A child receiving dialysis at Augusta Victoria Hospital, East Jerusalem. The presence of a parent for treatment is one of the key demands of the LWF. Photo: Atta Jabr
Security checks delay treatment and hinder parental accompaniment
(LWI) - Insufficient health care, limited access to specialized treatment, security checks delaying treatment or hindering the accompaniment of a parent: Palestinian children face many challenges to access health services.
In a side event to the 43rd session of the United Nations Human Rights Council (HRC), The Lutheran World Federation (LWF) together with Médécins du Monde (MDM) and Physicians for Human Rights Israel (PHRI) raised awareness about the alarming health care situation for children from Gaza.
Desolate health care system
Access to healthcare in Gaza and the Palestinian territories is extremely difficult, says the Jerusalem Coordinator of Médécins du Monde. The global organization is among others specialized in maternal and child health. According to the organization’s statistics, the health system in Gaza is in a desolate state: Only 40 percent of staff salaries are being paid, 52% of vital medication is constantly out of stock. Skilled doctors are rare and overworked, hospital largely operate with volunteer staff.
According to MDM, there is a high need for referral to receive treatment outside Gaza. In 2019, the number of patients referred outside Gaza stood at 16,000, a 30 percent increase. One in four patients is a child needing specialized care, for example for heart conditions or cancer. After obtaining necessary papers for treatment, the security checks and permits to actually leave Gaza and go to Jerusalem tend to delay treatment, with an average of 3 months between referral and begin of treatment.
No time to wait
“Every child with cancer is an urgent case,” says Dr. Khadra H. Salami, Pediatric hematology and oncology specialist at the LWF Augusta Victoria Hospital in East Jerusalem. “The prognosis depends on early diagnosis and treatment. Children die because of that waiting period.”
The doctor regularly witnesses cases of children whose treatment is jeopardized because of the permit process. The case of a 3-year old girl made international headlines – the mother had not been permitted to travel and even the sick toddler had been classified a security risk by Israeli authorities. Treatment was delayed by six months. “Cancer treatment is a long journey,” Salami says. “Waiting a month could mean the development from a cancer in its early stages to one that has spread and is difficult to treat.”
No permit for parents
The critical issue often is not only the travel permit for a sick child, sometimes of infant age, but for the accompanying parent. In 2017, only 44 percent of applications were approved. After international advocacy and the introduction of a special authorization, that number rose to 79 percent. Still today, in one out of five cases, the Israeli security check does not allow for parents to be with their children when they undergo radiation, chemotherapy or major surgery.
“Faced with this situation, the family has two impossible choices,” Majadli says. “They can either send their child with a relative aged older than 70 years, or they can reapply and lose more time.” Often elderly relatives do not know the child well, have health issues of their own and are not fully able to care for the child. Sometimes, they have to return home because of their own fragile health. “This puts additional strain on our staff,” Dr. Khadra says. In consequence, the hospitals in East Jerusalem have seen critically ill children die without their parent's.
Even with a good prognosis, the separation during such a critical time is traumatizing for the children: Nursing infants have to be abruptly weaned to travel with another relative, older children react with anxiety, refusing to eat, to speak or treatment altogether. Children who are with a parent on the opposite have stronger vital signs and a much better chance of recovery. “Settling for less when it comes to parental accompaniment compromises the child’s recovery prospects and violates their right to health,” Majadli says.
Advocacy for children’s right to health
Together with Médécins du Monde and Physicians for Human Rights Israel the LWF will be making a statement to the Human Rights Council, calling upon the international community to ensure that
· All children diagnosed with cancer be treated without delay
· Once diagnosed with cancer, the child should get a permit for an initial period of one year for active treatment and appropriate follow up, after which an assessment will be done on a case by case basis
· All children referred for medical treatment outside Gaza should be accompanied by at least one parent
For 70 years, LWF has been operating the Augusta Victoria Hospital on the Mount of Olives in East Jerusalem. AVH is part of the East Jerusalem Hospital Network, six specialized medical centers enabling Palestinians from the West Bank and Gaza to access health services otherwise not available to them. Specialized in oncology, nephrology and diabetes, AVH covers a gap in the Palestinian healthcare system. 30 % of the cancer patients in AVH come from Gaza. Each year, the hospital receives between 80 and 90 new cases of children with cancer.
