symmetry USPeace
Munich American Peace Committee (MAPC)

Visiting Gaza

Translation of an interview on the situation of the health sector in Gaza with
Dr. Yussef El Modalal
Director General of the Diwan of the Ministry of Health (video)

In general I can say, we actually suffer from many things in our medical institutions. As you know, the institutions in Gaza are government institutions, mostly hospitals. There are government hospitals as well as private and non-governmental hospitals. The private and the non-governmental hospitals cannot provide much. They don't have the capability to offer all services to the citizen.

That means, if anything goes wrong in the hospitals, then this is very dangerous, and this danger is generally borne by the people. And currently, under these circumstances, under this closure we suffer from lack, e.g. lack of drugs – and in this context I must say, there is also a  part – normally they have to come from Ramallah, you know Ramallah in the Westbank, the Palestinian government in Ramallah, and this part can simply not reach us here in Gaza. There are reasons for that. Sometimes they say it is because of the closure, sometimes the reasons are the political quarrels among the Palestinians themselves. But in general we suffer from a lack of medication and particularly drugs for cancer patients and for the chronically ill, those patients that suffer from chronic diseases.

That causes real problems for us. For example there are 450 kinds of drugs that should always be available in the hospitals. And currently with 120 of them we have close to zero in stock. Of these 120 kinds we have almost nothing or none. And we are constantly confronted with this problem in this situation. Also the parts for the equipment, the medical equipment. When equipment breaks down and needs to be repaired, we sometimes have to wait for months in order to obtain the parts. Since these units are very sensitive, we have no companies in Gaza that will simply repair them or have spare parts in stock. And therefore we always have to order these parts. Ordering means it has to come from the original company, from the producer. Sometimes they come from Germany, sometimes from some other place in the world, and due to the closure we cannot get them from one day to the next. No, it takes at least two to three months. We have experienced this with CT-equipment and with MRI-units. When they break down we unfortunately just have to wait for the repair and that really takes a lot time.

We also suffer from the fact that we have no possibility to train our doctors and the staff in all sections. It is not enough for us to say, OK, we have a large number of doctors and staff, people in all areas – male nurses and the like. These nurses or these doctors and all the other staff members have to be trained constantly and their knowledge has to be updated. For this we have no possibilities under these circumstances. Our people cannot go to the outside and we also cannot bring in trainers, and if trainers come in, they have to have certain permits from the Israelis or from the Egyptians. That means when they come they can stay a certain time and sometimes their schedule does not fit ours. We have to be able to prepare for this.

Sometimes they come unannounced, which makes it very problematic for us, because it causes a lot of difficulties for us when we cannot prepare ourselves for the visitors coming in that way. Training needs its plan and we need to prepare ourselves well and we often fail to do that. That means, as long as these people cannot travel in and out freely, we cannot use this possibility well. We need this desperately – I mean these trainers and the possibility for our people to go outside and educate themselves and take part at conferences. That has to be solved in some way - and we need it urgently. We have a big problem with our patients under these circumstances. We cannot offer everything to our patients. That means, sometimes we are forced to transfer people to the outside.

Under the current circumstances we cannot transfer our patients anytime. We have to wait until the crossing to Egypt is opened. And as you know that can take a while. The last time time the border was closed for 70 days. And naturally, in order to get the patients out we need a permit, which under these circumstances makes work for us very difficult. And due these circumstances a lot of people die. So far about 400 people have died here in Gaza due to lacking the possibility to take people outside, about 400 patients so far. The closure makes life for us very difficult and this at the expense of human lives. We need the border to be opened and that the world puts pressure on the Israelis - and also on the government in Ramallah for some things like drugs and one way-materials that we need in the hospitals and in the ministry, so that they bring these things into Gaza. Because otherwise the situation remains grave.

The basic medication for the not so seriously ill, the elementary drugs are available?

Yes, they are available to a large degree. This kind of medication was also donated after the war. And of these normal and light drugs – I must say – we have quite a bit of that. That is not always so good, because the drugs that we get donated often have a short expiration date and if not, we cannot store them the whole time. You know, when I need 100,000 pills I don't have to store a million. That sometimes causes difficulties for us; the storage of pills that we don't need or of which we have a surplus. We really have quite a few of these donations, and due to the expiration date or due to the surplus they have caused us quite some difficulties. Sometimes we have tried to distribute them to the non-governmental medical institutions. The most important thing when it comes to this issue, however, is: we need certain drugs that we cannot buy and that we cannot obtain through donations. As I mentioned in the beginning, this applies to the medications for the cancer patients. No donation can provide those, one cannot buy them in any pharmacy. They come separately and they are very expensive. Without them we cannot do anything for these patients.

How about the equipment of the operation rooms? Certain operations you cannot perform and you have to send the patients to Israel or to Egypt?

The transfer of these patients happens for several reasons. First, we may not have the cadre for this, the trained staff, doctors, for example, and teams of these doctors. I cannot claim that we naturally have these well trained doctors. We have good doctors, we also have many doctors who can do a lot of things, but there are limits, where these cannot do certain operations where experience and expertise are needed. Therefore we sometimes have to transfer these patients. Sometimes also because of the lack. Due to the closure there is a lack of medication and equipment. We cannot simply let the people die. Hence we transfer them to Egypt, to the Westbank and sometimes also to Israel, if it has to be.