In the shade of a cedar tree outside Augusta Victoria Hospital in East Jerusalem, a woman in a hijab sits with her father. A tube in her hand delivers the drugs she hopes will save her life.

But her eyes are sad above her black mask.

Nuha Hasanin, 27, has colon cancer. She and her family live in Gaza City, where the chemotherapy and immunotherapy she needs are unavailable.

Reports that Palestinian patients face long waits to enter Israel for treatment are familiar. Israel is usually blamed for supposedly denying permits to those who are too ill to pose any threat.

But Nuha’s case is different. Her delays have been caused by Palestinian Authority doctors and officials, who held her up for six months by demanding a bribe.

“If I had paid, my daughter would have come here much sooner,” says her father, Fathi, 59, who worked as a tiler in Israel before Hamas took over the Gaza Strip. “But we are poor, and there is corruption. Everything comes down to money or your connections.”

Nuha sighs. “The doctors here tell me that I have improved,” she says. “I’ll be having more treatments, and then a scan to see how I’m doing. But who knows what damage the delay may have done?”

This is the second time she has been through this ordeal. When she was diagnosed in June 2019, it soon became clear that Gazan hospitals lacked the means to treat her, and she needed to go to Israel.

But it took six months of pressure to get her name on the PA’s referral list.

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Nuha Hasani and her father Fathi

Finally, she says, she arrived in Jerusalem. She was a patient at the Augusta Victoria until February 2020, having chemotherapy and radiotherapy. Then she went home.

Back in Gaza, her condition deteriorated. Eventually, she had surgery at the al-Shifa hospital in Gaza that left her with a stoma. The wound became infected, and doctors said she needed to come to Israel again.

But there was a catch. When she approached the referrals unit in Gaza — which remains under the control of the PA Health Ministry — she was told she would have to first visit a private clinic.

That private clinic was run by two doctors who also happened to be members of the committee that determined who was placed on the referral list.
Nuha would have to be registered at the clinic, which would require a payment of some 5,000 shekels (£1,300).

“My wife said, ‘but the Augusta Victoria is recommending treatment there, she needs it to save her life’,” says Fathi. “And one of the staff cursed her and threw her out. She was told that without the payment, they did not recognise Nuha’s needs.”

The system, he adds, is clever. “They don’t simply ask you for money. But if you don’t register as a private patient in Gaza, you will get no treatment.

“Of course, you will not be treated there, but in Israel. So the bribe is concealed, but it still amounts to a bribe.

“If you can pay, you will get on the list immediately. That is the bottom line. But how can you measure the value of a life by how much has been paid?”

Fathi says he finally got his daughter referred by asking a friend, who has a powerful position in the PA’s ruling Fatah party, to pull strings in Ramallah.

It helped that Fathi has a good reputation as a social worker, where he supports Gaza police in reconciling feuding families. “I have a certain position in society and they know I’m not afraid to speak out,” he says.

He gestures around the hospital garden at other cancer patients. “I know four or five of the families you can see and they have also been asked for money,” he says. “Both from Gaza and the West Bank.”

At one of the other tables, he introduces a woman who asks not to be named, from the West Bank city of Nablus. “I am being treated for breast cancer,” she says. “I had no problem being referred to Israel.” But her family paid up, she confirms.

As ill-luck would have it, Fathi’s cousin, Hesham Hasanin, 59, also has cancer but is stuck in Gaza. Fathi reaches him on the phone.

“The doctors here have told me I need to have a difficult operation they can’t do in Gaza,” Hesham says. “I’ve tried to get a referral but I can’t. I’m not Hamas, and I’m not Fatah. I’m not politically affiliated. That makes it very difficult.

“You have to pay if you want treatment immediately. Everyone knows you have to go to a private clinic and then they say they can get you on the list. But I can’t afford it.”

He says that without treatment, he is going downhill fast. “I can’t get chemo. My stomach is swelling, and I’m throwing up all the time. This is not an Israeli decision but a Palestinian one. It’s all connections, corruption, money.”

Hesham has lost all hope. For now, Nuha hasn’t. “I hope to be cured,” she says, smiling for the first time in the interview. “If I am cured, I will give everyone sitting here sweets.”