How to Treat a Dying 'Terrorist' Child

Read this, and weep (perhaps, or if you think that this little girl is a 'terrorist', then say "Serves her right!" )

w w w . h a a r e t z . c o m Last update - 22:56 16/11/2007
Toxic treatment By Esti Ahronovitz - Edited for brevity only:

Jamal Harma sits in a coffee shop in the village of Hawara, near Nablus. He comes from the Balata refugee camp.

His daughter Farah died of cancer. "I don't wish the loss of a child on anyone," he says.

In January 2005, Farah, then 10 years old, was diagnosed with bone cancer. The tumor was discovered in her right knee after a biopsy at Rafidiya Hospital in Nablus. From there she was referred to Al-Watani Hospital in Nablus, and from there to Assuta Hospital in Tel Aviv for radiation treatment.
And even though the doctors in Nablus proposed that she go to Jordan for treatment, he preferred to take her to Assuta, in the framework of an agreement between the Palestinian Authority and the hospital, which stipulates that Assuta will accept, in return for payment, cancer patients who need radiation treatment that cannot be performed in the West Bank or Gaza Strip.

"We all cried. The good news was that the cells were still small. Microscopic. At Al-Watani Hospital, we were told that she wouldn't need chemotherapy, only radiation. That the tumor was just starting to grow."

On February 24, 2005, Farah and her grandmother took the daily minibus that transports patients from Nablus to Tel Aviv, and went to Assuta Hospital.

Jamal didn't have the necessary permits to leave Nablus, so he stayed at home, worrying.

When Farah returned home, there was a large circle drawn on her leg with a black marking pen, from the thigh to the calf - the area the doctor had marked as the target for radiation.

According to the civil suit filed two months ago in Tel Aviv Magistrate's Court, Prof. Natalio Walach, an oncologist who heads the chemotherapy unit at Assaf Harofeh Hospital and also served as director of radiotherapy at Assuta, sent Farah for radiation treatment without examining any medical information and without conducting any further examination to determine the exact type of the girl's cancer.

He looked at Farah's leg, and based on the referral letter from the Palestinian health ministry, decided on the treatment. The suit charges that Walach did this without following a standard procedure known as treatment planning, which is designed to ensure that maximum benefit is obtained from the dangerous radiation treatments - in other words, that maximum radiation is aimed at the tumor and minimum radiation at the healthy tissue.

...during the brief meeting with the doctor, Farah and her escort were not asked a single question and did not receive any explanation about the method of treatment. There was no physical examination.

This week, Walach said: "I don't remember the case that well."

"Fourteen times my daughter traveled to Assuta, for two weeks in a row. She left Nablus every day with her grandmother at seven in the morning, passed through the checkpoints and got to Tel Aviv." But her father was restless with worry.

On March 16, Harma took his daughter tor another radiation treatment at Assuta, and afterward they went to Ichilov Hospital, where they met with Dr. Yehuda Kollender, the deputy head of the orthopedic oncology department. "When we met Kollender," says Jamal, "he asked me: 'Why did you come to us so late?'

I told him: 'She's being treated at Assuta.' He asked me: 'What are you doing there at Assuta?' I said: 'What do you mean? Radiation.' Kollender took off his glasses, looked at me and clutched his head in his hands. He told his secretary not to let anyone else in the room. 'We're in big trouble,' he told me. I didn't understand what was happening. He called Assuta Hospital, while I was sitting there. I don't know whom he spoke to there.

'How could such a thing happen?' he asked them. 'You'll be responsible. This wouldn't happen to a child from Israel.''

This week, Kollender recalled: "A little girl came to me with an advanced and neglected tumor, and when her father told me that the girl was getting radiation at Assuta, my hair stood on end. Every expert in oncology, actually every specialist in oncology or orthopedics, knows that the standard treatment all over the world for such a case is chemotherapy, followed by limb-preserving surgery, and then another round of chemotherapy.

I called Assuta right away and started to shout and search for the oncologist who sent this girl for radiation.

When he called me back he said: 'She was referred for radiation, so I sent her for radiation.'"

At the request of Physicians for Human Rights, Bendel received Farah Harma's medical file. "We were stunned to discover that the file of a girl who was ill with an aggressive form of cancer consisted of just two pages," says Bendel. "The first page contained Walach's diagnosis, that Farah had osteosarcoma, and the second page documented the amounts of radiation. You've got a girl with such a dangerous tumor and this is her whole medical file?"

The papers show that Farah was given radiation with a Cobalt 60 machine. The lawsuit claims that this is a very outdated radiation instrument that has not been used for medical purposes in Israeli hospitals for years. Today there are more modern machines than the Cobalt 60, but these are used in a limited fashion, and only for very specific purposes. "As far as is known," says Sfard, "the standard method of radiation treatment is with a linear accelerator.

As a matter of fact, Assuta Hospital is the only medical institution that still administers radiation with a Cobalt 60, and it does not do so to Israelis. The only use made of this machine at Assuta is for the treatments the hospital gives Palestinians as part of the agreement with the PA."

Sfard, the attorney for Yesh Din - Volunteers for Human Rights, says he hears about awful things that happen to Palestinians every day. "But when I heard this story, I could hardly believe it. It's bloodcurdling. After I started looking into it, I was just appalled. It seems that at Assuta there's a separate medical channel for Palestinians, and they are given inferior care. And that's only the tip of the iceberg. Someone's making money from this. And we're talking about cancer-stricken children here."

"A Cobalt 60 machine was formerly in use at Assuta," the hospital said, "for those limited medical uses that were approved by top-ranking medical specialists in Israel, and in the past both Israelis and Palestinians were treated with it, as was standard in advanced Western countries like France, Italy, Belgium, England, Spain and in leading and recognized medical institutions in America."

Meller and Bendel decided not to ignore the matter. They requested a meeting with Assuta's medical director, Dr. Orna Ophir. At the meeting Ophir admitted that the Cobalt 60 machine did not meet the accepted standard in Israel and that the use made of it at Assuta was solely to meet the needs of the Palestinian Authority.

At the meeting, Bendel reproached Ophir, saying that Assuta had found a way to make money from a service it couldn't sell to Israelis. Bendel says Ophir confirmed this and even added, as the lawsuit says, that she saw no ethical problem in selling an out-of-date treatment to Palestinians.

"It's not my problem," she told the shocked Bendel and Meller.

Ophir acknowledged that in Harma's case, "a terrible mistake was made," but she backed Walach, saying that "he did what the Palestinian doctor told him to do." The lawsuit also asserts that Ophir remarked: "Farah's parents had given up on her before they came to us. They have fourth-rate doctors, and they want me to give them first-rate treatment." Bendel was horrified by Ophir's reaction: "Where is the ethical and moral responsibility you expect from a medical institution and the people running it?"

Sfard maintains that Assuta Hospital acted according to a discriminatory standard and followed a much lower medical standard than it does when treating Israelis. "The hospital violated its constitutional duty to preserve human dignity." Sfard adds that "when Assuta was asked to clarify its numerous faults, what was uncovered was an indifferent and racist system motivated by financial considerations, to the point that the hospital's paramount and central role of treating the sick seemed to have been forgotten."

This is a unique lawsuit.

The expert opinion of Prof. Meller is appended to the lawsuit. "It's a very tragic story," Meller said this week. "If something like this were to happen to an Israeli child, who knows how far the case would have gone. In the United States, a lawsuit like this would be for millions of dollars.

There are ethical violations here, and violations of the most minimal rules of medical conduct."

Assuta Hospital says that Farah Harma arrived there with a referral for radiation from the Palestinian hospital.

Meller chuckles. "It's as if you were to come to Assuta with a referral letter that said, 'Cut off her head.' Would they cut off your head then? It's not serious. If a little girl came to my department today, no matter where she came from, we wouldn't touch her before going over all the pathology material and doing every possible examination, including a biopsy. Not because I don't trust other doctors. It's a repeat examination for legal defense purposes that is standard all over the world. And they didn't do this; then they compounded the mistake by administering radiation with an outdated machine that they wouldn't dare use on an Israeli patient. The third thing is that kids are kids. You can't treat a little girl with osteosarcoma without the definite involvement of a pediatric oncologist and a multidisciplinary team. Prof. Walach is a retired oncologist who is employed by Assuta. He is not a pediatric oncologist."

What effect does unnecessary radiation have? "Radiation destroys cells. It causes localized damage and stunts the local growth of a limb. Radiation treatments increase the chances of tumors some years later, which are a consequence of the radiation."

The dramatic day when Harma met with Dr. Yehuda Kollender was the last day that Farah received radiation treatment.

Kollender and Meller ordered that the radiation at Assuta be halted and began to treat the girl in their department, in an attempt to save her life.

Jamal Harma stopped working and sold his car, which he had used as a taxi, in order to be able to stay in Tel Aviv by his daughter's side. He never budged from her bed.

"That was also the time there was a closure and they closed the checkpoints. Sometimes they wouldn't let me out. I'd carry Farah in my arms, or on my back, and trudge all the way through the mountains to get around the checkpoints. Then I'd take a taxi to Taibe, get a taxi from there to Kfar Sava and from there to the Tel Aviv central bus station. We didn't give up. "

When her hair started falling out, because of the chemotherapy, the doctor recommended that we shave it all off. I said to her, 'Daddy's little girl, your hair is going to fall out, it's better that I shave it off for you and afterward you'll grow new hair that's prettier and stronger and you'll be able to go back and play with your friends.' We went into the shower in the hospital and I shaved her head. It was so hard. She cried and I cried."

But the battle was lost. "Farah's condition was very serious and she didn't respond to the treatments," explains Prof. Meller.