The lonely journey of a Palestinian cancer patient

With fewer than a dozen oncologists to a population of 4 million in the Palestinian territories, cancer sufferer Maweya Abu Salah was forced to traverse Israeli checkpoints for treatment

Separation: Maweya Abu Salah’s family were denied permission to visit her in her final hours by Israeli authorities (The Washington Post)

The patient in room 120 is struggling, you can see right away, on what her oncologist called “the cancer journey”. She is three long years into this trip. Today she feels a jabbing pain in her right side. But Maweya Abu Salah is not done yet. She is a mother who wants to see her children again.

“I just feel a little down,” she says. “Come, come. Sit down.” She arranges herself under the bedspread. Outside her window at the Augusta Victoria Hospital in East Jerusalem, the spring flowers are in epic bloom. She praises God and her nurses. She is going home, if not today, in a day or two, she says. Salah is quick to tell anyone who passes by about her kids: the accountant, the chemist, the maths teacher.

And the youngest, just 13 years old, a blessing, a handful. The children want to be by her side. One son applied for a permit to accompany his mother to the hospital but was refused, Salah says. Another son was in Jordan and denied entry into Israel. In the days to come, her eldest daughter tried, too, but was turned away. They were Palestinians stuck on the other side of Israel’s borders and barriers.

TLC: oncologist Yousef Hamamreh tends to Maweya Abu Salah in early April in her final visit to an East Jerusalem hospital (The Washington Post)

One of her doctors tells us, “This happens every day.”

Only Salah’s husband of 34 years has a permit to come to the hospital and spend the night. He is alone, too, on his own journey, catnapping by his wife’s bed in a vinyl recliner, or pacing the corridors after midnight, when all is still, except for the beeping of machines.

“I need the kids here as much as she,” says Jamal Abu Salah.

There are many ways to tally the human costs of the Israeli occupation, which began 50 years ago.

Israel has faced rockets and three wars with the Islamist movement Hamas in Gaza, whose members deny Israel’s right to exist. Israelis endured two Palestinian uprisings, the second marked by suicide-bomb attacks against civilians. More recently there was a wave of knife and vehicular assaults. Thousands of Israelis have died in Palestinian attacks. This is why Israelis say they need walls and permits.

On the other side, Palestinians in 2017 live their lives under a cone of control that they say Israelis or Americans would rebel against.

There are checkpoints, walls – and more than a hundred kinds of permit that a Palestinian needs to enter Israel.

Permit is a bloodless term. An automobile needs a permit. What is a permit for a Palestinian?

A permit is required for a sick Palestinian to go to a Palestinian hospital in East Jerusalem. A permit is required for a son to be by his mother’s side in a cancer ward here.

Israel annexed East Jerusalem years ago. Palestinians consider this half of the city “occupied territory.” Israel says all of Jerusalem is theirs – “eternal and undivided.”

Transfer: Salah’s body is moved from an Israeli ambulance to a Palestinian one at the Qalandia checkpoint as her husband watches (The Washington Post)

Israel often highlights its generosity toward the Palestinians, especially their access to top-flight Israeli hospitals – care that the Palestinians, or their American and European patrons, pay for.

Left unsaid is the fact that Palestinians come to Israel because healthcare in the West Bank is substandard. It’s even worse in the impoverished Gaza Strip, which suffers from strict trade and travel restrictions imposed by Israel and Egypt and is ruled by the Islamist militant movement Hamas, a terrorist organisation.

Last year, the Palestinian Health Ministry sent 4,500 patients from the West Bank and Gaza to Israeli hospitals. It sent an additional 20,000 to the six hospitals in East Jerusalem, institutions such as Augusta Victoria Hospital, a 120-bed facility run by a Lutheran charity and staffed by Palestinians.

Walid Nammour, the hospital’s director, tells us, “Believe me, we would go to the moon to get our people the care they need.”

Nammour praises Israeli doctors. He calls an Israeli medical coordinator, “who works round the clock” to help get medical permits for his Palestinian patients, “a saint, an angel.”

Nammour said the cooperation between Jewish, Christian and Muslim medical workers is a model for how to put aside decades of hatred and suspicion, and to make peace together.

Pressure: Jamal Abu Salah was there for his wife but deprived of the support of his adult children (The Washington Post)

“As a Palestinian, I feel discriminated against everywhere I go, but never in an Israeli hospital,” he says. But all is not right. “Everything comes back to the occupation.”

A permit to get chemotherapy

We meet Maweya Abu Salah on a Sunday afternoon in April, tagging along with one of her oncologists on his rounds.

The 51-year-old is waiting for an oxygen bottle but pleased to have visitors because visitors are rare.

To come to the Victoria hospital for treatment Salah and Palestinians in the West Bank and Gaza need two things. They must get a referral from the Palestinian Health Ministry, which is essentially a promise to pay for services rendered – a cumbersome process. They also need a travel permit from Israel’s military and intelligence authorities. Patients, especially those from Gaza, are sometimes required to submit to interviews with Shin Bet intelligence officers before getting a permit.

Palestinian medical patients visiting Israel are usually allowed one escort, sometimes two, a close relative.

The Israelis can refuse permits to younger family members, especially males, for security reasons. Doctors at the Victoria hospital says sometimes even mothers and fathers can be denied permits to accompany their sick children.

That moment: a doctor informs Salah that his wife has died (The Washington Post)

“These are the saddest cases,” says the director.

For this, her last admission, Salah and her husband first travelled from their home in the northern West Bank by car. Then, by bus, they crossed into Israel via the Qalandia checkpoint, from Ramallah into Jerusalem. After that, they had to take another bus and finally a taxi to the hospital.

The 70-mile trip took four hours.

“If the situation was normal, we’d just take the family car,” says Salah. “But this is our life, what can you do? We have to thank God for what we have.”

Salah does not want to complain. But she does want to make one point. “I will say that the thing that exhausts me the most is the back and forth.”

One of her doctors, in English whispers to us, “You know that this is an end-stage cancer patient making these crazy bus trips, right?”

He looks at Salah, smiles and says in Arabic, “She refuses to use the wheelchair!”

Three years ago, Salah felt a mysterious ache and went to the Palestinian Authority’s public hospital in Jenin. A Palestinian doctor performed an ultrasound. There was something suspicious about the right kidney.

A foreign surgical team visiting Jenin “opened me up and then sewed me back up,” she says.

It was not until Salah was awarded a medical permit by the Israeli military to travel to a hospital in Tel Aviv that a definite diagnosis was reached. The Israelis performed a PET-CT scan and did a biopsy that confirmed kidney cancer.

“They were very nice to me,” she remembered.

Three months later, Salah was given a referral and another Israeli permit to go to St Joseph’s Hospital in East Jerusalem, where Palestinian surgeons removed her cancerous kidney.

Then she began her treatment here at Victoria hospital, where doctors had access to the latest drug therapies.

The Palestinian Health Ministry reports that half the medical patients from Gaza were denied access to Israel and East Jerusalem last year, while almost all the patients from the West Bank were accepted, though sometimes after lengthy delays. Israeli officials say they try to facilitate essential medical visits. They issued almost 112,000 permits to Palestinian patients last year. But they say they carefully watch whom they allow to accompany the patients.

Patience: a child and her grandmother outside a cancer ward – Israel does not regard old and young visitors as so much of a security threat (The Washington Post)

“My treatment is not available in the West Bank,” Salah tells us. “It should be, but I don’t know why.”

She says, “I will say it, health care in the West Bank is really not so good.”

This was the last time we would see Salah conscious.

A dire lack of options

In many ways Israel’s modern medical miracle helped Salah survive. But the occupation also threw obstacles in her path.

Her primary oncologist, Yousef Hamamreh, was trained by Israeli mentors at nearby Hadassah Medical Centre, which is considered world-class. Palestinian doctors at Victoria confer often on cases with their Israeli counterparts.

There are just seven Palestinian oncologists in East Jerusalem, and six in all of the West Bank, including two about to retire. There are three in Gaza. That’s it.

“This for a population of over 4 million people,” Hamamreh says, for all the West Bank and Gaza. “This is not right.”

When we spoke in his basement office, he made cups of strong coffee and unplugged the phone on his desk, which had been ringing and ringing.

“I’m a doctor, not a politician,” he says.

Final journey: Salah’s coffin is carried in Arraba on the West Bank (The Washington Post)

Hamamreh says there are no PET-CT scanners in the West Bank or Gaza, because the Israelis will not allow them. The scanners, which have revolutionised medicine in the past decade, produce radioactive byproducts that Israeli security forces fear could be handled improperly or even deployed by terrorists in a dirty bomb.

And so radiation therapy is not available for cancer patients in the West Bank and Gaza, for the same reason as the PET scanners, which means that every woman who needs radiation for breast cancer or man for a malignant prostrate must secure permits.

Chemotherapy is a different challenge. Hamamreh says many widely prescribed cancer drugs are not readily available in the West Bank, because the Palestinian Authority does not pay its bills.

“It’s much worse in Gaza,” he says. “Their shelves are empty.”

There are no targeted biological agents, either, no immunotherapy, all tools of modern cancer treatment.

Hospitals in Jordan and Egypt no longer accept patients referred to them by the Palestinian Authority, because they are not reimbursed.

In the past two years, US taxpayers have paid off $60m (£46m) of the Palestinian Authority’s debt to the East Jerusalem hospitals. Earlier this month, the Victoria hospital threatened to stop taking new referrals, including cancer patients, because the Palestinian government owed it $40m.

Palestinian health officials blame the occupation.

Nammour says: “The money is there. But it’s not their top priority.”

‘She’s shutting down’

On Wednesday, three days after our first visit with Salah, we found doctors at her door.

Things were bad.

“If she were an Israeli, I would have released her for palliative care, for end-of-life management. She’d get home visits, by a social worker, a psychotherapist, oncology nurse, a dietitian,” says Wasim Sharbati, one of her doctors.

Among friends: Roa’a Abu Salah, 24, second from right, and Siwar Abu Salah, 13, mourn their mother in Arraba (The Washington Post)

Now, though, it is too late.

“She’s shutting down,” says Sharbati.

Her husband, Jamal, stands a few feet away.

He is 62 and has spent his life constructing homes, hotels and offices for the Israelis. The day before his wife fell into unconsciousness, he had rushed back and forth from a work site in Tel Aviv, under a different permit, one for work.

His nails are still caked with plaster dust.

“We were wishing to go home,” he said.

His wife lies on the bed, making a gurgling sound.

Jamal combs her hair. He feels her forehead. He’s been smoking outside and pacing inside. He’s made phone calls. It was all very sudden. There was no time to bring his children across.

“This is not fair. Her kids should be here,” says Jamal Abu Salah.

That night Jamal says his wife suddenly stirred and spoke to him. She seemed frightened and confused.

She asked her husband why her grandchildren had come to the Israeli checkpoint alone. Of course, they had not, this was just a dream or a delusion. The grandchildren were toddlers. They were at home.

“I was surprised by this,” Jamal says. “I didn’t imagine this would be on her mind. But she kept going on about the checkpoint, the checkpoint, over and over.”

Jamal says his wife, at her last moments, was not seeing angels but Israeli soldiers.

One last checkpoint

It is on a Thursday afternoon in May that Maweya Abu Salah passes away.

A medical resident pats Jamal’s arm and says, “We think she’s gone.”

A nurse hands him his wife’s gold rings. Jamal puts his hands on his wife’s face. He reads a prayer from the Koran.

With help, he packs a bag with her shoes, her robe, her purse. He goes into the hallway, cries for a moment and then begins frantically calling his adult children.

Laid to rest: Salah’s husband Jamal guides her body (The Washington Post)

They have to make arrangements to get her home one last time.

Jamal hires a private Jerusalem ambulance to take them to the checkpoint. But not even ambulances are allowed to pass freely.

And so it is there, in a busy parking area, that Salah’s body is transferred from one ambulance to another, one gurney to the next, in full view of the passing cars and commuters, a steady stream of Jewish settlers and Palestinians, coming and going.

Jamal doesn't want his sons and daughter to come to the checkpoint to see this.

He’s warned them away. “Go and represent me in the village, I will bring her home.”

As her body is transferred from ambulance to ambulance, an Israeli policeman, with an armed Israeli soldier standing by, checks her papers one last time.

The officer looks at her face. He looks at the photograph on her Palestinian ID, at her death certificate and her final permit.

Children say goodbye

On the Friday, they bury her in Arraba, a picturesque hill town in the northern West Bank, with nearby ruins dating to Roman times and terraced fields.

Hundreds turned out for the funeral. She was carried on the shoulders of family and friends to a cemetery beside a grove of old olive trees. Her husband and two sons, Mohammad and Ali, the chemist and the accountant, placed her in the tomb. The eldest son, the maths teacher, was stuck in Jordan. They shovelled the earth upon her.

Afterward, Jamal tells us that his 13-year-old daughter, Siwar, was hysterical the night before, pounding him on the chest with her fists, asking, “How can Mother die without seeing me first?”

Augusta Victoria: the hospital in East Jerusalem is run by a Lutheran charity and staffed by Palestinians (The Washington Post)

Jamal says his daughter told him, “You took her away alive and brought her home dead.”

Ali the son adds: “I never gave up. I tried to get permits to be with her.” Seven times, he was refused, he says. Only once, for her first surgery, was he given permission. It was his first and only trip to Jerusalem in his life.

The son spoke quietly. Mourners were gathering for coffee, to share a meal, to offer condolences.

“The only thing between me and my mother was five miles and the checkpoint,” he said. “I was so close and so far.”

© Washington Post