GAZA CITY, Gaza Strip — Women confronting breast cancer are being hit hard after the Trump administration stopped USAID programs benefiting Palestinians, say aid groups, doctors, health care workers, and patients.
The US effectively stopped government aid programs benefiting Palestinians in February, and humanitarian aid groups and hospital administrators in Gaza and Jerusalem say aid cuts are doing serious harm to vulnerable patients at a time when health care systems used by Palestinians are already heavily strained.
Aid funding from the US totaling hundreds of millions of dollars benefiting Palestinians were cut off last year before Washington effectively ended aid to the West Bank and Gaza last month, moves critics say have had a devastating impact on health care programs, politicizing human health.
Among the programs stopped as a result of the cuts is one that was optimistically dubbed Gaza Health Matters 2020, a $50 million project that was supposed to run for five years, providing prenatal care for Palestinian women, treating the injured in Gaza, and funding mammograms and biopsies for women.
“For the women who needed biopsies, we did 5 or 6 but then just stopped,” said Eman Shanan, the founder of an organization called Aid and Hope, a local NGO that works to help Gazan women seek breast cancer treatment and diagnosis, and was the primary NGO implementing the Gaza Health Matters program with USAID funds along with the Al-Ahli Hospital in Gaza.
Shanan, who herself survived breast cancer, knows firsthand how difficult it is for Gazan women to seek diagnosis and treatment for the illness. Because of cultural stigmas, they will have to deal with pressure from their families and may lack funds to seek diagnosis or treatment, she said. Cancer treatment options in Gaza are also severely limited because of chronic drug shortages and lack of access to certain kinds of treatments, like radiotherapy, and obtaining permits to travel to Jerusalem to seek treatment can be a lengthy, frustrating process.
These factors have resulted in many Gazan women getting diagnosed and treated too late, pushing up the mortality rate for breast cancer. Shanan had hoped to change that.
More than 1,000 women who had mammograms done through the Health Matters program were flagged for follow-up appointments, said Shanan. Now they’ll have to seek them elsewhere.
The funding for the Gaza Health Matters program came through a project with International Medical Corps that has effectively been shut down since September 2018, say sources in the medical and aid communities.
“They were half of the way there actually in designing a number of development projects, but also some urgent responses addressing the immediate needs of patients including women with breast cancer,” said Fikr Shalltoot, director of programs in Gaza for the UK-based Medical Aid for Palestinians. “There was a big plan to build community awareness around breast cancer, to provide screening and follow-up.”
“But with the cut of funds, all the projects they were supporting had to be terminated pretty much totally.”
A USAID official noted President Donald Trump directed a review of US assistance to the Palestinian Authority and in the West Bank and Gaza in 2018 to make sure the funds benefited the US national interests.
“As a result of that review, we redirected to other high-priority projects” the more than $200 million in economic support funds that was originally slated to go to programs in the West Bank and Gaza, the official told BuzzFeed News.
Trump has made clear that aid to Palestinians is linked to their willingness to negotiate.
“That money is not going to them unless they sit down and negotiate peace, because I can tell you that Israel does want to make peace, and they’re going to have to want to make peace, too, or we’re going to have nothing to do with it any longer,” he said in January.
The issue is especially serious because aid groups say they’re facing a shortfall of funding sources more broadly.
“The US government has played a major role in developing the capacity of our hospitals,” said Walid Nammour, CEO of the Augusta Victoria Hospital in Jerusalem, saying many of their doctors had trained in the United States as well as at other hospitals in the country with assistance from USAID funds. “This was the case until our great man Trump came. They’re using sick children’s lives, human lives to put pressure on the Palestinian Authority, and this is inhumane, illegal and unacceptable.”
Beyond aid programs, the aid cuts are straining the network of six hospitals in East Jerusalem where Palestinians seek treatment. The hospitals said the cuts are straining capacity for the hospitals, delaying urgent and life-saving treatments to Palestinians that they can only obtain there.
Aid cuts were initially billed as a temporary measure early last year. But this month, Congress passed a law called the Anti-Terrorism Clarification Act, which aid groups say has cut off funding to them for the foreseeable future unless an amendment is passed carving out an exemption for humanitarian causes.
“The situation right now is not good,” said Mor Efrat of the Israel-based group Physicians for Human Rights. “The starting point was not good at all and it’s only going to get worse. The general direction is very pessimistic.”
Nammour runs Augusta Victoria, the main hospital in East Jerusalem where Palestinian women, especially those from Gaza, are able to obtain treatment for breast cancer. The Lutheran hospital relied on USAID funds, which were dispensed through the Palestinian Authority, for years to train its doctors and pay for treatment costs. Over the past year the PA has contributed only a fraction of the $51 million it was supposed to provide Augusta Victoria.
Augusta Victoria is particularly important to Gazan women because of chronic shortages of chemotherapy drugs and a lack of treatment options within Gaza. Breast cancer is the most common form of cancer among Palestinian women, but treatment options in Gaza are severely limited.
Women can receive screenings and some surgeries in Gaza, but must obtain a permit to travel to Jerusalem for more sophisticated treatments that are not available in Gaza, like radiotherapy — a process that is already fraught with lengthy wait times and unexplained denials. Thirty-nine percent of applications for permits to exit Gaza for medical care were rejected in 2018, according to the World Health Organization. This is a sharp decline from as recently as 2014, when more than 80% of patients were granted permits.
“We’ve received more and more requests from female cancer patients from Gaza telling us they can’t get a permit to get treatment,” said Efrat, whose organization has advocated on behalf of female Palestinian cancer patients to Israeli authorities involved in granting permits, including Shin Bet. “Seven years ago if you were a woman and you had cancer from Gaza, most likely you’d get a permit. Usually it was men who wouldn’t get them. But the situation got worse.”
According to the World Health Organization, only 65% of Gazan women diagnosed with breast cancer survive for five years after diagnosis — a mortality rate that’s significantly higher than that of Israeli patients. Gazan women may be slow to seek treatment for cost or cultural reasons and may not have access to good medical facilities. But another significant factor is the wait time they face for hospitals like Augusta Victoria — something that is increasing because of the USAID funding cuts, Nammour said. Waiting means more patients die.
Mercy Corps, an international medical NGO that funds medical programs in Gaza, said it had reduced its staff by 40% as a result of the US funding cuts.
“The humanitarian side of our program has basically been decimated. Our funding stopped in August and we haven’t been able to fill the gap,” said Andy Dwonch, program director at Mercy Corps in Jerusalem. “We’re working hard at it, but humanitarian funding doesn’t just turn off as other funding turns off. The broader issue is that we’re in a resource constrained environment, and all donors and organizations feel stretched.”
The WHO said this month that Gaza’s health care system is collapsing.
Beyond the humanitarian problems, critics of the aid cuts said they have damaged US credibility.
“It’s horrible,” said Dave Harden, the former mission director for USAID in the West Bank and Gaza. “It’s a monument to our lack of credibility. We can’t be making things worse — it would have been better not to come in the first place.”