Here, Gunmen Roam Halls With Medics
GAZA CITY -- Few theaters have showcased as much of the Israeli-Palestinian drama as Shifa Hospital, a gated compound among food stands and flower vendors at the center of this city. Poor, crowded and governed by rules that no one follows, the Gaza Strip's primary public health center is a nearly perfect reflection of the rough world outside its walls.
Now, with Gaza's own gates shut more often than not, Shifa is suffering the debilitating consequences of official corruption, sealed trade passages and the recent victory of the radical Islamic group Hamas in parliamentary elections. Life in its cancer wards, operating rooms and outpatient clinics has become a regimen of compromise, diminished expectations and poor prognosis, the story of Gaza six months after the Israeli evacuation.
Elective surgery is being delayed to preserve anesthesia for emergencies. The staff of hundreds received last month's paychecks more than two weeks late, and prospects for this month are not encouraging. Patients must beg for blood as transfusions substitute for dialysis because of a lack of necessary drugs.
Chemotherapy has been reduced because of shortages, but sending cancer patients abroad for treatment has become a luxury for the nearly bankrupt Palestinian public health system. Gaza's gunmen have stepped into this unruly triage, demanding at rifle-point that friends and relatives receive scarce medications or costly transfers to Egypt or Israel for care. The deputy health minister reacted to recent threats by fleeing to the West Bank.
‘There is no money, no medicine and no man higher up to sign my orders for more,’ said Ibrahim al-Habbash, Shifa's general director. ‘So the problems always return.’
As foreign donors seek ways to keep the Palestinian Authority afloat without financing Hamas's political program, the public health system is sinking. Preserving it after Hamas installs its cabinet later this month will present a challenge to the Bush administration and other foreign donors now planning to channel future humanitarian aid to the Palestinians through nongovernmental organizations.
Foreign governments have demanded that Hamas, whose charter calls for Israel's destruction, renounce violence, abide by agreements backed by the defeated Fatah movement and recognize the Jewish state in order for nearly $1 billion in annual aid to continue. Hamas, known formally as the Islamic Resistance Movement, has refused to do any of this. As a result, Israel has halted monthly tax transfers to the Palestinian Authority, and the United States has frozen development projects.
Half of the Palestinian Health Ministry's $2 million monthly budget, excluding salaries, is covered by foreign assistance. But a recent U.N. humanitarian assessment stated that ‘it is not possible to transfer responsibility of the public health system to the U.N. or NGOs,’ while warning that a reduction in aid would ‘hamper service delivery and prevention activities including immunization and mother and child care.’
Israel, citing threats of a possible Palestinian attack, has closed the main passage for goods and supplies to Gaza for more than five weeks this year. Following dire warnings from U.N. humanitarian monitors, Israel began allowing sugar, flour, cooking oil and other staples into Gaza for the first time in more than two weeks.
But the first trucks did not carry any of the two dozen items on Habbash's list of medications and supplies that have run out at Shifa or will in the next few days. And on Tuesday, the Israeli military closed the crossing again.
‘The health system could collapse if we do not get money,’ said Ghassan al-Khatib, the acting health minister.
A tour of Shifa's wards last week provided ample evidence of the problems ahead, from the ethic of lawlessness apparent on the hospital grounds to the lack of resources available for the more than 600 patients who fill waiting rooms on a typical day.
Habbash, a pale man with a blaze of short red hair, spent his morning in the cancer ward with a group of gunmen. A harrowing and increasingly common aspect of the health care system here, the gunmen demanded that a woman with stomach cancer be transferred to Egypt for treatment. The Health Ministry had rejected the request for a lack of money.
‘Security inside the hospital is terrible,’ Habbash said. ‘I can't emphasize this enough.’
Signs posted at hospital entrances and along corridors warn that weapons are prohibited. But like many other rules here, the ban is neither heeded nor enforced. In the ward for respiratory disease, a visitor smoked cigarettes a few yards from suffering patients.
The lime-green corridor turns a corner into the cancer ward, where a young man draped with the black-and-white scarf of the al-Aqsa Martyrs Brigades stood outside a room shared by three patients. The man grew angry when asked to explain his AK-47 assault rifle.
Samira el-Akluk, 52, the woman for whom the gunmen sought a transfer, moaned from a corner cot. Her yellow hands lay crossed over her stomach and a pair of yellow feet appeared from beneath the thin blanket.
The gunmen, part of the mob that accosted Habbash earlier in the day, remained to press demands that Akluk be sent to Egypt for treatment. But doctors said she was near death and did not have the proper documents to enter Israel en route to Egypt even if she qualified for transfer.
‘Don't worry about this. It is not a problem,’ a family member said with a smile.
Downstairs, a line formed outside the dialysis ward, full as usual. Eight blood-cleaning machines were attached to elderly men and women in varying states of consciousness -- some covered from head to toe in sheets, others sprawled in recliners and close to sleep.
A cabinet along one wall contained a shrinking supply of blood lines, the plastic tubes that run from a patient's arm to the dialysis machine where the blood is filtered. There were enough to accommodate patients -- about 60 of whom receive treatment each day -- for another two days.
A drug that increases hemoglobin in the blood had already run out, forcing dialysis patients such as Fawzia Jundiah to undergo more frequent transfusions.
But the hospital could no longer afford to supply blood for her twice-monthly treatments. So Jundiah, 57, now heads from her house to the police station before each transfusion to seek an officer, clerk or prisoner who will give her his blood.
‘From where else will I get blood every 15 days?’ said Jundiah, a coil of crimson-filled plastic running from her arm to the dialysis machine. ‘I needed this other medicine that strengthened my blood. But should I just die without it?’
As drug supplies shrink, treatment at the clinic has become improvisational.
For Hodgkin's disease, a form of lymphatic cancer, patients are receiving three of the four medications they need. The fourth ran out last week, and Habbash said a lack of money and the crossing closures had prevented supplies from arriving.
To prolong reserves, dosages have been reduced for everything from pain medications to hormone therapy.
‘This has been the worst,’ said the clinic's chief nurse, Saed al-Masri, who was trained at Jerusalem's prestigious Hadassah-Ein Kerem Hospital. ‘We've run short on antibiotics before. But this time we're running out of it all.’
When the hospital's only functioning elevator reached the second-floor surgery department, its door remained shut, squeaking against a hidden obstacle. A hefty nurse squeezed his fingers into the small opening and yanked the door aside.
Tea was being served in the waiting room, filled with anesthesiologists, surgeons and nurses on break. Schedules have been cut back as elective surgery is put off to preserve anesthesia for emergency cases, 70 percent of the volume in the violent strip.
‘It's not that bad delaying nonessential procedures,’ said Mohammed Sawaf, an anesthesiologist.
But Sawaf worried about other recent factors that have complicated emergency surgical cases. The hospital, he said, was out of drugs that help revive surgery patients from sedation. The department was also short on sutures, prosthetic hips and other supplies that have not been getting through because of border closures and the financial crisis.
‘There's not much you can do on some cases without them,’ Sawaf said.
Another problem looms. Early this week the Palestinian Authority paid 150,000 employees and trainees their February salaries, more than two weeks late. But how the authority will cover its $115 million monthly payroll at the end of the month, after Hamas is scheduled to install its cabinet, is unclear.
Mazen el-Aloul, Shifa's director of nursing, said the government would soon perform its own triage.
‘They'll pay the army,’ he said. ‘But who knows about the doctors and nurses and all the things we need here.’