Cancer patients take part in a rally to raise awareness about Breast Cancer in Gaza City on 26 October. Mohammed Asad APA images

Khuloud Abu Qamar spoke quietly but her words still shocked. “Israel is killing me slowly,” she said. “And it is killing my children, too.”

After undergoing surgery for breast cancer last year, Abu Qamar requires further treatment which she has not been able to receive in Gaza. She has asked Israel for permission to travel. Her applications have so far been rejected. Aged 40, she has six children, the youngest of whom is still a baby.

Her plight is shared by many others in Gaza. Estimates from the local health ministry indicate that several hundred women with breast cancer have been obstructed from traveling by Israel so far this year.

Leaving Gaza for treatment is vital as the coastal strip’s hospitals are not properly equipped to provide such services as radiotherapy.

As part of the state’s propaganda, Israel has portrayed itself as a global leader in cancer treatment and research. To promote breast cancer awareness in October, the Israeli Air Force painted its warplanes pink.

The gimmick gave no comfort to women in Gaza.

“I don’t want to die”

Alaa Masoud, a 25-year-old mother living in Jabaliya refugee camp, has also been diagnosed with breast cancer. She recently had her right breast removed at al-Shifa hospital in Gaza City.

Her doctors have stated that she now needs to see specialists working in Israel or the West Bank. So far, she has made five requests for permission to travel through Erez, the Israeli military checkpoint on Gaza’s northern boundary. All five of her requests have been rejected.

The refusal has exacerbated her suffering. Her cancer and surgery forced her to stop breastfeeding her baby Amir.

“I don’t want to die,” she said. “I want to see my baby grow up to be a lovely young man.”

Traveling through Erez is practically the only option for Gaza residents requiring treatment that they cannot receive in the strip’s hospitals and clinics.

Until recently, many patients had been referred to hospitals in Egypt. Yet the almost constant closure of the Rafah crossing between Gaza and Egypt has led to a sharp decline in the number of Palestinians being treated in Egypt.

Human rights groups have long documented how Israel has, in effect, sought to blackmail Palestinians who are seriously ill. Patients have been told that they will only be allowed to travel for treatment if they become informers to the Shin Bet, Israel’s domestic intelligence agency.

Dalia Abu Skhaila, a 34-year-old breast cancer patient from the southern Khan Younis area of Gaza, said that Israeli officers at Erez have tried to recruit her as an informer on a number of occasions. Because she has refused to accept that condition, she has been blocked from traveling.

“Dying in Gaza is much easier than betraying my people and country,” she said.

Education

Despite the barriers that Israel has placed on treatment, health workers in Gaza are striving to increase awareness of breast cancer.

According to Khaled Thabet, who heads the oncology department at al-Shifa hospital, one of the main challenges faced is that breast cancer is frequently at an advanced stage when it is detected, making treatment difficult. To aid early detection, he and other doctors are encouraging women to undergo tests for breast cancer.

“There is a lack of an inspection culture,” he said.

Hala al-Talmas, a 35-year-old from Jabaliya camp, was reluctant to have a check-up when she began experiencing slight pains in her right breast, particularly at night time.

A friend in whom she confided urged her to see a doctor. Yet Hala avoided doing so until a couple of months later. After the pains became more severe, she noticed a small lump inside her breast.

Hala told her mother, Hania, about the lump and visited al-Shifa. The staff there found that she had a pea-sized tumor in her breast. She was diagnosed with cancer.

When a doctor asked Hala why she had waited so long, she replied that she had been afraid.

With the help of her extended family, she managed to raise enough money for an operation. Her breast was removed.

Hala started chemotherapy following the operation. After just a few weeks of that treatment, she had a stroke and died.

“I wish my daughter had been more aware and that she had visited a doctor in the early stages of her disease,” said Hania, Hala’s mother.

Medicine under siege

Breast cancer is a leading cause of death among women in Gaza, according to the health ministry. Almost 750 cases of breast cancer were detected in 2015.

The Gaza authorities run classes to educate women about breast cancer.

The Electronic Intifada asked a sample of 200 women in Gaza if they had attended classes. About 90 percent of the women – aged from 25 to 65 – responded that they had not.

“I have a fear of such lessons and I keep myself away from them,” said Doaa al-Shami, a 31-year-old. “I have attended just one class since I got married.”

Gaza’s health authorities are struggling to cope with the effects of the siege that Israel has imposed on the territory for almost a decade.

Hospital machinery has often been blocked from entering Gaza. Vital medicines are in short supply.

“The problems facing the health ministry here are obvious,” Ahmed El Shorafa, head of the oncology department at the European Hospital in Rafah, a town in southern Gaza, said.

“They are caused by the shortages in money and equipment. We need more medical centers and more staff to provide health education in all parts of Gaza.”

Sarah Algherbawi is a freelance writer and translator from Gaza.