As Israel freezes aid, the West Bank's health care system is failing

Hospitals across the occupied West Bank are facing a lack of funds.

Beit Jala, occupied West Bank - Khaldoun Atwan starts each day in the oncology department of Beit Jala State Hospital, not knowing what obstacles will be in his way.

The Nabi Yunus checkpoint in Halhol seems to be "always closed," so the head of the daily oncology department at the hospital leaves his car and ends up commuting from Hebron by taxi.

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"More than once, by God, I saw a broken mirror. I saw a broken wiper," he said of his trip through the area where settlers are now operating.

Passing through a bewildering series of gates and checkpoints that open or close at will, he doesn't know if he'll get to the hospital, if his patients will arrive, or if the medicine they need will be on the shelf when they arrive.

Beit Jala is the only public hospital in Bethlehem province, which accommodates about 320,000 people. Inside his small, spartan office, Atwan struggles to keep up with his cancer patients who have been pushed back by missing vital appointments or essential drugs needed for their chemotherapy.

He recalls that even during the second intifada, the supply of drugs was not a problem. Now, it is inevitable.

"Everything is short ... whatever is available, we give," he said. "It's a disaster."

The financial resources of the Palestinian Authority (PA) have fallen in the past three years due to the reduction of international aid and the disruption of the transfer of Israeli tax receipts. Israeli actions in the occupied West Bank since October 2023, including widespread road closures, checkpoints and a series of settler massacres against Palestinian communities, have also affected the economy.

As a result, the occupied West Bank health care system is rapidly deteriorating, with staff receiving only half of their salaries, while the PA cannot pay for essential medications.

Along with others walking nervously in the yard, an elderly cancer patient from a village in Bethlehem province stood at the hospital entrance debating with his son what to do. "Every month they try their best, the doctors and the cleaning staff, but nothing is offered to them," he said.

The ministry's clinics now operate part-time, and doctors see more than 100 patients a day. Currently, even a doctor's visit is rushed and unaffordable: “If we want to go to the doctor for a checkup, we need 200 shekels [$65],” said an older cancer patient.

Iyad Dari, a doctor at the dialysis unit in Beit Jala, said: "This is not a story of lack of personnel. He added: "The government employee who receives only half of his salary only works two or three days a week because he does not work enough for all his working hours. As a result, the hospital is covered by emergency cases only

"At first [the patients] were [angry]," Derry said. But now everyone knows: everyone's suffering.

The medical equipment crisis in Beit Jala and across the West Bank is the result of Israel's failure to pay taxes intended for the Palestinian Authority, a measure led by Israeli Finance Minister Bezalel Smutrich.

"This crisis is very predictable and we saw it happen 100 percent," said Milena Ansari of Doctors for Human Rights Israel. Even before the start of the genocidal Gaza war in October 2023, Israel was periodically withholding tax revenues, endangering the health ministry's coffers, Milena said.

According to Yusuf Ojara, an internist in Beit Jala, the seized revenues have reduced the Ministry of Health's budget to pay medical providers who have now stopped providing services. The constant borrowing of resources between the public and private health care sectors has severely strained clinics, pharmacies and private hospitals.

Hisham Amel, an oncologist at the hospital, said the shortage was "an old problem, not a new one," but that about 90 percent of the critical cases — mostly for chemotherapy — already existed. At present, even immunotherapy and biological drugs do not exist, and cancer treatment is carried out on an unbroken chain. "If a patient misses one or two sessions, they've missed all the treatment before that," he said.

Atwan, senior oncology nurse, said: "When I first took over the department, drugs were available. Then he began listing all the important medications he was now missing for his patients. "There is no perfect protocol that I have."

The hospital's pharmacy manager, Khalud Doib, said that the ministry recently managed to acquire eight oncology drugs and four biological drugs that were previously missing. This should be enough between one and a half to two months. But many other drugs are still out of stock, he said.

Ansari noted: Unlike Gaza, Israel does not prevent the entry of drugs into the West Bank. The problem "extremely" is that the PA doesn't have the money to buy them. But he notes, "Israel, as an occupying power, has a primary legal duty to ensure adequate medical care and access to occupied populations."

For all of the southern West Bank, Beit Jala Hospital is the only public option available for cancer treatment and dialysis, with patients coming from Bethlehem and Hebron governorates, parts of occupied East Jerusalem, and sometimes Jericho.

But with the increase in Israeli checkpoints and gates, getting to the hospital has become a nightmare. Dari described a dialysis patient from Nahalin with an appointment at 7 or 8 in the morning that his village was flooded. "He sat at the checkpoint for about four, five hours," Derry said. Then he traveled a long way and passed through Jaba, Surif, Halhol and Al-Khalil and reached Vahad at four in the afternoon. A typical trip costs about 10 shekels. "The cost of a detour like this is more than 100 shekels, and some patients need dialysis four times a week," Derry said.

Meanwhile, the ministry's central logistics warehouse is in Nablus — and an hour-and-a-half drive can now take six to 10 hours to shut down, Doib said.

Often, Atwan's patients require treatments that are split between his unit and Augusta Victoria Hospital in occupied East Jerusalem. Before the war, cancer patients from the West Bank routinely received medical permits to enter Jerusalem. Some treatments are available in Beit Jala, while others are only available in East Jerusalem. But there is no longer any guarantee that the patients will be able to reach Jerusalem. "I have a cancer patient...he was waiting for a referral, and there is no treatment, and after all this running again, he was also rejected by security," Atwan said. I mean, he doesn't get a pass to go to [Augusta Victoria]? Where is he going to go?"

Atwan recalled patients who became neutropenic due to missing treatment sessions, and one of them was lucky not to develop sepsis. "These are disasters."

He's not sure exactly how many cancer patients he's lost to mistreatment. Many poorer patients simply go home and die there, he said.

"I started tapering off, not bingeing"

Nervous exhaustion permeates the old halls of the hospital as crowds crowd the reception desks and people wait at the hospital entrance. "People are really anxious. Everyone's scared," Derry said.

Atwan, who receives half of his salary, is struggling to pay for his travel to and from Hebron and to help support his daughters.

"Let's not talk about our state of mind - for God's sake we start crying," Atwan said. "Our morale is at an all-time low...we smile in spite of ourselves."

Amid mass unemployment and systematically revoked work permits, more and more sick Palestinians are driven to government hospitals, as these hospitals have less to offer. Hospitals "prioritize someone who will actually pay them," Ansari added.

Ahmed, a Palestinian from Bethlehem with a medical degree, checked with the pharmacist every two days to see if they had Humira, an ampoule that his sister, who has Crohn's disease, needs. For three months, pharmacists were out of stock. Buying directly from the pharmaceutical company costs about 2,000 shekels ($650) for one or two injections. "We couldn't afford it," he said. So we just tried until it became available again.

An elderly cancer patient from a village facing a massacre of settlers has reduced his medication. "It doesn't come out regularly," he said. The cost of one course is 20,000 shekels ($6,500). "I'm starting to taper off, not a lot," he added.

Amid the lack of resources and manpower, surgical backlogs have accumulated. Seyyed Ayad, 22 years old, from al-Aizariya, fell to the ground in an accident last month and broke his ankle badly. Prioritizing serious operations, he waited three weeks for a break.

"They told me 60 people are waiting for the operation," he said. "One day we couldn't do the surgery because there was no medicine, no painkillers, no anesthesia and nothing."

Khalud Doib, who heads Beit Jala's pharmaceutical department, has to manage a worsening crisis as patients struggle with financial and health problems. "There is no security. We have no political, health or even financial security."

He thinks about things like a young man with multiple sclerosis studying medicine in Egypt. The Ministry of Health provided his drug through private purchase until the company stopped the drug without payment. His mother came to see him. "I want to sell my house so I can get my son's shot," the mother told him. "Because he is in Egypt, he is far from home, he is studying and... he can no longer see, he cannot walk."