Khaldoun Atwan starts each day in the oncology ward at Beit Jala Government Hospital, not knowing what barriers will come his way.
asserted
barriers → start → Hospital
The Nabi Yunis checkpoint in Halhul seems to be “always closed”, so the head of the daytime oncology unit at the hospital leaves his car and finishes the commute from Hebron by taxi.
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“More than once, by God, I found the mirror broken.
asserted
mirror → seem → God
I found the wiper broken,” he said about his journey through an area where settlers are now active.
asserted
settlers → find → area
Traversing a dizzying array of gates and checkpoints opening or closing at will, he does not know whether he will reach the hospital, whether his patients will, or whether the drugs they need will be on the shelf when they do.
asserted
they → traverse → shelf
Inside his tiny, spartan office, Atwan is struggling to keep up with his cancer patients who have regressed because they missed crucial appointments or essential drugs needed for their chemotherapy treatment.
asserted
they → struggle → treatment
Not even during the second Intifada, he recalls, was drug supply an issue.
asserted
issue → recall → Intifada
Now, it’s inescapable.
asserted
it → ’ → ?
“Everything’s short … whatever’s available we give,” he said.
asserted
he → ’ → ?
“It’s a disaster.”
asserted
It → ’ → ?
The Palestinian Authority (PA)’s finances have collapsed over the last three years due to a reduction in international aid and disruptions in Israel’s transfers of tax receipts.
asserted
finances → collapse → receipts
Israel’s actions in the occupied West Bank since October 2023, including widespread road closures, checkpoints and a series of settler pogroms against Palestinian communities, have also impacted the economy.
asserted
actions → include → economy
As a result, the occupied West Bank’s healthcare system is rapidly deteriorating, with staff receiving just half their salaries, while the PA can’t pay for essential medications.
asserted
PA → deteriorate → medications
Alongside others nervously pacing in the courtyard, an older cancer patient from a village in Bethlehem governorate stood at the entrance of the hospital, weighing with his son what to do.
asserted
patient → pace → what
“Every month they do their best, the doctors and the cleaning staff, but they aren’t provided with anything,” he said.
asserted
he → do → anything
Ministry clinics are now operating part-time, with doctors seeing well more than 100 patients a day when they are.
asserted
they → operate → patients
Now, even a doctor’s visit is rushed and unaffordable: “If we want to go to the doctor for a checkup, we need 200 shekels [$65],” said an older cancer patient.
asserted
patient → want → shekels
“It’s not a story of there being no staff,” said Iyad Dari, the attending physician at the dialysis unit at Beit Jala.
asserted
Dari → ’ → Jala
Getting paid only half their salaries, “the government employee is working just two or three days a week, because he hasn’t got enough to come in for his full hours,” he added.
asserted
he → pay → hours
As a result, the hospital ends up covering emergency cases only.
asserted
hospital → end → cases
But now everyone understands: Everyone’s suffering,” Dari said.
asserted
Dari → understand → ?
The medical supplies crisis in Beit Jala and across the West Bank is the result of Israel’s withholding of tax revenues earmarked for the PA, an action spearheaded by Israeli Finance Minister Bezalel Smotrich.
asserted
crisis → earmark → Smotrich
“This crisis is very predictable, and we saw it coming 100 percent,” said Milena Ansari of Physicians for Human Rights Israel.
asserted
Ansari → see → Rights
Even before the genocidal war on Gaza began in October 2023, Israel was periodically withholding tax revenues, endangering the Ministry of Health’s coffers, Milena said.
asserted
Milena → begin → coffers
According to Yosef Ojra, an internal medicine specialist at Beit Jala, the withheld revenues have depleted the Health Ministry’s funds to pay medical suppliers, who are now withholding their services.
uncertain
who → accord → services
The ongoing borrowing of supplies between the public and private arms of healthcare has greatly strained private clinics, pharmacies and hospitals.
asserted
borrowing → strain → clinics
Hisham Amle, an oncologist at the hospital, said shortages are “an old problem, not a new one”, but that about 90 percent of important items – for chemotherapy, above all – used to be there.
asserted
percent → say → all
Now, even immunotherapies and biologics are missing, and cancer treatment runs on an unbroken chain.
asserted
treatment → miss → chain
“If the patient misses a session or two, he’s lost all the treatment before it,” he said.
asserted
he → miss → it
“When I first took over the department, the drugs were available,” said Atwan, the lead oncology nurse.
asserted
Atwan → take → department
He then began to list all the crucial drugs he was now missing for his patients.
asserted
he → begin → patients
“There’s not one single complete protocol I’ve got.”
asserted
I → ’ → ?
Khuloud Dweib, the hospital’s director of pharmacy, said the ministry recently managed to obtain eight previously missing oncology drugs and four biologics.
asserted
ministry → say → drugs
But many other drugs are still out of stock, she said.
asserted
she → say → stock
Unlike in Gaza, Israel is not blocking medicines from entering the West Bank, Ansari noted.
asserted
Ansari → block → Bank
The problem is “strictly” that the PA has no money to buy them.
asserted
PA → have → them
But “Israel has the primary legal obligation as an occupying power,” she notes, to ensure adequate medical care and access to occupied populations.
asserted
she → have → populations
Denied movement, denied care
For all of the southern West Bank, Beit Jala’s hospital is the only public option available for cancer and dialysis treatment, with patients coming from Bethlehem and Hebron governorates, parts of occupied East Jerusalem and sometimes Jericho.
asserted
patients → deny → Jerusalem
But as Israeli checkpoints and gates multiply, reaching the hospital has become a nightmare.
asserted
reaching → multiply → hospital
Dari described a dialysis patient from Nahalin, with an appointment at seven or eight in the morning, whose village was sealed.
asserted
village → describe → morning
“He sat about four, five hours at the checkpoint,” Dari said.
asserted
Dari → sit → checkpoint
…and 54 more, not listed.
The Aporia
