In this hospital, Palestinians' healthcare may feel brunt of Donald Trump's cuts

Paediatric wards are among many specialisms that could wither under US president's Middle East policy

Four-year-old Palestinian Ritag Harami from Bethlehem is lifted by her mother during her kidney dialysis treatment at the Augusta Victoria Hospital on the Mount of Olives in east Jerusalem. All photos by Heidi Levine for The National

Twelve-year-old Mohamed Derbach, who has leukemia, from Gaza at the pediatric oncology department.

Palestinian Shaheed Siam, 11, from Ramallah during her kidney dialysis treatment.

Shireen sits with Mayar during her kidney dialysis treatment.

Amani Salah, 18, following her kidney dialysis treatment. She is from El Khader near Bethlehem but lives at the hospital for full-time care.

Palestinians with their hospitalised family members from the palliative department on a terrace of the Augusta Victoria Hospital.

Basma Khoury from the city of Ramallah after an appointment to review her test results at the oncology department.

Women wait for their chemotherapy treatment at the oncology department.

Sixteen-year-old Loay Hani Abu Haniya, who has colon cancer, during his chemotherapy treatment at the oncology department.

At first glance in the Augusta Victoria hospital, on the southern side of the Mount of Olives in East Jerusalem, it seems like healthcare as usual.

Patients and doctors scurry around while families tend to their relatives.

In such places, worry beads are a common sight among Arab men. They are less usual for a 12-year-old to be holding.

Such is the small comfort for Mohammed Darbah, from Rafah in the Gaza Strip, as he begins another chemotherapy session for leukemia. 
His mother Wafa stands by his side in the pediatric ward.

"He's getting better since he started to come here," she told The National.

But Mohammed's treatment is taking place under the shadow of US funding cuts. This hospital is likely to be hit by President Donald Trump's decision to cut $25-million of funding set aside for it and five others in East Jerusalem.

Despite efforts to keep the children's spirits up, parents, medics and nurses are deeply worried about how children's care could be affected.

The move, part of US penalties on the Palestinian leadership for its classing the US as no longer being an honest broker for peace talks, hits the most vulnerable group imaginable: those already grappling with life threatening disease.

Mohammed is one among many. Sat at a nearby table are two other 12-year-olds, hooked up to intravenous chemotherapy while they paint images of Spiderman. Down the hall, two red-nosed clowns speak cheerily to the young patients, singing and drawing smiles from very small children who are receiving dialysis treatment.

The politics of the health cuts is causing dismay.

"This American decision arouses fear," said Wafa Darbah.

"It's very dangerous. Let Mohammed finish his treatment so that he can continue his life normally, freely, go back to his school and play with his friends."

Her son is one of 800 inpatients and outpatients treated daily at the hospital, which provides advanced care beyond the more rudimentary facilities of the Gaza Strip and West Bank.

Basma Khoury, 58, a former United Nations Development Program project manager, from Ramallah, who is being treated for breast cancer that spread to her spinal chord, is jolted by the Trump administration's action.

"I'm afraid I'll be affected. It's very unfair from a human view. The US is trying to press the PA but the cancer patients are not responsible for politics."

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Ms Khoury's resilience is obvious – she wore a shirt that said "Good Vibes Only" – but she has been battling cancer since 1997.

She has had her chemotherapy treatment changed several times and takes a great deal of morphine.

"This kind of chemo causes a lot of bone pain, joint pain and fatigue. I am always having cramps in my intestines. One treatment causes a week of suffering."

She had to stop working three years ago.

"I reached the point where I couldn't stand on my legs. I was in extreme pain. Taking pain medication made me drowsy and so I wasn't all there. It wasn't fair to my employer to stay in my job."

However, with the absence of a welfare safety net in the Palestinian Authority areas, Ms Khoury has been forced since to rely on support from relatives.

With her treatment unavailable elsewhere in the occupied West Bank, Augusta Victoria is her only viable care venue. She cannot afford an Israeli hospital and traveling to Jordan is difficult and expensive.

"Of course it's life saving treatment here and it's not just the treatment that is life saving, it's the psychological support you get. We have social workers and a psychotherapist comes to see me every time I have a treatment. Today she told me 'you can call me at 2:00 in the morning and I will answer you.'"

Of the US decision, she added: "It's very stressful. When you are sick, you have a lot of uncertainties. Being a cancer patient means uncertainties. Not knowing you'll have treatment is another kind of uncertainty."

The health of such Palestinians is not worth maintaining in the US view. A US state department official told Reuters Saturday the money withheld from the hospitals would be redirected to "high priority projects elsewhere."

The White House ordered a review of US funding to Palestinians after President Mahmoud Abbas decided to boycott US officials after the American decision to recognise Jerusalem as Israel's capital. That upended decades of US policy and was followed by the relocation of the American embassy to Jerusalem from Tel Aviv.

In recent weeks, the US withdrew $200-million in assistance to the Palestinian Authority and cut all US funding for the UN agency responsible for Palestinian refugees, the United Nations Relief and Works Agency (Unrwa). But Palestinian leaders say they will not cave in and return to peace talks under US auspices, citing what they say is obvious bias from the Trump administration towards Israel.

How much more dire the hospital situation will become – and how fast – is not yet clear.

The Palestinian Authority has pledged to step in and make up the $25-million shortfall.

"Hopefully the short term will be managed by additional funding from the national budget," said Walid Nammour, chief executive of Augusta Victoria and secretary of the East Jerusalem Hospitals Network.

"At this stage the question mark is more over the long term."

A quarter of the hospital's budget was in the past supplied by the United States Agency for International Development, he said.

The picture is bleak, according to Physicians for Human Rights-Israel, an Israeli organisation that assists Palestinians with health care, given that the PA already owes the hospitals enormous sums of money.

"Hospitals in East Jerusalem have been in financial distress for some time and closing the tap could lead to their complete collapse while withholding the right to health from tens of thousands of patients," it said in a statement.

A physician treating Mohammed Darbah, who asked not to be identified, said of the youngsters: "He's improving but he still needs a lot of heavy chemotherapy which is very tiring and very risky. In the coming round he will need blood and platelets. He's finished the easy part and the hard part is on its way."

The same doctor said of the American funding cuts. "I'm worried that at some point it will affect the quality of treatment. At some point, we will face difficulties with our diagnostic and treatment options."

"This is like blackmail. It is outrageous that you blackmail kids through their treatment."