Fatima was 41 years old, a mother of six, and living through an active bombardment when she first detected a lump in her breast. What followed was not simply a medical ordeal - it was a systematic collapse of every mechanism that makes cancer survivable: timely diagnosis, uninterrupted treatment, pain management, shelter, and dignity. Her story is not an isolated case. It is a precise account of what happens to chronic and critical illness when healthcare infrastructure is deliberately or incidentally destroyed.
A Diagnosis Deferred by Destruction
Under normal conditions, a breast cancer diagnosis follows a relatively swift pathway: a clinical examination, imaging, a biopsy, and results typically returned within weeks. In Ireland, for example, biopsy results are generally shared within a couple of weeks of the procedure. For Fatima, the same process took eight months - not because of systemic inefficiency, but because the hospitals she attended were bombed, her biopsy samples were lost, and her medical files became inaccessible amid the chaos of a war zone.
The delay matters enormously in clinical terms. Breast cancer is among the most treatable cancers when caught early. Stage one and two diagnoses carry survival rates that are substantially higher than those at stage three or four. Every month of diagnostic delay allows a tumour to progress, potentially crossing the threshold between a condition that is curable and one that is not. By the time Fatima received her confirmed diagnosis, the window for early intervention had already narrowed.
Her account also illustrates a specific cruelty of conflict medicine: the destruction of medical records. In modern oncology, continuity of care depends on documentation - pathology reports, imaging results, treatment histories. When a patient cannot produce those records, clinical teams must begin again, consuming time and resources that neither the patient nor the system can spare.
Treatment Under Bombardment
Chemotherapy is one of the most physically demanding treatments in medicine under any circumstances. It works by targeting rapidly dividing cells - which includes cancer cells, but also healthy cells in the digestive tract, hair follicles, and bone marrow. The resulting side-effects - nausea, diarrhoea, bone pain, extreme fatigue, and hair loss - are severe even when patients have access to adequate supportive care: antiemetics, painkillers, rest, nutrition, and sanitation.
Fatima had none of these. A blockade on goods and aid entering Gaza meant that essential medicines, including basic analgesics, were in critically short supply. She underwent multiple rounds of chemotherapy - ten doses in total across two interrupted courses - without adequate pain relief. She described the bone pain as feeling as though her skeleton was breaking from within. She experienced the side-effects of her treatment inside a tent in al-Mawasi, a coastal displacement site housing hundreds of thousands of people, where there were no functioning toilets and no private space.
Her chemotherapy was also interrupted for two full months when medication supplies were cut off due to the war. That interruption is clinically significant. Chemotherapy protocols are designed as timed sequences; gaps allow tumours to recover and potentially develop resistance to the drugs being used. Fatima's tumour spread during that period, and her pain intensified. When treatment resumed, her regimen had to be extended.
During one session, the hospital she was in was struck by an airstrike. She woke to the sound of an explosion, to women being pulled from rubble, and to the thought - articulated with devastating clarity - that she did not know whether cancer or a missile would kill her first.
The Compounding Crisis of Displacement and Malnutrition
Cancer recovery is partly nutritional. The body's ability to tolerate chemotherapy, repair tissue, and sustain immune function depends on adequate protein, caloric intake, and micronutrients. Oncology dieticians routinely work alongside cancer teams for this reason. For Fatima, food security during treatment consisted largely of watercress foraged from around the displacement tents, supplemented - when available - by edible wild plants recommended in sessions run by Christian Aid's local partner, the Culture and Free Thought Association (CFTA).
At a CFTA session, she tasted chicken for the first time in months. She nearly wept. The other women with her - also cancer patients - laughed and cried together. That moment, ordinary in any other context, carries the full weight of what prolonged food deprivation looks like inside a population enduring both war and serious illness simultaneously.
The psychological dimension of her ordeal is equally documented. Her children, confined with her in a cramped tent, witnessed her suffering at close range. She had no space to hide her pain from them. Hair loss - one of the most psychologically significant side-effects of chemotherapy - she confronted by collecting her fallen hair and preserving it in a plastic bag hung inside the tent. It was, she said, a way of preserving the memory of a woman who was still here and still fighting.
Denied the Treatment That Could Save Her Life
In late October 2024, Fatima had a mastectomy. In January 2025, she learned the cancer had returned. She is again undergoing chemotherapy and awaiting confirmation of whether a second mastectomy will be required. She has not received radiotherapy at any point. Radiotherapy is unavailable in Gaza, and medical referrals for treatment outside the territory have been effectively blocked by closed crossings and ignored applications.
She is one of approximately 11,000 cancer patients in Gaza urgently requiring treatment that cannot be provided within the territory. Radiotherapy is a standard and often essential component of breast cancer treatment following surgery; its absence materially affects outcomes. For Fatima, the knowledge that the treatment she needs exists, is accessible to patients in other countries, and is being withheld from her by circumstances of policy and conflict represents - in her own words - the ultimate helplessness.
Despite this, Fatima continues to attend CFTA's psychological support sessions and now supports other women navigating their own diagnoses. The group, she says, does not talk about death. They talk about how to live despite the cancer. That distinction - between surviving and enduring, between treatment and sheer will - is what the destruction of a healthcare system forces onto those who have no other options left.