Among many other services, the clinic in Shajaia offers its patients affordable pharmaceutical care. (photo: Tamara Abdul Hadi)
A young child receives a checkup at the clinic administered by the Near East Council of Churches in Shajaia. (photo: Tamara Abdul Hadi)
The clinic offers care to mothers and infants of all backgrounds. (photo: Wissam Nassar)
Shadia Daher sits with her family after the birth of her tenth child, Mahmoud, in early February. (photo: Wissam Nassar)
Palestinian mothers and children receive care at a Near East Council of Churches clinic in the Gaza neighborhood of Shajaia. (photo: Wissam Nassar)
Shadia Daher had thought her days of childbirth were behind her. Five years had passed since the delivery of her ninth child, and the 39-year-old now suffers from a painful chronic illness affecting her chances of ever having children again.
But “God’s will is stronger than humans’ will. I am pregnant now.”
Mrs. Daher lives with her husband and seven of their children — four daughters and three sons — in a small two-room apartment in the Gaza City neighborhood of Shajaia. Their other two daughters, both married, live with their husbands.
Shadia Daher’s husband works as a construction worker and receives wages equivalent to about $10 a day.
“We receive food aid from a local civic organization,” she says, as the family’s income is “barely enough to live on.”
Nevertheless, Mrs. Daher is able to receive regular health care — including primary care in addition to pre- and post-natal services — through a CNEWA-supported clinic operated by the Near East Council of Churches (N.E.C.C.) in Shajaia.
“I have visited this clinic for many years,” she says, adding that this clinic has provided care through all of her pregnancies. She regards it as a place of “care and respect.”
The Shajaia facility is one of the three N.E.C.C.-administered clinics providing medical services in densely populated, marginalized and impoverished areas of Gaza, considered one of the most densely settled population centers in the world. The council has a second clinic in the Al Daraj neighborhood and a third clinic in Khirbet al Adas, in the city of Rafah in the southern part of the Gaza Strip.
Women in the Gaza Strip have long struggled for access to adequate health care in Gaza, but conditions worsened as a result of the blockade imposed on the region since 2007. As conditions deteriorate, shortages of food, medicine and other essentials have become the rule rather than the exception. Moreover, hundreds of women are deprived of traveling beyond the territory to receive adequate care for more serious needs.
According to international and local reports, the current situation in the Gaza Strip is the worst and most severe its population has seen — particularly among women, who bear a heavier burden.
Although considered the weakest link in wars and crises, women and children, particularly in Gaza, are dauntless sources of strength, hope and love. And institutions such as the clinics of the Near East Council of Churches work to shoulder some of their immense burden, to help keep that hope kindled.
In the Gaza Strip, the narrow coastal tract of land where poverty and unemployment are highest among the Palestinian territories, the physical and mental health of women and children suffer most from the effects of both poverty and unemployment.
According to the Palestinian Central Bureau of Statistics (P.C.B.S.), women make up approximately 50 percent of the overall population in the Palestinian territory, and more than half are married. Women become widowed at about nine times the rate of men. A report prepared by P.C.B.S. reveals widespread poverty across the Palestinian territories, growing still more acute among families with a woman serving as head of household.
Health care services are provided in Gaza by three main parties — the government, the United Nations Relief and Work Agency for Palestine Refugees in the Near East, and hospitals and health clinics run by charitable organizations. The three clinics of the council offer care to the poorest of the poor in areas otherwise lacking access to health and medical services.
Dr. Eman Saad, a specialist in Obstetrics and Gynecology, says the Shajaia clinic provides health care for pregnant women from the second month of pregnancy until delivery, and then offers care for the mother, in addition to post-natal and early pediatric services for the child — including medical and laboratory tests, fetal ultrasounds and both health and psychological counseling for pregnant women. The clinic even makes an effort to follow up with patients periodically, and uses calls and text messages to remind patients of appointments.
During emergencies, such as pregnancies with complications, Dr. Saad says the clinic transfers patients to hospitals capable of addressing a broader array of needs — such as surgical intervention and other specific medical treatments unavailable at the clinic.
According to Dr. Saad, anemia has become highly prevalent, present in about three quarters of pregnancies she serves. Other common concerns include fetal kidney disorders caused by the contaminated water pumped to Gaza homes, used for drinking, cooking and hygiene.
She adds that many pregnant women of large families suffer from chronic stress. Moreover, the political instability and frequent military interventions put the Palestinian families, particularly women, under societal and economic pressure.
“I provide consultations and advice for pregnant women to help them remain healthy and successfully give birth to healthy babies,” Dr. Saad says. “However, I cannot say that I completely succeed in my mission, because of the very difficult political and economic situation Gaza’s population suffers.”
Yasmeen Abu Saada, 20, expects to deliver her second baby in a matter of weeks. She has been married for three years.
She says she visits the clinic regularly to receive primary care. This time, however, she has come for a consultation concerning her next pregnancy; she hopes to fulfill her husband’s desire to also have a baby boy.
“I started receiving health care at this clinic after becoming pregnant for the second [current] time, because doctors and midwives provide special health services, medical treatment and psychological support for mothers and their children,” Mrs. Abu Saada says.
Mrs. Abu Saada lives with her husband and child in the home of her husband’s family, sharing a residence with the families of her three brothers-in-law. Her husband works on a donkey-pulled cart, bringing home about $10 a day.
“My husband’s income is not enough to raise a family and live independently, so we live together with his parents, sharing their house and expenses,” she says. “My father-in-law is the family’s main breadwinner, so we suffer no food shortage.”
Mrs. Abu Saada married at a young age. She grew up in a family of nine members, and she left school at age 15. She believes that an ideal family includes four or six children, with an equal number of males and females.
“Of course we cannot predict the future. The economic situation is difficult, but we should build a family and live in peace, and God will definitely provide us with livelihood and enable us to get food and drink,” Mrs. Abu Saada says.
According to the P.C.B.S., Palestine has an extremely young population; children make up 42.7 percent of the population in the Gaza Strip and 47.6 percent of the West Bank. About half of the Palestinian population is below the age of 20.
Children in the Gaza Strip carry the effects of the deteriorating economic situation in their health and well-being. As unemployment rates rise, so do the rates of infectious diseases among children due to dwindling access to clean food and water.
Dr. Mustafa Za’anin, a child nutrition specialist, diagnoses and treats dozens of children through the N.E.C.C.’s clinic. The volume of patients generally increases in the winter months because of cold weather and poor heating.
Dr. Za’anin says a “lack of awareness” of healthy practices further contributes to these problems. “There is strong evidence that the prevailing poverty and unemployment in Gaza are the main reasons [for this unawareness],” he says, “in spite of the advice offered by various clinics for families.”
But a more complete picture involves many interrelated factors, he says.
Disease spreads more widely and rapidly among larger families, especially those struggling with malnutrition, he says. “Moreover, weak infrastructure, contaminated water and environmental pollution, particularly in impoverished and remote neighborhoods from the center of the city, cause severe infections and diseases.”
But poor health does not strike the poor and uneducated alone.
Samira Abu Muheisen, 25, a mother of 7-month-old twins Muhammad and Rawan, has come to the Shajaia clinic to treat the twins’ coughs, which have been interrupting their sleep.
After examining the children and listening to Mrs. Muheisen’s concerns, Dr. Za’anin prescribes a treatment and advises her to continue breastfeeding her twins and to keep them warm until their health improves.
Mrs. Muheisen has been married for two years. She lives in a house with the twins and her husband, who works at a governmental school and receives a monthly salary of about $300. A third of their income goes to rent, while the rest is spent on daily needs.
A university graduate, Mrs. Muheisen has had little success finding a job due to lack of opportunities and gender discrimination.
Overall unemployment among adult women in Gaza stands at about 60 percent, compared with at about 36 percent among men.
Yet among those with high levels of education, the two sexes face opposite outcomes — unemployment falls to about 29 percent for men and rises to just above 61 percent for women.
“We live in a house with no adequate ventilation, electricity or heating, due to frequent power outages. I exert my greatest efforts to maintain my twins’ health, against winter colds and flu,” she explains.
“I would like to have a big family of at least six kids. For now, I have a son and daughter.” She hopes to continue growing her family, and to maintain parity between sexes.
“I also look for a job, to help my husband in housekeeping.”
“We receive a large number of cases daily that exceeds the clinic’s capacity. Nevertheless, we check up our patients and treat the most needy,” says Asma Abu Hassan, the clinic supervisor.
“We serve tens of thousands of patients monthly; hundreds of patients daily come to our clinic for treatment. We serve the largest possible number of them.”
The administrator puts the pressure on the clinic into context. “The clinic has a small medical team of four doctors in different specialties and seven nurses, in addition to a laboratory technician and a pharmacist,” she says. “So the clinic’s team works at the maximum capacity.”
According to the Palestinian Ministry of Interior, an average of 4,500 babies are born every month in the Gaza Strip — translating to about 150 every day, or about one every ten minutes.
Children in the Gaza Strip suffer from diseases and epidemics caused by environmental pollution, lack of potable water, overpopulation and poor hygiene caused by frequent power outages and a lack of clean water.
Dr. Rami Tarazi, a dermatologist at the Shajaia clinic, says about four out of five patients he treats at the present moment suffer from scabies, which spreads rapidly among patients in the densely populated area.
“Scabies tends to transmit easily through direct physical contact. Moreover, lack of awareness among the population sometimes leads to disease transmission to the same persons more than once. Overpopulation impedes halting the disease’s spread.” He adds that official organizations tend to be negligent of these matters.
“Today, for instance, I have treated 43 patients up to this moment; among them, 25 suffered from scabies.”
Dr. Tarazi says in areas such as Shajaia, many families keep livestock such as donkeys and horses in their houses, which increase bacterial, fungal and viral skin diseases among the population.
The people of Gaza face a health crisis so broad and multifaceted, it can seem insurmountable. Still, Ms. Abu Hassan maintains a positive attitude, focusing on those immediately before her.
“We are trying hard to serve people here and offer our best, in order to keep the family intact — physically and psychologically.”
Hazem Balousha is a journalist based in Palestine.