Occupation and oncology: cancer care in Palestine

Cancer care in fragile and conflict-affected settings is increasingly recognized as a challenge for global oncology. This Policy and Practice Review examines cancer care in Palestine as a case study of how prolonged occupation, armed conflict, restricted mobility, fragmented governance, fiscal constraint, and limited health sovereignty interact to shape early diagnosis, treatment continuity, radiotherapy access, systemic therapy, referral pathways, and patients' rights. Rather than treating occupation as a uniform determinant of health outcomes, the manuscript advances a more defensible framework: cancer systems deteriorate where political control, poor governance, conflict, and fiscal crisis interrupt institutional continuity; conversely, health systems consolidate after conflict or occupation only when reconstruction is linked to restored civilian authority, accountable institutions, protected movement, and sustained infrastructure investment. Palestine is analyzed alongside brief historical and regional comparators, including Japan, West Germany, East Timor, Israel, and neighboring referral systems. The review highlights the absence of radiotherapy in the Gaza Strip, the late and still limited introduction of radiotherapy in the West Bank, dependence on permit-mediated referrals to East Jerusalem and regional centers, the collapse of oncology access after October 2023, and recent medicine shortages affecting cancer treatment in both the Gaza Strip and the West Bank. It connects oncology disruption with patients' rights, structural violence, ecologies of war, therapeutic geographies, and health-system governance under occupation. Finally, it proposes practical actions: protected oncology referral corridors, urgent diagnostic recovery, chemotherapy and essential-medicine protection, companion-supported medical evacuation, radiotherapy reconstruction, audited cancer financing, regional mutual-aid agreements, digital oncology records, workforce support, and rights-based monitoring of delays, denials, and preventable deaths.