Offline: The dark heart of the wood

Abstract

“A family reunion that keeps us connected to the outside world.” So said Mamdouh Aker, a Trustee of Birzeit University, as he opened the annual scientific gathering of The Lancet Palestinian Health Alliance (LPHA), which last week returned in its eighth year to the home of its birth. Birzeit is one of the State of Palestine's most prestigious global universities. The LPHA is a loose network of Palestinian, regional, and international researchers committed to the highest scientific standards in describing, analysing, and evaluating the health and health care of Palestinians—contributing to the global scientific literature and developing local evidence-based policy and practice. The alliance is supported by universities, such as Birzeit and the American University of Beirut, multilateral organisations (WHO and the UN Relief and Works Agency), and charities (Medical Aid for Palestinians). This year's meeting was the strongest yet. Over 400 people attended, a record in a region of restricted travel opportunities. The largest source of high-quality work came from the Gaza Strip, another record. Only 9 of 19 young Gazan researchers who applied to present their findings were granted permits. The aim of the LPHA is to advance the health of all Palestinian people, those living in the West Bank, Gaza Strip, and East Jerusalem, together with Palestinian refugees in neighbouring countries. What we heard at Birzeit offered a manifesto for immediate action. Here is a snapshot of what we learned (first authors follow). The 5-year survival rate for women diagnosed with breast cancer is only 54%, but screening mammography without appropriate access to surgery, chemotherapy, and radiotherapy is an ineffective use of resources (Shyma Al-Waheidi). Prevalence of anaemia in pre-school children in the Gaza Strip is high at 31%, with likely severe implications for childhood development (Jehad Elhissi). Stroke units and guidelines for managing patients with acute ischaemic stroke are urgently needed (Amir Abukaresh). Too often there is poor adherence to the best standards of care for patients diagnosed with community-acquired pneumonia—again, guidelines are needed, together with better clinical audit (Said Alyacoubi). Many health providers seem to have a poor understanding of infection control, but these omissions can be substantially rectified with better education (Nasser Abu-El-Noor). Cardiovascular health in urban, rural, and refugee settings is suboptimal, reflecting the rapid epidemiological transition affecting Palestinians (Fida Zeidan). Herbal remedies are commonly—and worryingly—used by large numbers of women with breast cancer (Nidal Amin Jaradat). Acute poisoning with drugs and organophosphates is increasing in the Gaza Strip, and poison control and treatment facilities, together with better drug information services, are needed (Mohammed Kamel El-Habil). Multidrug-resistant bacteria are a growing public health challenge in the State of Palestine (Adham Abu Taha). Mental ill-health is common among patients with physical conditions, such as type 2 diabetes (Khaled Abu Saman). Adolescent health is a disappointingly neglected issue (Maysoun Turban). And patients living with degenerative neurological diseases, such as multiple sclerosis, often have a very poor quality of life (Doaa Tarifi). I met Palestine's Minister of Health, Dr Jawad Awwad, to discuss these findings. Trained in Kiev and specialising in dermatology, he seems to have an impossibly tough assignment. Managing the health sector in Palestine is a permanent emergency, he emphasised. Still, there were priorities. He needed more health workers. He hoped the health research community could do more to provide solutions, not merely describe in ever better ways the problems he already knew he faced. But he didn't wish to portray Palestine as a passive victim. He was proud of his country's humanitarian assistance to Ecuador and Mauritania. The State of Palestine is a regional source of expertise, not only in disaster management, but also in addressing non-communicable diseases. I left Ramallah, a cosmopolitan, exciting, and ever more vibrant city, wondering whether health research really does have a part to play in promoting peace and justice in times of conflict? It would be reckless and hubristic to over claim. But I do believe, I hope not naively, that enabling a nation to tell its story through health enhances the agency, dignity, resilience, and self-determination of its citizens and communities. We meet again in Beirut in 2018.