Gaza’s sick pay price of blockade

Gaza has had chronic shortages of medicines as a result of political division between the West Bank and Gaza, as well as Israel’s siege.Eyad Al BabaAPA images

Isra Saleh el-Namey-27 July 2016

Huda Jalal is still mourning the death of her baby in late May.

The 32-year-old went into premature labor and gave birth before her baby’s lungs had developed sufficiently.

The hospital put the baby, Sami, in an incubator at which point he should have received a Betamethasone injection. Betamethasone is used to stimulate growth of the lungs in premature babies.

But the drug, which is not expensive according to Mahmoud Deeb Daher, head of the World Health Organization’s Gaza sub-office, was not available. Sami passed away after only one day in the incubator.

“I know that it is not easy to give birth in the eighth month, but there are drugs and advanced medical care that can help save lives,” Jalal, whose two other children suffered no complications at birth, told The Electronic Intifada.

Hamsa Abu Ajeen, a doctor at al-Aqsa hospital in Deir al-Balah in the central Gaza Strip where Jalal lost her baby, said there is a shortage of medicine as a result of the Israeli blockade on Gaza, now nearly a decade old. Increasingly, the Ministry of Health in Gaza is struggling with a lack of funds for drugs and vital equipment. The funding shortfall is a direct consequence of the siege harming the economy.

Israel, furthermore, prohibits a whole host of goods and construction materials from entering Gaza, citing “security reasons” and the possibility of “dual use,” military and civilian.

But the list is in some cases vague and general, including things like “communications equipment,” and while medicines and vital health care products are not meant to be included, X-ray machines and other visual imaging equipment have proven difficult to import and are often held up in Israel.

Putting babies at risk

International observers like the World Health Organization, the United Nations and individual politicians have on numerous occasions reported that the blockade negatively affects the delivery of medical services in Gaza and leads to a shortage of potentially life-saving drugs.

Abu Ajeen said Betamethasone injections should be given to women undergoing difficult pregnancies and who are likely to give premature birth, and should preferably be administered before and not after birth. If administered in time, babies’ lives stand a better chance of being saved. Betamethasone can also be administered after birth as would have been done in Sami’s case had it been available.

“At our ward, the lack of very important drugs, injections and medical equipment has eroded our ability to offer advanced medical care to our patients,” Abu Ajeen told The Electronic Intifada.

There is not enough medicine for injections to stimulate uterus contractions to accelerate labor, the doctor said, while there is a limited number of working electrocardiogram machines to check the hearts of newborn babies. The ward also suffers a shortage of incubators and beds compared to local need.

“In many cases, we have had to discharge women who have just given birth to free up bed space, even though the woman might still need medical attention,” the doctor said.

In addition, frequent power cuts — Gaza’s authorities are unable to import the necessary equipment to fix the Strip’s sole power plant — and the shortage of fuel to power generators mean doctors are always concerned that incubators and other life-saving equipment will stop functioning, Abu Ajeen said.

Critical shortage

According to Munir al-Bursh, head of the pharmacy department at Gaza’s Ministry of Health, hospitals, pharmacies and clinics in Gaza are short of 149 medicines, equipping them with only 69 percent of what is needed.

The depleted stores of drugs include some used to treat chronic diseases like hemophilia, thalassemia, cancer and blood diseases, al-Bursh said. Also, a severe shortage of vaccines and antibiotics has further hindered doctors’ abilities to treat their patients.

In response, an increasing number of Gaza’s patients try to seek medical care abroad, but they are stymied again by the Israeli blockade and the near-continuous closure on the Egyptian side at Rafah, the sole crossing available to the Strip’s nearly 1.9 million residents.

But it is not just the Israeli blockade that is causing shortages. The political division between Hamas, which administers internal affairs in the Gaza Strip, and Fatah, which heads the US and EU-backed Palestinian Authority in the West Bank plays a role.

Dr. Ashraf al-Qedra, the health ministry spokesperson in Gaza, said his ministry does not receive its agreed allocation of medicines from the Palestinian Authority Ministry of Health in the occupied West Bank. He said Gaza gets only 16 percent of what it ought to receive of drugs and other medical requirements.

“Gaza should have 40 percent of its medical needs provided from the West Bank. We get less than 20 percent. This means that we are in imminent danger of a health crisis that could put patients’ lives at risk,” he said.

The lack of funds and the depletion of both human and material resources have forced the ministry to terminate some of its essential medical services, said al-Qedra.

Wael Alyan has his own complaint in this regard.

The 43-year-old has suffered from kidney failure for five years and needs to have dialysis treatment four times a week. “It’s hard to adjust to this new life,” Alyan told The Electronic Intifada. “Every time, I make sure that I arrive early at the hospital to wait for the treatment.”

He hopes to have surgery outside Gaza, but for now he cannot afford the cost. He’s heard of patients who were lucky enough to find a suitable kidney replacement, and he looks to the day when he can end his own ordeal.

“I hope I can one day secure the funds needed to undergo this operation so that I can lead a normal life again,” he said.

Looking for solutions

The difficulty in securing enough stores of medicine has propelled a team of pharmacists to look for methods to prolong the life-cycle of some vital drugs.

The team worked for four years and finally succeeded in validating — allowing drugs to be used beyond their stated expiration dates — 23 kinds of drugs used in treating cancer and kidney disease, and for which hospitals do not have alternatives should they run out.

Nahed Shaat, the head of the team, said the group gained valuable insight from past American military experiences.

“The ghastly reality of Gaza has pushed us to look for other alternatives, and the attempts made by the [Department of Defense] in 1986 to validate 122 drugs were very useful to guide us in our own project,” Shaat said.

Naima Siam, a member of the team, noted that the process is not easy, because they have to follow very strict rules prescribed by the World Health Organization.

“Each drug has to be validated on its own terms and in the right way. So far, we have been able to extend life-cycles by up to three months,” she said.

She estimates that the team’s work has saved the Ministry of Health some $200,000 and is giving patients greater access to essential drugs.

“The wellbeing of our patients is our first priority,” said Siam, who voiced anger at both Israel and the West Bank Palestinian Authority for policies that keep vital medicines away from Gaza.

“The right to access drugs and working medical services should be respected for all Gazans, not be held hostage to this political game.”

Isra Saleh el-Namey is a journalist from Gaza.