As Israel Blocks PA Funding, West Bank Health System Collapses | Health news

Beit Jala, occupied West Bank – Khaldoun Atwan starts each day in the oncology ward at Beit Jala Government Hospital, not knowing what barriers will come his way.

The Nabi Yunis checkpoint in Halhul seems to be “always closed”, so the head of the day oncology unit at the hospital leaves his car and completes the commute from Hebron by taxi.

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“More than once, by God, I found the mirror broken. I found the wipers broken,” he said of his journey through an area where settlers are now active.

Through a dizzying array of gates and checkpoints that open or close at will, he doesn’t know if he’ll reach the hospital, if his patients will, or if the drugs they need will be on the shelf when they do.

Beit Jala is the only government hospital in Bethlehem Governorate, home to approximately 320,000 people. In his small, spartan office, Atwan struggles to keep up with his cancer patients, who have withdrawn because they missed crucial appointments or essential drugs for their chemotherapy treatment.

Not even during the second intifada, he recalls, was drug supply an issue. Now it is inevitable.

“Everything is short … whatever is available, we go,” he said. “It’s a disaster.”

The finances of the Palestinian Authority (PA) have collapsed over the past three years due to a reduction in international aid and disruptions in Israel’s transfers of tax receipts. Israel’s actions in the occupied West Bank since October 2023, including widespread road closures, checkpoints and a series of settler pogroms against Palestinian communities, have also affected the economy.

As a result, the health system of the occupied West Bank has deteriorated rapidly, with staff receiving only half of their salaries, while the PA cannot pay for essential medicines.

‘Emergencies only’

Next to others nervously in the yard, an elderly cancer patient from a village in Bethlehem Gouverneur was standing at the entrance of the hospital, wondering what to do with his son. “Every month they do their best, the doctors and the cleaning staff, but they are delivered with nothing,” he said.

Ministry clinics now work part-time, with doctors seeing well over 100 patients a day when they are there. Now even a visit to the doctor is fast and unacceptable: “If we want to go to the doctor for a check-up, we need 200 shekels [$65]” said an elderly cancer patient.

“It is not a story that there is no staff,” said Iyad Dari, the attending physician at the dialysis unit in Beit Jala. Being paid only half of their salaries, “the civil servant only works two or three days a week, because he does not have enough to come in for his full hours,” he added. As a result, the hospital ended up only covering emergencies.

“In the beginning, [patients] were [angry]. But now everyone understands: everyone is suffering,” said Dari.

The medical supply crisis in Beit Jala and across the West Bank is the result of Israel’s withholding of tax revenues earmarked for the PA, an action led by Israeli Finance Minister Bezalel Smotrich.

“This crisis is very predictable, and we saw it coming 100 percent,” said Milena Ansari of Physicians for Human Rights Israel. Even before the genocidal war on Gaza began in October 2023, Israel periodically withheld tax revenues, putting the health ministry’s coffers at risk, Milena said.

According to Yosef Ojra, an internal medicine specialist at Beit Jala, the withholding of revenue has depleted the Ministry of Health’s funds to pay medical providers, who are now withholding their services. The ongoing loan of supplies between the public and private arms of health care has greatly burdened private clinics, pharmacies and hospitals.

Hisham Amle, an oncologist at the hospital, said that shortages are “an old problem, not a new one,” but that about 90 percent of important items – especially for chemotherapy – used to be there. Now immunotherapies and biological drugs are also lacking, and cancer treatment runs on an unbroken chain. “If the patient misses a session or two, he has lost all the treatment before him,” he said.

“When I first took over the department, the drugs were available,” said Atwan, the lead oncology nurse. He then began to list all the crucial medicines he now lacked for his patients. “There is not a single complete protocol that I have.”

Khuloud Dweib, the director of the hospital’s pharmacy, said that the ministry recently managed to get eight previously missing oncology drugs and four biologics. This should be between a month and a half and two months. But many other drugs are still out of stock, she said.

Unlike Gaza, Israel does not block medicine from entering the West Bank, Ansari noted. The problem is “strictly” that the PA does not have the money to buy them. But “Israel has the primary legal obligation as an occupying power,” she says, to ensure adequate medical care and access to occupied populations.

Movement denied, care denied

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

But as Israeli checkpoints and gates multiply, reaching the hospital has become a nightmare. Dari describes a dialysis patient from Nahalin, with an appointment at seven or eight in the morning, whose village was closed. “He sat at the checkpoint for about four, five hours,” Dari said. Then he took the long way around, through Jaba, Surif, Halhul and Hebron, and reached the unit at four in the afternoon. A normal trip costs about 10 shekels. “A detour like this costs more than 100 shekels,” Dari said, and some patients need dialysis four times a week.

The ministry’s central supply depot, meanwhile, is in Nablus, Dweib said — and an hour-and-a-half drive can now take six to 10 hours when the lockdown hits.

Often, Atwan’s patients require treatment between his unit and the 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 are no longer any guarantees 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 the runs it is back, he is also denied security,” said Atwan. “I don’t think he gets permission to go [Augusta Victoria]? Where should he go?”

Atwan recalls patients who became neutropenic due to missed treatment sessions, and one was lucky not to end up with sepsis. “These are disasters.”

He is not sure how many cancer patients he has lost to missed and incomplete treatments; many of the poor patients, he said, simply go home and die there.

‘I started cutting, not taking much’

As people swell at the reception desks and people wait at the entrance to the hospital, a nervous exhaustion permeates the old halls of the hospital. “People are really tense. Everyone’s scared,” Dari said.

Atwan, who receives half his salary, struggles to cover his commute from Hebron and help support his daughters at university.

“Let’s not talk about our state of mind – we’re starting to cry, for God’s sake,” Atwan said. “Our morale is at rock bottom… We laugh in spite of ourselves.”

In mass unemployment with work permits systematically withdrawn, more sick Palestinians are pushed into public hospitals, as those hospitals have less to offer. Hospitals “will prioritize someone who actually pays them,” Ansari added.

Ahmed, a Palestinian from Bethlehem with a medical degree, would check with the pharmacist every few days to see if they had Humira, an injection every two weeks that his sister with Crohn’s disease needed. For three months the pharmacists were out of stock. Buying directly from the pharmaceutical company would cost about 2,000 shekels ($650) for one or two injections. “We couldn’t afford that,” he said. “So we just fought until it became available again.”

The elderly cancer patient from a village with settler pogroms cut off his own medication. “It’s not delivered regularly,” he said. A course costs 20,000 shekels ($6,500). “I started cutting back, not taking much,” he added.

Amid supply and staff shortages, surgery backlogs have piled up. Sayed Ayyad, 22, from al-Eizariya, fell during an accident, badly breaking his ankle last month. With serious operations priority, he waited three weeks for a slot.

“They told me there were 60 people waiting for an operation,” he said. “One day we couldn’t do the operation because there was no medicine, no pain, no anesthesia, nothing.”

Fate is left to chance

Khuloud Dweib, the head of the pharmacy department in Beit Jala, has to manage the worsening crisis as patients struggle with their health and finances. “There is no security. We have no political, or health, or even financial security,” she said.

She is left thinking about cases like a young man with multiple sclerosis studying medicine in Egypt. The Ministry of Health provided its medicine through private purchase until the company stopped supplying without payment. His mother came to see her. “I want to sell my house so I can get the injection for my son,” the mother told her. “Because he is in Egypt, away from home, studying, and … he stopped seeing, stopped walking.”

“So, what can I tell you,” Dweib said, fighting back tears. “God help the people.”

The medical staff fear that with their supplies running out, they could face a similar fate to their colleagues in Gaza, who have been kidnapped or killed.

“We know that we can be counted as medical personnel at any time, just because we are medical personnel providing services to people,” Dweib said. “We are a father and a mother in this society.”

No one in the aging hospital wards sees an end in sight. “The longer we stay, the worse the situation gets,” Dari said.

At three o’clock every afternoon, Atwan has to leave in the hope that he can reach Bab az-Zawiya in Hebron, where he waits for a shared taxi.

“Maybe there will be a checkpoint for me, maybe there won’t be,” he said. It is not so different from the conundrums of his patients. “When a patient gets sick, it’s his luck if the medicine is there,” he said. “We have no future. I swear: We have no future.”