Project Context:
The Gaza Strip is a narrow piece of land along the Mediterranean coast between Israel and Egypt. Just 25 miles long and 10 km wide, it is home to more than 1.5 million Palestinians. The majority of Gaza's residents are from refugee families which fled were expelled from the land that became Israel in 1948. Life in Gaza has become increasingly difficult since Israel began to restrict freedom of movement in 2000, culminating in the blockade which has been fully in place since 2007. This has had serious consequences for the provision of healthcare in Gaza, not simply because patients are unable to leave in order to seek access to better healthcare, but also because vital medical equipment is subject to shortages due to the blockade. Furthermore, periods of intense crisis, such as the 2008 attack on Gaza, are not only very dangerous for patients who require regular access to care (for example dialysis patients) but also extremely damaging to Gaza's healthcare infrastructure.
For over 500 of Gaza's inhabitants who suffer from kidney failure, the situation is dire. Dialysis, never a good option, is especially difficult in Gaza given the volatile situation and the daily effects of the blockade, such as regular power cuts. This is why we believe that establishing a sustainable transplant unit in Gaza is so important. Our partner within Gaza is al-Shifa Hospital, the biggest public healthcare provider in the Gaza Strip.
The Long-Term Healthcare Impact of Building a Transplant System in Gaza:
The long-term benefits of building a transplant system in Gaza can be considered from both an individual and a societal perspective.
For individuals who benefit from the kidney transplantation program, long-term clinical results are proven to be vastly superior to clinical results achieved on dialysis. The average kidney transplant recipient not only has a much better quality of life, but lives for around 15 years longer than a patient on dialysis. This is extended to 20 years when the kidney is taken from a live donor. For children, who are key beneficiaries of our project, the long-term impact of kidney transplantation will be even greater.
Setting aside the long-term benefits for the individual, the long-term societal impact lies not only in the training of Gaza’s medics, but in building an appropriate system through which organ transplantation can be established. Ensuring that there is an independent transplant authority has been a key achievement in this regard. This guarantees the sustainability and consistent growth of the program. Furthermore, by insisting on an assurance of independence of the authority, we were able to secure the maintenance of the system long-term regardless of the political colour of Gaza’s governing authority.
Given the difficult situation regarding power outages and the consistent importation of necessary dialysis equipment and consumables to Gaza, over the long-term dialysis is more risky than transplantation. This is because there can be no scheduling or other measures taken in crisis or emergency situations, which unfortunately are common in Gaza. Over the short term, live donor transplants provide a second option for some patients. However, given the scarcity of matching live donors, for many patients cadaver donated organs are the only other option. Therefore, any transplantation system that aspires to provide long-term solutions must establish the necessary legislative framework, and this has been a key part of our project
The Impact of a Transplant System on Poverty Alleviation
Establishing a renal transplant system in Gaza will help to alleviate poverty in both a direct and an indirect manner.
Directly, the impact on patients’ lives cannot be underestimated. Taking an example, Mr. Zaid Matouk, our first transplant patient, will allow us to better comprehend the impact of kidney transplantation on poverty alleviation. As a falafel vendor, living in the Maghazi refugee camp in Central Gaza, Mr. Metouk could not afford to leave Gaza and undertake the transplant operation in Egypt. This left dialysis as his only option. The onerous and tiring process of dialysis, however, meant that he could no longer work and provide his family with an income. Receiving a transplant operation not only removed the immense financial burden that finding treatment had placed on Mr. Matouk, it also gave him the ability to return to work and support his family.
It is important to bear in mind that once kidney transplantation is established in Gaza it is estimated that 120 of the 500 patients currently on dialysis will be able to benefit from kidney transplantations. The impact on poverty alleviation of 120 men, women and children being able to positively contribute to the economic welfare of their families, rather than being dependent on a very overburdened public welfare sector, should not be underestimated.
Considering the limits of Gaza’s public sector expenditure is key to understanding the indirect contribution to poverty alleviation in the Gaza Strip. In the long term, dialysis is far more expensive than kidney transplantation. The NHS estimates that the cost benefit of kidney transplantation compared to dialysis over a period of ten years (the median transplant survival time) is £241,000. For public health expenditure as limited as that in Gaza, it is clear that a system of dialysis is not only short-sighted and costly, it is unsustainable.
It is important that poverty alleviation is seen not simply through the lens of case-by-case analysis, but rather through recognizing and changing systems which allow the public sector to perpetuate, rather than mitigate poverty in the Gaza strip.
The Gaza Strip is a narrow piece of land along the Mediterranean coast between Israel and Egypt. Just 25 miles long and 10 km wide, it is home to more than 1.5 million Palestinians. The majority of Gaza's residents are from refugee families which fled were expelled from the land that became Israel in 1948. Life in Gaza has become increasingly difficult since Israel began to restrict freedom of movement in 2000, culminating in the blockade which has been fully in place since 2007. This has had serious consequences for the provision of healthcare in Gaza, not simply because patients are unable to leave in order to seek access to better healthcare, but also because vital medical equipment is subject to shortages due to the blockade. Furthermore, periods of intense crisis, such as the 2008 attack on Gaza, are not only very dangerous for patients who require regular access to care (for example dialysis patients) but also extremely damaging to Gaza's healthcare infrastructure.
For over 500 of Gaza's inhabitants who suffer from kidney failure, the situation is dire. Dialysis, never a good option, is especially difficult in Gaza given the volatile situation and the daily effects of the blockade, such as regular power cuts. This is why we believe that establishing a sustainable transplant unit in Gaza is so important. Our partner within Gaza is al-Shifa Hospital, the biggest public healthcare provider in the Gaza Strip.
The Long-Term Healthcare Impact of Building a Transplant System in Gaza:
The long-term benefits of building a transplant system in Gaza can be considered from both an individual and a societal perspective.
For individuals who benefit from the kidney transplantation program, long-term clinical results are proven to be vastly superior to clinical results achieved on dialysis. The average kidney transplant recipient not only has a much better quality of life, but lives for around 15 years longer than a patient on dialysis. This is extended to 20 years when the kidney is taken from a live donor. For children, who are key beneficiaries of our project, the long-term impact of kidney transplantation will be even greater.
Setting aside the long-term benefits for the individual, the long-term societal impact lies not only in the training of Gaza’s medics, but in building an appropriate system through which organ transplantation can be established. Ensuring that there is an independent transplant authority has been a key achievement in this regard. This guarantees the sustainability and consistent growth of the program. Furthermore, by insisting on an assurance of independence of the authority, we were able to secure the maintenance of the system long-term regardless of the political colour of Gaza’s governing authority.
Given the difficult situation regarding power outages and the consistent importation of necessary dialysis equipment and consumables to Gaza, over the long-term dialysis is more risky than transplantation. This is because there can be no scheduling or other measures taken in crisis or emergency situations, which unfortunately are common in Gaza. Over the short term, live donor transplants provide a second option for some patients. However, given the scarcity of matching live donors, for many patients cadaver donated organs are the only other option. Therefore, any transplantation system that aspires to provide long-term solutions must establish the necessary legislative framework, and this has been a key part of our project
The Impact of a Transplant System on Poverty Alleviation
Establishing a renal transplant system in Gaza will help to alleviate poverty in both a direct and an indirect manner.
Directly, the impact on patients’ lives cannot be underestimated. Taking an example, Mr. Zaid Matouk, our first transplant patient, will allow us to better comprehend the impact of kidney transplantation on poverty alleviation. As a falafel vendor, living in the Maghazi refugee camp in Central Gaza, Mr. Metouk could not afford to leave Gaza and undertake the transplant operation in Egypt. This left dialysis as his only option. The onerous and tiring process of dialysis, however, meant that he could no longer work and provide his family with an income. Receiving a transplant operation not only removed the immense financial burden that finding treatment had placed on Mr. Matouk, it also gave him the ability to return to work and support his family.
It is important to bear in mind that once kidney transplantation is established in Gaza it is estimated that 120 of the 500 patients currently on dialysis will be able to benefit from kidney transplantations. The impact on poverty alleviation of 120 men, women and children being able to positively contribute to the economic welfare of their families, rather than being dependent on a very overburdened public welfare sector, should not be underestimated.
Considering the limits of Gaza’s public sector expenditure is key to understanding the indirect contribution to poverty alleviation in the Gaza Strip. In the long term, dialysis is far more expensive than kidney transplantation. The NHS estimates that the cost benefit of kidney transplantation compared to dialysis over a period of ten years (the median transplant survival time) is £241,000. For public health expenditure as limited as that in Gaza, it is clear that a system of dialysis is not only short-sighted and costly, it is unsustainable.
It is important that poverty alleviation is seen not simply through the lens of case-by-case analysis, but rather through recognizing and changing systems which allow the public sector to perpetuate, rather than mitigate poverty in the Gaza strip.
In partnership with the British Palestinian Medical Association (PALMED UK) photographs copyright of Craig Stennett