West Bank Hospitals in Crisis as Israel Withholds Palestinian Tax Funds

Beit Jala, occupied West Bank – Every day, Dr. Khaldoun Atwan begins his shift in the oncology ward of Beit Jala Government Hospital without knowing what obstacles he will face on the way. The Nabi Yunis checkpoint in Halhul seems to be "always closed," so the hospital's daytime head of oncology must abandon his car and take a taxi for the rest of the journey from Hebron. "More than once, I've seen my car mirrors smashed and the windshield wipers broken," he says of the route through an area where growing numbers of settlers are active.

Having to weave through countless gates and checkpoints that open and close at will leaves him unsure whether he will reach the hospital, whether patients will reach it, and whether the medicines they need will still be on the shelves when they arrive. Beit Jala is the only government hospital in Bethlehem governorate, home to some 320,000 people. In a small, sparsely furnished office, Atwan struggles with cancer patients whose disease has returned after they missed crucial appointments or went without essential chemotherapy drugs.

According to him, even during the Second Intifada, medicine supplies were never a problem. Now shortages are unavoidable. "Everything is lacking… we give whatever we have," he says. "This is a disaster."

Palestinian Authority (PA) finances have collapsed over the past three years due to falling international aid and Israel's disruption of tax transfers. Israel's actions in the occupied West Bank since October 2023, including widespread road closures, additional checkpoints and settler attacks on Palestinian communities, have also hit the economy hard. As a result, the West Bank health system is deteriorating fast: staff receive only half their salaries, and the PA has no money to buy essential medicines.

"Only emergency cases accepted"

Beside anxious people pacing in the courtyard, an elderly cancer patient from a village in Bethlehem governorate stands at the hospital entrance with his son, weighing what to do. "Every month the doctors and cleaners do their best, but they are given nothing," he says.

Ministry of Health clinics now operate only part-time; when they open, doctors see more than 100 patients a day. Even a single visit has become rushed and prohibitively expensive: "To get a check-up, we need 200 shekels (about $65)," one elderly cancer patient says.

"This is not a staffing problem," says Dr. Iyad Dari, who heads the dialysis department at Beit Jala. With only half pay, "civil servants work only two or three days a week, because they can't afford to come in full-time." As a result, the hospital can handle only emergency cases. "At first patients were [angry]. But now everyone understands: everyone is suffering," Dari says.

The medical supply crisis in Beit Jala and across the West Bank is a consequence of Israel withholding tax revenues owed to the PA, a move initiated by Israeli Finance Minister Bezalel Smotrich. "This crisis was entirely predictable, and we saw it coming long ago," says Milena Ansari of Physicians for Human Rights Israel. According to her, even before the war in Gaza began in October 2023, Israel had periodically withheld tax money, threatening the Health Ministry's budget.

According to internist Dr. Yosef Ojra of Beit Jala, the withheld revenues have drained the Health Ministry's funds for paying medical suppliers, causing them to stop delivering. Public and private facilities borrowing supplies from one another has put enormous strain on clinics, pharmacies and private hospitals.

Oncologist Dr. Hisham Amle describes the shortages as "an old problem, not a new one," but notes that previously about 90 percent of critical supplies, especially for chemotherapy, were available. Now even immunotherapy and biologic drugs are scarce, while cancer treatment is a chain that cannot be broken. "If a patient misses one or two sessions, everything that came before is lost," he says.

"When I first took over the department, medicines were plentiful," recalls Atwan, head nurse of the oncology ward. He lists a series of vital drugs now unavailable to patients. "I don't have a single complete treatment protocol."

Khuloud Dweib, the hospital's chief pharmacist, says the health ministry recently managed to obtain eight cancer drugs and four biologic medicines that had been lacking, enough for about six weeks to two months. Many other drugs, however, remain out of stock.

Unlike Gaza, Israel does not block medicines from entering the West Bank, Ansari notes. The problem is "precisely" that the PA has no money to buy them. But in her view, "Israel bears the primary legal obligation as the occupying power" to ensure adequate healthcare and access for the occupied population.

Movement blocked, care blocked

For the entire southern West Bank, Beit Jala hospital is the only public option for cancer treatment and dialysis, with patients coming from Bethlehem and Hebron governorates, parts of occupied East Jerusalem and occasionally Jericho.

But as Israeli checkpoints and barriers multiply, getting to the hospital has become a nightmare. Dari recalls a dialysis patient from Nahalin whose appointment was at 7–8 a.m., but whose village was sealed off. "He sat at the checkpoint for about four or five hours," Dari says. The patient then had to take a long detour through Jaba, Surif, Halhul and Hebron, arriving at the department at 4 p.m. A normal trip costs about 10 shekels; "a detour like that costs more than 100 shekels," Dari says, while some patients need dialysis four times a week.

According to Dweib, the health ministry's central supply warehouse is in Nablus, and what is normally a 90-minute journey can now take six to 10 hours when roads are closed.

Many of Atwan's patients need treatment split between his department and Augusta Victoria Hospital in occupied East Jerusalem. Before the war, cancer patients from the West Bank were routinely granted medical permits to enter Jerusalem. Some treatments are available at Beit Jala, others only in East Jerusalem. But nothing now guarantees patients can reach Jerusalem. "I have a cancer patient… he waited for a referral, received no treatment, and after countless attempts was refused on security grounds," Atwan says. "Not allowed to go [to Augusta Victoria]? So where is he supposed to go?"

Atwan recalls patients who developed neutropenia after missing sessions, one of whom was fortunate not to slip into sepsis. "Those are disasters." He is unsure exactly how many cancer patients he has lost to interrupted treatment; according to him, many poor patients simply go home and die there.

"I started cutting back, taking less"

As crowds jostle at the reception desk and patients wait outside the hospital doors, a tense exhaustion spreads through the aging corridors. "Everyone is very stressed. Everyone is afraid," Dari says.

Atwan, who receives only half his salary, struggles to cover the commute from Hebron and to support two daughters studying at university. "Don't talk about our mood anymore – we'll start crying," he says. "Our morale is at rock bottom… We laugh out of defiance."

Amid mass unemployment and the systematic revocation of work permits, more and more sick Palestinians are turning to public hospitals, just as those hospitals have less to offer. The hospital "will prioritize those who can actually pay," Ansari adds.

Ahmed, a Palestinian in Bethlehem with a medical degree, asks the pharmacy every few days whether Humira – an injection taken every two weeks that his sister with Crohn's disease needs – is in stock yet. For three months, it has been out. Buying directly from the drug company costs about 2,000 shekels ($650) for one or two injections. "We can't afford it," he says. "So we just endure until the medicine comes back."

The elderly cancer patient from a village facing settler attacks has been rationing his own medication. "The drugs aren't supplied regularly," he says. One course of treatment costs 20,000 shekels ($6,500). "I started cutting back, taking less," he adds.

With supplies and staff short, surgeries are piling up. Sayed Ayyad, 22, from al-Eizariya, fell and badly broke his ankle last month. Because serious operations are prioritized, he waited three weeks for a slot. "They told me there were 60 people waiting for surgery," he says. "One day they couldn't operate because there was no medicine, no painkillers, no anesthesia, nothing at all."

Fate left to chance

Khuloud Dweib, chief pharmacist at Beit Jala, must navigate a worsening crisis while patients struggle with their health and their finances. "There is no safety. We have no political safety, no health safety, not even financial safety," she says.

She recalls the case of a young man with multiple sclerosis studying medicine in Egypt. The Health Ministry used to provide his medication through external purchases until the company stopped supplying it because it was not being paid. His mother came to see her. "I want to sell my house to buy injections for my son," the mother told her. "Because he is in Egypt, far from home, studying, and… he can no longer see, no longer walk."

"So what am I supposed to say," Dweib says, her voice breaking. "May God help everyone."

Medical staff fear that as supplies run ever lower, they could share the fate of their colleagues in Gaza – who have been abducted or killed. "We know we can be targeted at any moment as medical staff, simply because we are medical staff providing services to people," Dweib says. "In this society, we are both fathers and mothers."

No one in the aging hospital compounds sees an end in sight. "The longer we stay, the worse it gets," Dari says.

Every day at 3 p.m., Atwan has to leave, hoping to reach Bab az-Zawiya in Hebron in time to catch a shared taxi. "Maybe a checkpoint will stop me, maybe not," he says. It is not so different from his patients' predicament. "When patients get sick, whether there is medicine or not is down to their luck," he says. "We have no future. I swear: we have no future."