By Kevin Begos

Cancer Care in a Conflict Zone

By Kevin Begos

Jordan is one of the most stable countries in the Middle East, but fly an hour (or less) in almost any direction from Amman and the situation is often dramatically different. Fighting in Iraq, Lebanon and the West Bank may not officially cross borders, but refugees and tensions do. CR spoke to Lebanese, Palistinian and Israeli doctors about how war has affected their work, and the lives of patients and families.

Salim Adib is the chairman of the department of community health at St. Joseph University School of Medicine in Beirut. He says the 2006 conflict between Israel and Hezbollah militia forces saw heavy bombing over about 40 percent of his country, resulting in 1 million internal refugees. Cancer care centers were not directly affected, but a large number of patients were unable to travel or keep appointments. Local physicians stepped into the void to administer care, Adib says.

Psychologically, many people were convinced that experimental weapons filled with possibly toxic compounds were used in some areas, and newspapers investigated the topic. Adib says there was no evidence of that, but “in our part of the world, we like conspiracy approaches. There’s always this feeling that all of this firepower could not have been just that—just firepower.” The result was that whenever a new health issue came up after the fighting, many people believed “it must have been linked” to the conflict, Adib says. The good news is that refugees returned home quickly after the bombing stopped, he says, and three months later, “almost everything went back to normal” in terms of the health care system.

Fouad Sabatin faces an entirely different challenge. He’s an oncologist and the director of the cancer care program at the Augusta Victoria Hospital in East Jerusalem, which has been occupied by Israel, along with the West Bank, since 1967. Over the last eight years, checkpoints operated by the Israeli military to control militants and suicide bombers have also disrupted everyday life and medical care for the entire population.

“There are no rules, and sometimes you can be held for hours,” Sabatin says. “And sometimes the patients in the ambulance—they get held at the checkpoint for hours. It’s not a joke. For example if somebody’s coming from Ramallah to Jerusalem, they have to first start in a Palestinian ambulance, then at a checkpoint they have to move to another ambulance with an Israeli license plate.” Israeli authorities also strictly limit the availability and use of radioactive medical compounds, for fear they could fall into the wrong hands and be used as a dirty bomb—a hypothetical, improvised explosive device that could contaminate a large area with radiation.

The checkpoints affect staff, too, Sabatin says. “Even basic things like going to work in your own car, it’s becoming like a dream for the Palestinian physicians. Sometimes a 20-minute trip can take two to three hours. Some of our employees were denied [entry] permits, so they ended up not being able to get to Jerusalem.”

The Israel Ministry of Foreign Affairs points out that militants have used ambulances as a cover. In March 2002 an ambulance containing “an explosives belt and explosives” was stopped at a roadblock. The explosives were hidden under the mattress of a stretcher. And Israeli doctors and patients face their own challenges: During the 2006 conflict, Hezbollah rockets hit three Israeli hospitals, and more than 45 rockets landed within 500 meters of Rambam Hospital in Haifa, according to Human Rights Watch.

Abraham Kuten, the director of the oncology department at Rambam, says the staff there were completely unprepared for the rocket attacks. But people quickly adapted. “After missile alerts, we would go to the radiotherapy unit,” he says, because the thick concrete walls that had been designed to shield the rest of the hospital from radiation also provided the best protection from the attacks outside. The medical oncology staff basically continued its work, he says. “Here we were attacked by missiles, and patients came [in] for follow-ups.”