VISITING Gaza, after 25 years, was like coming home. My husband and I had worked for 16 months as medical volunteers with Medical Aid for Palestinians (MAP) at Al-Ahli Hospital in 1991/92 – he as an anaesthetist and me as a surgeon. Being reunited with friends and colleagues after so long, many of them still working at the same hospital, has been a joyful aspect of my regular visits over the last few years.

The heartfelt welcome makes it all the more painful to witness the change – and also the lack of change – over the quarter-century since the ‘‘Peace Process’’ started.

Gazans are now, on average, 25% poorer than in the 1990s, with more than half of people living below the poverty line.

The continuing collapse of the economy has left more than 80% of people dependent on some form of international aid, food insecurity is rife and 98% of water is undrinkable.

Life for Gazans has become much worse since Israel blockaded the Gaza Strip in 2007. The closure has left two million people, half of them children and two thirds of them refugees, trapped in an area roughly five by 25 miles.

In many ways the closure has left Gaza’s health sector frozen in time, cut off from advances in medicine, particularly cancer treatment, being made around the world.

The National: Dr Whitford performing surgery at the Al Ahli Hospital in GazaDr Whitford performing surgery at the Al Ahli Hospital in Gaza

Having been a breast cancer surgeon for over 30 years, MAP offered me the chance to go on a fact-finding visit, in 2016, to review services in Gaza.

On visiting a women’s support group, I was shocked to find that, regardless of the size or stage of disease, every single woman had undergone a radical mastectomy and axillary node clearance: an approach that had not been routine practice in the UK for more than 20 years and which had left half of them suffering with severe arm swelling known as lymphoedema.

This is unsurprising given that last year just 15% of Palestinian health workers who applied to the Israeli authorities for permission to travel to external conferences or training were granted permits to exit Gaza.

While doctors read widely and study what is available through the internet, the lack of opportunity to develop their professional skills and improve treatment for their patients creates a sense of isolation and impacts on the morale of Gaza’s medical workforce.

The MAP team and I therefore set about trying to create a programme of peer support and training for breast cancer teams in the West Bank and Gaza.

Having previously been a network lead clinician, I was able to send out a call for volunteers right across Scotland to recruit the specialists we needed: radiologists, oncologists, cancer nurses and fellow surgeons.

It is fantastic that they are willing to give up some of their holidays every year to travel to Gaza or the West Bank, where we work alongside our Palestinian counterparts to support the development of local breast cancer services through training, advice and equipment.

The progress in just two years has been remarkable, particularly in Gaza where I led the first team visit in September 2017.

Women are now diagnosed before surgery with core needle biopsies which are subjected to detailed analysis, allowing better planning of their treatment right from the start. Surgical practice has also changed, with breast conservation replacing mastectomy for patients with smaller tumours, and more targeted “sentinel lymph node biopsy” limiting the number of women undergoing radical axillary node clearance, thereby reducing complications. Undergoing a mastectomy affects not just a woman’s health but her self-esteem and confidence, so it is important that more Palestinian women have the option of breast conservation if clinically appropriate.

At 7am every Tuesday morning Scottish volunteers link, via Skype, with the new Gaza breast cancer team for a treatment planning meeting; with a similar service being developed for the West Bank.

In Gaza, this international medical bridge also enables our Palestinian colleagues to access updates and technical developments from around the world. I led on the development of the first clinical audit standards for breast cancer in Scotland in 2000, and am now working with MAP to develop the same in Palestine.

The National: Dr Whitford with MAP's team in GazaDr Whitford with MAP's team in Gaza

As well as the isolation, our Palestinian colleagues face many other challenges due to the ongoing 12-year blockade and closure of Gaza.

THE supply of many chemotherapy drugs is insecure, leading to gaps in treatment and thereby reducing its effectiveness and the patient’s chance of a cure.

The lack of any radiotherapy equipment in Gaza means women must travel to the only centre providing this vital cancer treatment in the entire occupied Palestinian territory: the Augusta Victoria Hospital in East Jerusalem. Getting an exit permit from Gaza is by no means guaranteed, however.

Last year, 39% of patients requesting permits to leave Gaza for medical treatment were denied or delayed by the Israeli authorities.

The year before, 54 Gazan patients died after missing scheduled medical appointments – 46 of whom had cancer. As a result, many surgeons carried out mastectomies, fearing their patients would not get access to radiation treatment.

The cancer journey is hard for every patient, and their family, but for Palestinians it can be unbearable. The treatment of patients continues to be compromised by the restrictions and indignities imposed by life under military occupation in the West Bank and the closure of Gaza.

The National: Dr Whitford visiting the Al Ahli hospital in GazaDr Whitford visiting the Al Ahli hospital in Gaza

I have spent most of my working life trying to ensure women have access to the best breast cancer treatment available and it is unacceptable that this is denied to Palestinian women for no other reason than where they live.

I am proud of what this Scottish-Palestinian partnership has achieved in just two short years, but we must continue to provide support and training to Palestinian breast cancer teams and, through them, hope for the women they care for. Our project, however, is just patching up one of the symptoms of ongoing occupation and blockade. The UK Government must do more through international development aid, but particularly through diplomatic pressure, to end the closure of Gaza and ensure Palestinians can access the kind of quality health care we take for granted.