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Sunday, 7 May 2006

Palestinian medical crisis looms

As funds cut, many patients worsen, die

By Matthew Kalman and Sa'id Ghazali, Globe Correspondents | May 7, 2006

RAMALLAH, West Bank -- Palestinian doctors say the cutoff of funds to the new Hamas-led government is causing a growing crisis in the Palestinian healthcare system, and has already contributed to the deaths of some patients.

For the first time since he became director of the Ramallah Hospital in 1998, Dr. Husni Atari said, the facility is running out of medicines, sterile dressings, and other disposables. None of his 346 doctors, nurses, and ancillary staff has received salaries from the Palestinian Ministry of Finance since February, he added in an interview.

Ramallah Hospital is the main medical referral center for the West Bank, with 155 beds, treating 20,000 in-patients and 70,000 emergency cases each year.

''The doctors and other staff are still coming to work even though they have not been paid. Soon they will have no money to get to the hospital. When I look at my store cupboards, I see things are in danger of collapse. If this goes on, we will have to close," Atari said.

Many Western countries, led by the United States, have banned financial transactions with the Palestinian government because they consider Hamas a terrorist organization. The United States and other countries have said they will continue to provide humanitarian aid, and some Arab governments have offered to make up the lost funding. But international banks have been unwilling to transfer the funds to Palestinian organizations for fear of being accused of violating the ban.

At the Shifa Hospital in Gaza, dozens of kidney patients have seen their dialysis sessions cut because of dwindling supplies because of the cutbacks in funding, and five patients have already died, doctors and nurses say.

''More than 160 patients who have kidney failure eventually will die," said Ayman al Sisi, a senior nurse in charge of the renal department. He said five patients had died recently because of a lack of proper treatment resulting from the drop in resources.

At the same hospital, Asmaa al Saidi, a 56-year-old breast cancer patient, was lying unconscious and close to death because the hospital has run out of supplies to perform chemotherapy, which doctors said had been readily available until the funding freeze.

''What crime has my mother done to be punished by Israel and the US?" asked her son, Ismail Siyam, 38. ''I blame any one with a sense of humanity who does not help us."

At the Palestinian Ministry of Health in Ramallah, the outlook also is bleak. Dr. Anan Masri, a pediatric cardiologist who has been deputy minister of health for the past 18 months, said supplies were so sparse that he feared for the lives of 800 dialysis patients in Palestinian facilities throughout the West Bank and Gaza.

''We have an emergency here," Masri said. ''It is like a war but even worse, because the people do not understand why the situation is so bad when it seems to them like an ordinary day."

The alarms are not just coming from the Palestinians. On Friday, the UN Relief and Works Agency for Palestinian Refugees, declared that a ''crisis is on our doorstep," warning of a shortage of medical supplies at hospitals and a large increase in the number of refugees coming to its centers seeking food aid and cash assistance, Agence France-Presse reported.

Israeli officials said they are doing their best to avert a humanitarian crisis in the Palestinian Authority and are allowing a free flow of medical and humanitarian supplies.

''We regularly allow medical supplies into Gaza through the Karni crossing with priority for the solution needed to treat dialysis and cancer patients," said Yossi Temach, a spokesman for the Israeli administration responsible for links to Gaza. ''We don't know which address this is going to, we simply allow the supplies to pass into Gaza."

The United States says it is sensitive to the hardships the Palestinians face and that it has recently increased humanitarian assistance through nongovernmental organizations and through the UN agency for Palestinian Refugees.

''We don't want the Palestinian people themselves to suffer from a lack of assistance from the international community," Nicholas Burns, undersecretary of state for political affairs, said Friday in Boston during a meeting with reporters and editors from The Boston Globe. He stressed that isolating Hamas ''is a very principled issue that we will not compromise on."

The Palestinian Authority government is bankrupt and has been unable to pay March or April salaries to its 167,000 civil servants, whose pay supports about one quarter of the 4 million Palestinians in the West Bank and Gaza.

Israel suspended some $950 million in annual payments to the Palestinians of customs and taxes for goods and services conducted through Israel. The European Union suspended about $600 million in annual budgetary assistance.

Hamas ministers have managed to raise some funds from Gulf states and other supporting nations, but the bank-transfer problems have held up donations.

''The problem is not with raising money," Palestinian Prime Minister Ismail Haniyeh of Hamas told reporters in Gaza City last week. ''The problem is how to transfer this money to the Palestinians."

In Jenin, Palestinian activist Adnan al Sabbah, 56, and two other local men have begun a hunger strike to protest the international sanctions. ''I do not want to stay alive watching the Palestinian children, men, and women die from cancer and kidney failure," Sabbah said in a telephone interview.

The US sanctions are also threatening charities providing Palestinians with healthcare, said Steve Sosebee, founder and director of the Palestine Children's Relief Fund, an Ohio-based organization that treats more than 2,000 critically ill children each year.

As part of the group's efforts, Dr. Walid Yassir, an orthopedic surgeon from Tufts New England Medical Center, is scheduled to come to Bethlehem in June to perform spine surgery for children with scoliosis and to train local doctors. But Yassir's visit is now pending clarification of the US rules, Sosebee said.

''It's better for the children not to leave their families, and taking family members along makes it very expensive. We get more bang for the buck bringing the doctors here, and we get the added benefit of local physicians working alongside them and learning from them," Sosebee said.

Under guidelines issued by the US Treasury Department last month, US citizens and organizations must conclude all direct transactions with the Palestinian Authority by May 14 unless specifically permitted to continue. The order does not apply to contact with Palestinian President Mahmoud Abbas, or non-Hamas members of the Palestinian Legislative Council.

Molly Millerwise, spokeswoman for the Treasury Department, said by telephone from Washington that the PCRF missions would have to be judged case by case, depending on ''the precise terms of the proposed activity."

But for Palestinian doctors, the sanctions feel like a death blow.

''If this goes on more than a couple of weeks, the healthcare system will collapse in Palestine," said Mahmoud Nashashibi, a Palestinian pediatric cardiologist who operates a heart clinic funded by Sosebee's organization at the El-Mokassed Hospital in East Jerusalem. ''The healthcare issue should be viewed differently from the political question of Hamas."

Roy Greene of the Globe staff contributed to this report from Boston.

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