Imagine. You’ve found a lump in your breast.
- not knowing that this is a significant issue that requires investigation
- being too afraid to get a diagnosis because people may think your cancer is contagious, or you fear your husband may leave.
- there are no hospitals nearby to treat you
- you have to apply for a permit to reach a hospital which can treat you
- your permit is not accepted at the border
Breast cancer is one of the biggest killers of women in the Gaza Strip.
We know that early detection is the key to treating breast cancer effectively. In Australia, we enjoy a first class medical system that offers screening and relatively quick and effective treatment.
In Australia, a woman who is treated for breast cancer has an 80% survival rate at 5 years.
For a woman in Gaza, it is 40%.
Incidence and rates of survival
Breast cancer is the leading cause of cancer-related death among women in Gaza. Significant disparities exist between the five year survival rates for Palestinian, Israeli and Australian women diagnosed with breast cancer:
Gaza Strip: 40%
Contributing factors to high mortality rates in the Gaza Strip:
- 60% of women with breast cancer in Gaza are only diagnosed after they are already at an advanced stage of their disease.
- Social, cultural and religious factors and fears in Muslim communities can be responsible for a reluctance for women to discuss breast cancer openly or agree to having a clinic breast examination, such as: fear that her husband will take a second wife (following a positive diagnosis of breast cancer); modesty; or concern of the negative impact a positive diagnosis may have on her daughter’s chances of marrying.
Misconceptions about breast cancer are significantly higher among women living in Gaza than in neighbouring countries, such as the belief that breast cancer is contagious or not very prevalent.
Studies indicate breast cancer has a younger age of onset and higher mortality rates among Arab women than among women of European origin, perhaps related to an unidentified gene mutation, a more aggressive type of breast cancer, or a combination of the two.
With 45% unemployment, and 50% of the population living on less than $2 per day, families are often unable to access even the basic medical tests associated with early cancer detection. Mammography screens can cost $US30 per appointment in Gaza, an unaffordable amount for most women.
Chronic exposure to pesticides and to contaminated groundwater
Limited medical services inside the Gaza Strip
- The Israeli Government control of all Gaza Strip borders restricts access to essential oncology medication, medical equipment, and personnel qualified to provide oncological services.
- No radiation therapy is available in the Gaza Strip. All Palestinians requiring radiation therapy must travel to Egypt, Jordan or Israel for treatment
- Radiation therapy is unavailable primarily due to Israel’s objection to the importation of radioactive materials into the Gaza Strip, and also to lack of expertise in handling such equipment
- There is only one histopathology lab in the Gaza Strip, which is necessary for the diagnosis of tumours and testing of surrounding tissue following removal of a tumour
- The Palestinian Ministry of Health does have protocols in place to guide the appropriate treatment of cancer, however the protocols cannot be followed due to the unavailability of specified medication and treatment facilities, such as radiation therapy. Additionally, the protocols are not necessarily well known/understand by staff in the public medical facilities in Gaza
- The occupation of the Palestinian territories by Israel, and political divisions within Palestinian authorities in the West Bank and Gaza Strip has seriously undermined health care services available to Palestinian people
Limited access to treatment outside the Gaza Strip:
- Any patient requiring medical treatment outside Gaza must gain permission from the Israeli Government to travel. Many patients miss appointments in Israeli hospitals as the permission system is ‘unpredictable’: permits may be granted AFTER the appointment dates, permits may be issued for the escort/carer but not the patient, or some patients are simply just denied permission to seek medical access outside Gaza
- The referral system for medical treatment is managed by the Palestinian Authority (PA) in Ramallah. In 2005, more than 31 000 patients were referred for medical treatment outside the Palestinian Ministry of Health facilities, within the occupied Palestinian territory or in other countries (mainly Egypt, Jordan, and Israel). The total cost was about US$60 million. Demand for oncology treatment significantly exceeds the PA oncology budget, which can also cause delays in access to treatment or unqualified medical staff treating cancer patients.