My name is Ghada Hammad. I grew up in Khan Younis in the Gaza Strip, and I studied chemistry before becoming a public health worker. I was 27 when the Israeli blockade began, and I’m 42 now. I’ve lived through all the wars between Hamas and Israel.
Khan Younis is my home. I live here now with my husband, Islam, a teacher, and our five children. The first time I tried to leave Gaza after the siege started was 2013, because we were having fertility problems. The restrictions on movement were not as tough then, and I remember the process being quite smooth, which is part of the reason I am shocked at how difficult it is now for me to get cancer treatment.
I was referred to an IVF clinic in Nablus in the West Bank and ended up having six babies, although one of them died. Our quintuplets are now nine, and our eldest daughter is 13. As you might imagine, our family life is pretty busy.
The human toll of non-communicable diseases (NCDs) is huge and rising. These illnesses end the lives of approximately 41 million of the 56 million people who die every year – and three quarters of them are in the developing world.
NCDs are simply that; unlike, say, a virus, you can’t catch them. Instead, they are caused by a combination of genetic, physiological, environmental and behavioural factors. The main types are cancers, chronic respiratory illnesses, diabetes and cardiovascular disease – heart attacks and stroke. Approximately 80% are preventable, and all are on the rise, spreading inexorably around the world as ageing populations and lifestyles pushed by economic growth and urbanisation make being unhealthy a global phenomenon.
NCDs, once seen as illnesses of the wealthy, now have a grip on the poor. Disease, disability and death are perfectly designed to create and widen inequality – and being poor makes it less likely you will be diagnosed accurately or treated.
Investment in tackling these common and chronic conditions that kill 71% of us is incredibly low, while the cost to families, economies and communities is staggeringly high.
In low-income countries NCDs – typically slow and debilitating illnesses – are seeing a fraction of the money needed being invested or donated. Attention remains focused on the threats from communicable diseases, yet cancer death rates have long sped past the death toll from malaria, TB and HIV/Aids combined.
'A common condition' is a new Guardian series reporting on NCDs in the developing world: their prevalence, the solutions, the causes and consequences, telling the stories of people living with these illnesses.
Tracy McVeigh, editor
When I was still nursing, I had a fever and felt ill but I was so preoccupied with the babies I didn’t pay attention to it. Then I could feel something in my breast, and it was painful, but I went to a doctor who said that everything looked fine. They took a sample, though, and it came back as stage 2 breast cancer.
The hospital in Gaza scheduled a single mastectomy, and I also had chemotherapy and hormonal therapy, which ended in 2015. It was a very difficult time because the babies were still so young. The problems really began when I was referred for radiotherapy after those treatments ended, as there are no medical facilities in Gaza that can do it. You have to get permission from the Israelis to travel to Jerusalem or the West Bank for treatment, or from the Egyptians to go to Cairo.
To get medical treatment outside Gaza, normally you have to get a referral appointment from the hospital in the West Bank, and then apply to the Palestinian body that coordinates travel permits for medical treatment with the Israelis. Budgets for medical coverage from the Palestinian Authority are really tight; there are more patients for complicated surgeries and cancer treatment. Usually, only people in a critical condition get permits quickly.
Getting a travel permit for Egypt is a bit easier, but the journey is much longer and harder, and you might need to get all your tests done again in the Egyptian medical system. Islam and I would have to cover much more of the costs ourselves, and we can’t afford it.
We’d also have to leave the children with relatives for an unknown amount of time. If I could go to Jerusalem, my mother would travel with me as an escort and Islam would stay with the kids. There’s no point in trying to get Islam a visa to travel through Israel; they hardly ever give permission to men under 50.
I applied with my doctor to go to the Augusta Victoria hospital in Jerusalem for radiotherapy nine times, and we never even got a reply saying yes or no. Apparently, radiotherapy is useless if you don’t have it within a certain time frame of a few weeks after surgery, so in the end, more than a year later, I just gave up.
Once during that process in 2015, I did go to the Erez Crossing for a security interview with the Israelis. That in itself is a big deal, because most Palestinians worry about what they will be asked.
In the meeting the officer didn’t ask me anything about why I wanted to travel or my medical case, they just wanted to know about the men in my family: who they are, what they do, phone numbers. I had been so busy with the babies I didn’t even know Islam’s phone number off by heart, let alone those of other relatives and friends. Maybe they thought that was suspicious.
The Israelis said recently they never received my travel applications in 2015, but that doesn’t make sense, because otherwise, why was I asked to go to the interview at Erez?
This May, I felt something in the same place, the same breast, when I was taking a shower. I immediately went to the doctor, and it turns out the cancer has come back in my chest muscle. I had another surgery to remove it, and I’m going through chemotherapy. I had forgotten how ill and exhausted it makes you; I am struggling to do anything at home, so that burden is now on Islam and our relatives.
This time my doctor says I must get the radiotherapy. She was angry with me, and blamed me for giving up before. She said that’s why the cancer came back.
I have an appointment scheduled in Jerusalem on 6 November. Based on my past experiences, I am not optimistic I will get permission to leave, but my husband believes since I’m over 40 now I might get luckier.
Most of the time they only tell you if you have a permit the day before you are supposed to travel, or they don’t tell you anything at all. Even if this one works, I’ll have to apply again if I need appointments in future, and they might be denied. That’s not an efficient way to treat cancer.
Psychologically, it’s a struggle, and the kids are old enough to understand what is going on this time, which is hard for them. I hate the way some people in the community act as if I need sympathy. I want to be treated normally.
It’s difficult to think about the future. Most of the time I focus on being strong for my children. The only thing I want to hear is a doctor telling me I have the all clear, so I can live my life again.
