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One man's struggle to get heart surgery shows how hard it is to find care in Gaza

ARI SHAPIRO, HOST:

You may know what it's like to have your life suddenly interrupted by a health scare in the family - finding the right doctor, the right hospital for specialized surgery. Now imagine doing that in a place that is largely cut off from the rest of the world, the Gaza Strip. This week, we're going to follow the story of one man in Gaza needing heart surgery. To do that, we have a special series from our co-host, Daniel Estrin.

Hey, Daniel.

DANIEL ESTRIN, HOST:

Hi, Ari.

SHAPIRO: I know you're going to be telling us the story of one man over several days. And I want to just begin with where the story is set, in the Gaza Strip. What makes this place special, distinctive, unique?

ESTRIN: It's a tiny strip of land along the Mediterranean Sea. There are 2 million Palestinians who live there, and they have been virtually confined there for the last 15 years. Gaza was taken over by the militant group Hamas. It frequently launches attacks on Israel, so Israel imposed a blockade, and Egypt restricted its border, too. And there's been conflict and war there every few years. That's been the case for the last 15 years. And that whole time, I've watched conditions deteriorate in Gaza, and especially health care.

Now, it wasn't always like this. Gaza used to be this portal to the rest of the Mediterranean, especially during ancient times. There's even a theory that the word gauze comes from the word Gaza because it was made there centuries ago. But today, the modern health system in Gaza is in shambles.

And the thing is, you do have well-equipped hospitals just a few hours' drive away. In Jerusalem, in the West Bank, in Israel - they're all willing to accept Gaza patients. But whenever I'm in Gaza, I hear stories about people whose medical issues get worse. They lose their eyesight. They even die while they're waiting for permission to go to those hospitals.

SHAPIRO: And so as you've watched this gap grow, as you've watched the health care system deteriorate in Gaza, what drew you to the story that you're about to share with us?

ESTRIN: I think what drew me is that when I report from Gaza - I go there every few months or so, even during the quiet times when there's no war and Gaza's not in the headlines. I'm based in the region for NPR. And whenever I'm there, I hear these stories, people struggling to get health care for themselves or for someone in their family. They're caught up in this web of conflict and suspicion and geopolitics. And it's been getting worse over the course of 15 years. If you're really sick, you are bound to get caught up in it.

So I wanted to understand what it takes for someone in Gaza to get care. My colleague Anas Baba and I went to Gaza's main hospital, Shifa Hospital, late last year. We went looking for a patient we could follow, and we found one in the chaos of the waiting room.

Wow. Everyone is crowding here.

ANAS BABA, BYLINE: They're going to lock the doors.

ESTRIN: Security guards are trying to control the crowds clamoring to see a doctor.

Can we ask someone what they're doing here?

And in a sea of patients, we approach one man with a trim beard and a gaunt face.

YOUSEF AL KURD: (Speaking Arabic).

ESTRIN: "I haven't slept since yesterday," he says. His name is Yousef al Kurd. He's 70 years old, and he's with his son, Ibrahim.

Why did you come here?

IBRAHIM AL KURD: (Speaking Arabic).

BABA: "He needs open-heart surgery."

I AL KURD: (Speaking Arabic).

BABA: "Three months - we are totally suffering for three months now. We just want him to be operated. That's all."

ESTRIN: Should we take his number in case...

And that's how we meet Yousef al Kurd. So let me tell you a little bit more about him.

You can hear the evening prayers.

All around Gaza, you hear mosque loudspeakers, which Yousef al Kurd himself repaired. His son tells me his dad studied electrical engineering in Germany and returned home to a career fixing sound systems in Gaza.

I AL KURD: (Speaking Arabic).

BABA: "And he's the most famous technician in Gaza. He fixes the mixers, street vendors' microphones, mosques' microphones, schools' microphones."

ESTRIN: He did that for 30 years. He retired a few years ago but trained his sons how to do the same work. And it was in their workshop that their dad had his first heart attack.

I AL KURD: (Speaking Arabic).

BABA: "Suddenly, one day from nowhere, he just started to feel the cardiac attack."

ESTRIN: He's a heavy smoker with diabetes. The doctor said he needed heart bypass surgery. This was in the spring of 2020. But with the COVID pandemic, his cardiologist was reassigned to a COVID ward, and Kurd himself was hesitant to get surgery.

I AL KURD: (Speaking Arabic).

BABA: "At the same time, he was afraid that there is COVID in the hospitals, and at the same time an open-heart - so he just postponed it."

ESTRIN: A year later, he developed another condition - ulcers on his legs. His sons rushed him back to the hospital.

I AL KURD: (Speaking Arabic).

BABA: "We went back to Dr. Mohammad Nassar and was totally shocked and surprised that Dr. Mohammad Nassar left Gaza forever."

ESTRIN: The head of cardiac surgery had left for Spain, following the path of many doctors fleeing Gaza's tough conditions over the last few years. A new doctor was put in charge.

SAHER ABU GHALI: Hello. My name is Dr. Saher Abu Ghali. I'm 40 years old.

ESTRIN: He was one of only four remaining cardiac surgeons in Gaza. But a doctor in his department died, actually of cardiac arrest. A month after that, another died of COVID.

ABU GHALI: From four, we became three, and now we became two.

ESTRIN: Only two heart surgeons are left in Gaza for a population of 2 million. That's what Dr. Abu Ali told me when we spoke earlier this year. And it's still the case. He thinks Gaza needs 10 surgeons. In the U.S. and Europe, the accepted ratio is about 55.

ABU GHALI: Not only we are - the number of the surgeons is only two. This is not the only problem. You don't have all the instrumentation. You don't have all the resources.

ESTRIN: Israel restricts the import of medical devices, like some X-ray equipment it says Hamas could convert for military uses. And the Palestinian Authority in the West Bank doesn't give Gaza enough medical supplies. The reason for that might be that it's rivals for power with Hamas. So there are chronic shortages of supplies, like something called the cannula, the thin tube they place in your heart during bypass surgery. Dr. Abu Ghali says you're supposed to only use them once and throw them away.

ABU GHALI: Here, every cannula is re-sterilized more than 100 times. Yes, this is true. This is Gaza - because if you want to use it once and throw it out, you will not operate. You will never operate.

ESTRIN: Now, Israel does let doctors into Gaza to help a few days a month, but that's not enough. And with the blockade, Israel doesn't let out Palestinian doctors very much to get training. With the health systems stretched so thin, it's too risky to do a lot of complex procedures in Gaza. Yousef al Kurd needs coronary artery bypass surgery, and Dr. Abu Ghali can't do it.

ABU GHALI: No, it's difficult to be done safely in Gaza. We need heart surgeons. We need vascular surgeons. We need the instrumentations. So it was a very high-risk surgery for us.

ESTRIN: The doctor recommends he go to a better-equipped Palestinian hospital in the West Bank, a Palestinian territory not controlled by Hamas and not under blockade less than 2 hours away. But when I meet him in that waiting room in the hospital, he's stuck waiting for Israeli permission to get out to the West Bank. He's already scheduled the surgery a couple of times but missed it each time. He didn't have the Israeli permit he needed for travel.

(Speaking Arabic).

I AL KURD: (Speaking Arabic).

ESTRIN: "The surgery is very urgent," his son says.

BABA: "If they just cancel it, I do believe that my father will pass away. He will die."

ESTRIN: He's afraid if his father doesn't get an Israeli travel permit for surgery, he might not live much longer.

SHAPIRO: Daniel, I want to know how this story ends. And I know you're going to be telling it to us over the next few days, but this patient, Yousef al Kurd, is in a really difficult situation at this moment.

ESTRIN: Yes. He needs heart surgery that is too complicated to do in Gaza. There are only two heart surgeons left in Gaza. The others have fled or have died. There is not enough medical equipment in Gaza to do it. And that's just one example of how Gaza has been deteriorating since Hamas took over and since Israel and much of the world have tried to isolate it.

Now, Israel says this blockade is necessary to contain Hamas. Israel, the U.S. and the E.U. consider it a terrorist group, and it launches attacks on Israel. But 2 million Palestinians live there, and rights groups call it collective punishment.

SHAPIRO: Are there any efforts to improve conditions, whether that's getting in more medical equipment or surgeons?

ESTRIN: Well, the World Health Organization has been calling for this for years. They want Israel to make it easier to bring in medical equipment, to allow doctors out of Gaza for training and also for the Palestinian Authority to pay for more medicines and equipment to Gaza. But Hamas controls Gaza. Israel and Hamas are enemies. The entire conflict is just stuck, and health care is one victim of that.

SHAPIRO: Who pays for this medical care?

ESTRIN: Well, that's the thing. The Palestinian Authority pays for it, and - because it's a government-provided health care system the Palestinians have. And they also pay for treatment outside of Gaza. So if someone needs surgery that they can't get in Gaza, they pay for the care outside.

The thing is, there's not a lot of money. It comes from international donors - the U.S. and other countries. There's not a lot of it, so they have to be very selective in who they send for care.

SHAPIRO: So tell us what we're going to hear tomorrow.

ESTRIN: Next, we're going to look at how Kurd and his family are going to try to get him out of Gaza for surgery. It involves a lot of approvals. Palestinian officials need to make the first call. And they have to be especially selective because they don't have a lot of money to send patients outside Gaza and because Israel only allows out the most dire cases and there are thousands. So we're going to meet a Palestinian doctor who has really difficult choices about what does and does not constitute an urgent case. And when we were in his office, he got a call about another patient who was on the operating table in Gaza with a complication they couldn't treat there. And the question was, should they take him out of Gaza or not? And here's what the doctor said.

So he's not bleeding.

UNIDENTIFIED DOCTOR: He is not in active bleeding - some oozing from the side of surgery. So it's not active bleeding, so it's not top emergency. We can wait. And we...

ESTRIN: It's just an example of how selective it is and how high the stakes are for a man like Yousef al Kurd, who just needs to get heart surgery.

SHAPIRO: Daniel Estrin, looking forward to hearing the next installment of the story. Thank you.

ESTRIN: Thanks, Ari.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

Daniel Estrin is NPR's international correspondent in Jerusalem.