The war in Gaza had been going on for six months. It was the week before Easter, and the third week of Ramadan. The Old City of Jerusalem, normally packed with pilgrims, seemed deserted.

“Look around you; this is not like Easter,” Bishop Sani Ibrahim Azar of the Evangelical Lutheran Church in Jordan and the Holy Land told members of a Lutheran World Federation delegation during a visit this past Maundy Thursday. Azar noted that the annual Lutheran procession to the Garden of Gethsemane was much smaller than usual. Israeli authorities had not allowed church members from the West Bank to attend.

Signs of the Muslim season of Ramadan were also hard to see in Jerusalem. There were no Ramadan lights. Once festive, the Iftar meals held after sundown had become a solemn affair. The impact of the war could be seen everywhere, including at the Augusta-Victoria Hospital (AVH), located on the Mount of Olives.

The conflict has deeply impacted patients and health care services at Augusta-Victoria, a Lutheran World Federation run hospital that specializes in cancer and kidney care. It is the only Palestinian hospital that provides this treatment. Patients come here from the West Bank and Gaza, but they need a permit to get through checkpoints. Since the war began, cancer and hemodialysis patients have been cut off from life-saving treatment.

“What we hear is horrifying, and we know this is only a small part of what is really happening,” said Bisan Khair, director of resources development for AVH.

Khair and her team repeatedly tried but were not allowed to send cancer medication into Gaza. Instead, hospital staff try to reach patients by phone to listen and talk with those for whom they have cared. When there is a phone connection, staff hear about attacks on hospitals, surgery without anesthetics and hunger. “We are trying not to lose hope,” Khair said. “As much as the situation affects us, it is so much worse for our patients from Gaza.”

When I visited AVH this spring with a Lutheran delegation, 96 people from Gaza, cancer patients and their companions, were living in the hospital compound. AVH staff have been providing meals, clothes, hygiene kits and psychosocial support, such as counseling and volunteer-led creative activities.

But nothing could distract the patients from Gaza from the news of Israeli military bombings, family members killed, their homes destroyed, and other loved ones living in unbearable conditions. Some of the most heartbreaking stories come from parents staying at AVH, who fear for the lives of their children in Gaza.

One mom, Samar (names have been changed for privacy), traveled to AVH with her son Khalid, 8, so that he could be treated for leukemia. “The doctors make me look ugly,” he said, trying to refuse even a blood pressure exam. He had lost his hair, and his face was swollen— side effects of chemotherapy. His mother had made Ramadan paper lanterns with him and arranged for a wig. She tried to cheer him up, but her smile did not reach her eyes.

Samar’s husband and three younger children are in northern Gaza. Sometimes they were able to talk by phone. Samar heard that their family’s house had been destroyed by the bombing. They have also told her that there is no food. “There is no hygiene, no water. My daughter has lice… It’s driving me crazy,” Samar said, worriedly. Recently, Samar’s youngest daughter said “Mama” to her sister, who has been caring for the two-year-old. Samar’s fiveyear old daughter refuses to talk with her. Her children in Gaza envy Khalid, who is with their mother, while the sick boy longs for his family in Gaza.

Every year, some 400 children from Gaza and the West Bank are diagnosed with cancer. About 100 child cancer patients are treated at AVH annually, and two-thirds of these children come from the Gaza strip, said Dr. Khadra Salami. An AVH pediatric oncologist, Salami radiates compassion and energy.

Her smile, when it emerged, was steely and strained. “We have a special relationship with our patients,” she said. “But now we’ve lost contact with most of them. Many have died in the war.” The past months have been very difficult, she said, adding: “When we receive news these days, it’s usually bad news.”

By the end of March, the hospital would normally have expected to add 50 new child patients for cancer treatment. Since the Hamas attacks of October 2023, only those already at the hospital have received treatment.

In late March, the Israeli administration asked hospitals in East Jerusalem to provide a list of patients from Gaza who had completed treatment, to deport them back to the Gaza strip. A legal injunction stopped the order.

Children like Khalid need special food, medication, physiotherapy and a clean environment once they finished a round of treatment. Not only has Gaza’s health care system broken down—to the point where hospital staff say not even paracetamol (acetaminophen) is available—but many AVH patients no longer have a home they can return to.

“I could not send Khalid and the other children to a tent,” Salami said.

AVH nurses and doctors are under considerable stress, said Dr. Amal Abu Awad, the hospital’s chief nursing officer. The team is understaffed. Because of the checkpoints, AVH staff who live only 25 minutes away in the West Bank now must allocate hours to come to work. And the stress continues at home for many staff, for a variety of reasons, including settler violence, partners who have lost their jobs and restrictions on visiting even close family who live in neighboring villages. Although the hospital offers counseling and support groups for staff as well as patients, many said they are too busy to think about themselves. Instead, they focus on serving. “What gives us strength is to help our patients,” Awad said. “We are family with them.”

In the office next to Awad’s, Dareen Tadros, hospital project manager focuses on a better future. AVH had been preparing for the November 2023 launch of a new oncologic diagnostic and treatment center at Al Ahli Hospital in Gaza City. At presstime, before the center’s official opening, the hospital had been attacked several times. “The facility had some damages, but the building and equipment are still in acceptable condition,” Tadros said. However, the realization that in this conflict not even hospitals are safe has been a shock, she said.

She and the AVH team hope to rebuild health services and cancer care in Gaza after the war. “Approximately 10,000 cancer patients in Gaza are suffering without access to treatment,” Tadros said.

To begin to grasp the impact of the war in the Palestinian Territories, one only need only follow the AVH community outreach program in the West Bank. The program consists of a mobile mammography unit and a bus that is outfitted as a diabetes clinic. Because many residents can’t leave the West Bank to access medical training, the AVH team is also helping by training nurses locally.

At presstime this past spring, outreach staff were allowed to pass checkpoints fairly unhindered, according to Lana Nasser Eddin, community outreach program chief. However, the reality of life in the West Bank emerges when Eddin describes having to reschedule a mobile visit after someone who was Palestinian was shot in a community that AVH staff had planned to visit the next day.

Driving along the clinic’s route, it is impossible not to see the separation wall and the many settlements dividing the region. Checkpoints with armed soldiers are now inside Palestinian villages. Signs of poverty are obvious among patients, who wear cheap plastic sandals despite having diabetic feet.

In conversation with staff and patients of the diabetes bus, it soon becomes obvious that the prevalence of diabetes in the West Bank is not merely a medical issue. Since the war began, many people here have lost their livelihoods. The conflict has also exacerbated limited healthcare resources. Public clinics do not have enough medication available, and patients no longer have an income to pay the out-ofpocket costs.

“I can avoid soft drinks, but I cannot avoid stress,” said Marwan, 49. After the Hamas attack last October, he and his adult son lost their Israeli work permits, and consequently their jobs working on an Israeli construction site. Marwan used to be able to pay for his specialized diabetes medication from his own earnings. These days, he barely knows how to feed his family.

It wasn’t always this way. Marwan used to own an olive grove. In October 2023, soldiers began occupying the land and cut down the trees. It was more than just a financial loss. “My father planted these trees,” Marwan said. “For 300 years, we have owned this land. I have documentation.” Regardless of his legal paperwork, if he tries to go to his family’s land now, he risks being shot.

“So, I am staying away,” he said, despondently. “We want to feel safe. We want peace.”

Visit www.elca.org/ldr (click on Middle East Crisis) to learn how Lutheran Disaster Response is helping.

Cornelia Kästner-Meyer is senior communication officer at the Lutheran World Federation in Geneva, Switzerland. She’s the communication focal point for the humanitarian and development work and writes about it on lutheranworld.org.

This article appeared in the July/August 2024 issue of Gather. To read more like it, subscribe to Gather.