Khan Younis, Gaza Strip - Residents of the Gaza Strip are facing tighter restrictions on obtaining medical care outside of the besieged coastal enclave, according to a recent monthly report issued by the World Health Organisation's Eastern Mediterranean Regional Office.
According to the report, the closure of the Rafah border with Egypt has "virtually eliminated access to specialised medical treatments outside of Gaza for private patients", while 20 percent of patients applying for permits to travel through Israel's Erez checkpoint for medical care last month were not approved.
Ashraf Alkdra, a spokesman for Gaza's health ministry, said restrictions on these border crossings have exacerbated the health conditions of Gazans living with chronic illness. "Increasingly, we are unable to provide them treatment," he said.
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In 2006, after Hamas won elections and took power in Gaza, Israel imposed a strict embargo on the densely populated Palestinian territory. This embargo, coupled with three Israeli wars on Gaza since 2009, has affected the lives of everyone in Gaza. But those suffering from chronic illness face an added layer of hardship.
Dr Akihiro Seita, the health department director of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), told Al Jazeera that chronic illnesses "are highly prevalent in Gaza", and that continued restrictions on the movement of Gaza's population worsen public health problems.
Given Israeli Prime Minister Benyamin Netanyahu's recent electoral victory, and Egypt's President Abdel Fattah al-Sisi labelling Hamas a terrorist organisation, it seems likely that Gaza's borders will remain closed for the foreseeable future.
During the last war, I was trapped inside Dr Qdeih's clinic for weeks. We were being bombed, and I was so worried about my family, I couldn't eat or sleep. Now, I worry that if I have heart problems, I won't be able to leave Gaza [for treatment].
Fikr Shaltoot, Medical Aid Palestine's director of programmes in the Gaza Strip, concurred with Seita, explaining that the closed borders have severe consequences for those living with chronic illness.
"If the crossings were open, including the Rafah crossing, some medicine would be donated through international Arab organisations," Shaltoot said. "Also, [Palestinians] would have purchased Egyptian medication at a lower cost."
Drugs coming from Israel are far more expensive than what used to come through Rafah, she said, adding that their delivery also takes longer.
Speaking from a doctor's clinic near Khan Younis, Aisha Aborjela, a 57-year-old mother of four, told Al Jazeera that her hypertension and Type 2 diabetes cause her great difficulty in everyday life.
Her husband makes "barely enough" to provide for their family, despite workdays that last up to 14 hours, and Aborjela maintains the household in his absence.
"I am on my feet from sunrise to sunset," she told Al Jazeera. "The diabetes causes me to become very tired. There are times when I can't see, and I'm always hungry," Aborjela said, citing common symptoms of the chronic illness.
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The United Nations Relief and Works Agency (UNRWA) provides free medication for Gaza's refugees, who account for 1.2 of the more than 1.5 million people living there.
Although this has helped Aborjela, the living conditions in Gaza can lead to additional health problems: For example, the stress she experienced during the past three wars caused her blood pressure to rise for extended periods, which can lead to heart disease, a condition common in her family.
"During the last war, I was trapped inside Dr Qdeih's clinic for weeks. We were being bombed, and I was so worried about my family, I couldn't eat or sleep," Aborjela recalled. "Now, I worry that if I have heart problems, I won't be able to leave Gaza [for treatment]."
Gaza's long blackouts - there are 18 hours of scheduled electrical outages a day, due to lack of energy supplies and infrastructure damaged by Israeli bombings - also have major effects on public health, according to the United Nations Office for the Coordination of Humanitarian Affairs in the Occupied Palestinian Territories.
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Ibrahim Arjela, 22, was diagnosed with Type 1 diabetes last summer, during Israel's Operation Protective Edge offensive on Gaza. The insulin he must take daily to treat his condition requires constant refrigeration, stored between 2.2 and 7.8 degrees Celsius, for it to retain its effectiveness over long periods.
"When it's too hot, or too cold, it's useless. My electricity goes out for nearly nine hours every day, so when it's hot outside I can't keep it cool. When it's cold, it doesn't stay warm enough," Arjela complained, adding that he often has to travel to the UNRWA centre in Gaza City to replace spoiled insulin, as temperatures in Gaza were uncharacteristically harsh this past winter, with five children reportedly dying as a result of cold and lack of shelter.
Compounding Gaza's public health problems is its food crisis, caused by years of siege. The price of chicken rose from 10 NIS ($2.83 US) to 15 NIS ($4.24 US) in August 2014, and both farmers and fishermen suffer from Israeli military attacks, making it difficult for Gazans to find fresh vegetables or fish.
Diabetics are advised to eat lean meats, fish and vegetables; and to stay away from foods high in carbohydrates, such as bread and rice, which are staples of the Palestinian diet.
But Seita, the UNRWA health department director, said the siege causes "people with diabetes to have no choice but unhealthy diet, e.g. they can only eat bread as it [is] subsidised".
Nevertheless, Arjela is hopeful that he will be able to adjust to the reality faced by him and other Gazans suffering from chronic illness. "I've got to work with what I've got. I'll figure it out," he concluded optimistically.
Source: Al Jazeera