severely impacting their access to proper medical treatment at every stage of the cancer process; from denying women access to initial diagnosis to vital radiology, to enduring (often unnecessary) full mastectomies because there is a lack of medical care or the cancer was found too late. This all adds to the high mortality rate women with breast cancer face in Palestine.
 
The reason for this low survival rate is due to the late presentation of women seeking help, Medical Aid for Palestinians Advocacy and Campaigns Manager Rohan Talbot explained.
 
“A very large proportion of Palestinian women, especially those in Gaza get diagnosed at a point where the cancer has spread or metastasised to other parts of the body. Therefore, the five-year survival rate will always be lower in those sorts of situations.”
 
Talbot said there are many reasons for this late diagnosis, including a “self-fulfilling death sentence” women see breast cancer as.
 
“Because there is a lack of understanding and information in Palestine about [breast cancer] it means women are less likely to seek care until it’s quite late which decreases survival rates, and, because survival rates are low, they just think they're going to die of it anyway,” Talbot said. “They think 'I don't want any of the shame and the stigma.’”
 
This 'stigma’ and shame surrounding breast cancer is an issue Dr Nufuz Maslamani, Director of the not-for-profit Dunya Women’s Cancer Clinic in Ramallah is trying to overcome through awareness and education of the disease.
 
“Sometimes mothers are worried that nobody will marry her daughter, they think that breast cancer is passed through their genes. We must explain only 15 percent of breast cancer is genetic,” Dr Maslamani said.
 
There is also deep shame when it comes to breast removal and hair loss due to chemotherapy Dr. Maslamani said, as breast reconstruction is often prohibitively expensive and there is a lack of specialists in this field.
 
“This is very painful and sometimes they feel they are better to die in peace and think, 'nobody will know I have cancer and nobody will see I have no hair.’”
 
Dr. Maslamani explained the support Dunya tries to provide. “But we tell them, 'a woman is not just their breasts or their uterus’, we think about the woman as her soul, her giving, her role.”
 
 
Located in Ramallah, the Dunya Women’s Cancer Clinic is the first centre of its kind in the West Bank providing specialist diagnostic services to over 2000 women each year. Photo: Myriam Purtscher.  

Cancer under occupation
 

Since Israel took control of Palestine after the 1967 six-day war, they also gained control over the importing and exporting of goods across the Palestinian borders.
 
Israel allows the importing of humanitarian goods and medicine into the West Bank and Gaza, however many vital medical needs have found their way onto the Israeli 'dual-use’ list which contains items which are primarily civilian in nature but could potentially also have military uses.
 
Dr. Maslamani explained how one tool used for assessing the health of women’s lymph nodes, has found its way onto the Israeli ban-list meaning many women undergo, often unnecessary, removal of the lymph leading to lymphedema causing painful swelling and water retention.
 
“They [Israel] say we can make a bomb from this. Because of this 'security issue’ they kill Palestinian people.”
 
Such 'dual-list’ banned goods also includes radiotherapy used to biopsy lymph nodes and assess the spread of breast cancer in women.
 
The only hospital available to Palestinians which has a radiotherapy unit is located in East Jerusalem, beyond the checkpoint for many living the West Bank and for those from Gaza, it means obtaining a permit.  
 
“They [Israel] don't give permission for Palestinians to go to Jerusalem under 'security’ reasons. It is very important after chemotherapy and surgery to have radiology, but there is no radiology in the West Bank.”
 
“Many people die waiting for permission,” Dr. Maslamani said.  

'Collective punishment’ as political gain
 

In 2017 statistics from the World Health Organisation (WHO) show only 54 percent of patient applications to exit Gaza via Erez - the only people crossing from Gaza to Israel - were successful, indicating the lowest rate of approvals ever recorded by the WHO.
 
This shows a severe and continuous decline in approval rates since 2012, when approximately 93 percent of patient applications were approved.
 
Figures obtained from the Israeli Ministry of Defence in response to a Freedom of Information Act request by left-wing Israeli Human Rights group Gisha indicate in the first quarter of 2018, 833 medical exit permit applications by Gazans were denied by Israel on the grounds the applicants’ “first-degree relative is a Hamas operative”.
 
Comparatively, there were 21 denials on the same grounds during 2017.
 
Gisha spokesperson, Shai Grunberg said this dramatic tightening of Israel’s border for Gazans is a form of 'collective punishment’ using people in the besieged enclave with medical needs as a form of political power.
 
“Israel is punishing these people, and in this case they are punishing the most vulnerable of members of the civilian population for actions they are not responsible for,” Grundberg told Palestine Monitor.
 
“Whether they are punishing Hamas or not, you cannot use people as leverage, especially those in the most vulnerable situation. It is wrong and it is illegal.”
 
This marked escalation in Israel’s permit policy is allegedly in response to a Security Cabinet decision from January 2017 which included such measures as “canceling exit from Gaza for medical treatment to relatives of Hamas members.”
 
“Israel must differentiate its political objectives and legitimate security needs from its obligation to protect Gaza’s resident’s rights to freedom of movement and to live their lives in dignity,” Grundberg said. 
The Israeli Coordination of Government Activities in the Territories (COGAT) who controls the movement of people leaving Gaza was contacted for comment, however failed to provide a response in time for publication.

Lead image: Dr. Nufuz Maslamani, director of the Dunya Clinic said they can make a breast cancer diagnosis in just two weeks, as opposed to the average six months. Dr. Maslamani explained this can mean the difference between life and death for women in the West Bank. Photo: Myriam Purtscher.

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