Breast screening for 10,000 women in Gaza

This month is Breast Cancer Awareness Month, which is known in Gaza as Rosy October.

Today I want to tell you about some of the wraparound community work that Al Ahli Hospital undertakes, which includes encouraging women to get screening, as well as the non-medical support offered to women who do receive a positive diagnosis as they go through their treatment journey. 

--

Early diagnosis of breast cancer is vital; this can only be done by overcoming fear and social stigma. Al Ahli Arab Hospital seeks to educate 5,000 women a year about the importance of breast screening. They aim to screen over 3,000 women over 40 every year. But the solution starts away from the hospital, meeting women where they are through their 35 mobile clinics and community outreach programmes. Women, often those diagnosed with breast cancer themselves, go out to local communities, particularly in poorer areas where there may be lower levels of education. They spend time encouraging women to go for screening, talking them through the process, telling their stories and explaining why early diagnosis is so important. But it does not stop with the women; the community outreach workers speak to the men too, encouraging them to support their wives in going forward for screening and to continue supporting them, whatever the result.

Al Ahli also works with cancer support centres. In May we visited one such centre called the Smile of Hope Cancer Centre with Mohamed, the head of the hospital’s social work team. Upon entry at Smile of Hope, you are surrounded by colourful, uplifting messages and images and information about Rosy October is on every wall. We are greeted by Sami, who tells us:

“Early discovery is critical and must be our priority; that is why we need mobile clinics going out to all the communities.”

As well as educating people about the importance of screening, the centre is a place for cancer patients to go for support throughout their journey. 

Sami explains, “If you find you have cancer in Gaza, the Government will pay for you to have treatment in Israel, including accommodation, but they do not pay for transport. The hospital applies for the permit, but if the woman gets permission to travel, we organise and pay for it. We use Palestinian and Israeli volunteers from the West Bank.”

Sami went on to show us the leaflets they give out advising on what to expect, what people can and cannot take through the checkpoints and even vocabulary lists of useful Hebrew words. 

The centre also provides return support such as physiotherapy, counselling, and even a haircare service. Amal’s hair salon is full of wigs made from hair that had been donated. Amal told us her name meant hope and said, “I had cancer in 2003. I was lucky; I did not lose all my hair, but I was worried I would. Instead, it got a lot thinner. I want to help women feel their best during a difficult time.”

Thank you for your ongoing support of our work with women in Gaza. 

We were recently able to visit Gaza, and our partners Al Ahli Hospital, where we support their breast cancer screening and community programme. Breast cancer accounts for over 32% of the case of cancer in women. It kills more women than any other form of cancer in Gaza, and women are 3 times more likely to die from breast cancer in Gaza than in the UK. 

Some of the reasons for this include late detection, due to social stigma around breast cancer and fear and shame which prevents women from presenting for screening when they find a lump. According to Islamic Relief’s report ‘Mapping Study for cancer care in the Gaza Strip’: ‘Barriers to cancer-seeking behaviour, the patients are afraid of unexpected results, or fearful of social stigma, or emerging family problems (the husband may remarry if his wife has breast cancer.

 Such stigma leads to many late diagnoses. When breast cancer is detected at the later stages women often need radiotherapy which presents huge complications in Gaza. Radioisotopes, which are integral to radiotherapy treatment, are forbidden entry into Gaza by the Israeli authorities, meaning patients must travel to Jerusalem for treatment. They need to try to obtain a visa to leave Gaza and then must travel alone to receive treatment, often leaving children at home. 

One woman, Nadaa, told us that during 52 days of the 56 days that she was in Jerusalem for treatment for breast cancer, the 52-day long 2014 attack on Gaza was taking place. She had left her two young daughters in Gaza with her father. She talked of the fear she felt for her daughters and her father all whilst receiving this brutal treatment. 

The time taken to get a visa will further delay access to treatment meaning that the cancer may have spread. According to WHO in 2019 there was only a 65% approval rate for visas by the Israeli Authorities. In the meantime, other treatments like chemotherapy are often not successful as the courses are interrupted due to a lack of medication as a result of the blockade. The consequence of late diagnosis  and limited medical options is a much higher number of double mastectomies with all the complications that this entails.

Al Ahli is determined to screen as many women over 40 as possible ensuring earlier detection of breast cancer and thus a better prognosis. The staff seek to educate 5,000 women a year about breast cancer through their community-based awareness raising programme. They aim to provide annual screening to 3,000 women. 350 women a year get breast cancer in Gaza, of which around 50 will attend Al Ahli hospital. 

The programme is built around Al Ahli’s partnership with 35 local community groups throughout the Gaza strip and the creation of local grassroots support groups. The hospital believes that the key first step is to break the taboos around breast cancer for both women and men. The ‘challengers’ as they call the women who find they do have breast cancer play a vital role in educating people within their communities about the importance of early detection. 

The screening programme consists of a screening clinic where women receive a mammogram and are also taught about self-examination. Women with any suspicious lumps are immediately then offered ultrasound and if necessary surgical consultation followed by through-cut biopsy or fine needle aspiration to confirm diagnosis. If a woman has a positive diagnosis the hospital will provide the appropriate course of action or if she needs radiotherapy they will recommend her for visas and put her in touch with local groups that will help with transport and support.

On this visit we were particularly impressed with the holistic care supplied by the Health, Mind and Body clinics and their practitioners. All the women who receive a positive diagnosis of breast cancer through Al Ahli (about 40 per year) are offered a place in this group which meets twice a week for 2 hours at a time. Women are offered psychological support and education around self-care methods such as massage. A place to share together, the women told us how they can laugh and cry with one another. The group clearly provides an incredible support network and helps women to socialise again.

Thank you for your support of this vital programme for women in Gaza.