"August, September, October, November." Ghafra Faraj is recalling how many times she applied to the Israeli authorities for a permit so she could leave Gaza and travel to East Jerusalem to access radiotherapy after she was diagnosed with breast cancer.
Radiotherapy is vital for fighting the disease but it's unavailable in Gaza and so hundreds of patients who require this treatment are referred to East Jerusalem every month. But to get there they must navigate Israel's opaque bureaucracy just to get a permit to exit Gaza.
As she waited for permission, Ghafra's eyesight stated to fade, she lost her teeth, and her fingernails went black. "My voice changed, and I lost all my hair," she recalls. But still, her applications kept getting rejected. "My son went to the doctor, and he told him, you can't wait anymore, you have to go with your mother to Egypt."
At 5am Ghafra prayed Fajra, the dawn prayer, and then made her way to the Rafah Crossing where she waited for more than 12 hours to cross into Egypt. Mother and son travelled across the Sinai Peninsula, up to Cairo, and arrived at the Nasser Institute health care centre in the Egyptian capital. But the guard sent them away. "It's Friday today, and no referrals can be admitted into the hospital," he told them.
Over the following days Ghafra and her son went back and forth between the hospital and the hotel where they were staying, trying to convince the medical staff to let them in so Ghafra could be treated. They offered bribes and explained that because they were from Gaza, they couldn't afford to wait a further four weeks to be seen.
One and half months and $1,500 later, Ghafra returned to Gaza having completed her radiotherapy sessions. "I hope nobody ever has to go to Egypt for treatment," she says. "The journey is very difficult."
Speaking from the Women's Health Centre in the Burij refugee camp in Gaza, through a live stream and virtual media delegation organised by Medical Aid for Palestinians, Ghafra is one of thousands of cancer patients who must overcome a series of hurdles to access care, not least an Israeli and Egyptian blockade which has been imposed on the Strip since 2007.
Six patients including three children have died so far this year due to a delay or denial of permits from Israel, according to MAP. In August, 42 per cent of permit applications were either denied or delayed by the time their hospital appointment came around.
Besides the lack of radiotherapy, there is a shortage in certain chemotherapy drugs and medical supplies in general, says Dr Ahmed Al-Naji, one of the main breast surgeons in Gaza, who spoke from the Nasser Hospital in Khan Yunis. Yet every month Dr Al-Naji's department discover 7-10 new breast cancer cases, making it the most common cancer in Gaza.
"There is also an electricity problem due to the siege. Can you imagine that [our hospital equipment] doesn't work properly? Imagine how this will affect the patients and how they will suffer," he adds.
Dr Khadra Salami is a Paediatric Haematology Oncology Specialist at Augusta Victoria Hospital in East Jerusalem where many of the patients in Gaza are cared for if they are granted permission to get there. As the only hospital with radiology facilities and advanced chemotherapy treatments in Palestine, they serve two million people in Gaza and three million from the West Bank.
"The medical team are overloaded,' Dr Khadra says.
Sometimes, when children are accepted for treatment in this hospital, their parents are denied permits to come with them. "It's a very stressful with the disease itself, and then the trauma of being separated from their parents," says Dr Khadra. "Sometimes we have nursing infants who are separated from their parents. Mothers are not allowed to come. You can't imagine how this could happen in any part of the world when you are dealing with a very sick child. Counselling the parents by phone, giving them a treatment plan and outcome by phone."
"If you are doing this job in the UK, America or even in Israel, you will study the outcome of the patients when they've received chemotherapy every two weeks comparing it to three weeks," she continues, "but in our situation you are just waiting for your patient to come to the appointment, which most of the time is interrupted. This will affect the prognosis of the disease."
For those that cannot get out of Gaza, there are human rights organisations, like the Culture and Free Thought Association, which raise awareness about the importance of early detection with women who are often afraid to get screened, says its director, Firyal Thabet. The CFTA drives mobile clinics with diagnostic services and parks them up in marginalised areas for women who struggle to get to a hospital.
"All people in Gaza need the right to access health services," she says. "Here in Gaza, we love life. We need hope, and we need peace."
The views expressed in this article belong to the author and do not necessarily reflect the editorial policy of Middle East Monitor.