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Article: Access to advanced cancer care services in the West Bank-occupied Palestinian territory.

Mitwalli, Suzan / Hammoudeh, Weeam / Giacaman, Rita / Harding, Richard

2023 Volume 13, Page(s) 1120783

Abstract: Introduction: Universal Health Coverage (UHC) identifies the provision of palliative care for people with advanced disease as an essential health service. Palliative care is also stipulated as a human right under existing covenants. Oncology services ... ...

Abstract	Introduction: Universal Health Coverage (UHC) identifies the provision of palliative care for people with advanced disease as an essential health service. Palliative care is also stipulated as a human right under existing covenants. Oncology services provided by the Palestinian Authority under Israeli military occupation are limited to surgery and chemotherapy treatment. Our study aimed to describe the experiences of patients with advanced-stage cancer in the West Bank in accessing oncology services and meeting their health care needs. Methodology: We conducted a qualitative study among adult patients diagnosed with advanced lung, colon, or breast cancer in three Palestinian governmental hospitals, and with oncologists. Thematic analysis was conducted on the verbatim interview transcripts. Results: The sample consisted of 22 Palestinian patients (10 men and 12 women) and 3 practicing oncologists. The findings reveal that cancer care is fragmented, with limited access to the services needed. Patients face referral delays in accessing treatment which worsen their health condition in some cases. Some patients reported difficulties in getting Israeli permits to access radiotherapy treatment in East-Jerusalem, and others experienced interruptions of their chemotherapy treatment sessions due to the unavailability of chemotherapy medications caused by Israeli-side delays. Other reported problems were related to the Palestinian health system and service delivery and quality, including fragmentation of services, infrastructure issues, and unavailability of medications. Advanced diagnostic services and palliative care are almost absent at Palestinian governmental hospitals, and patients need to seek these services in the private sector. Conclusion: The data demonstrate specific access restrictions to cancer care in the West Bank due to Israeli military occupation of Palestinian land. This affects all stages of the care pathway, from restricted diagnosis services, to limited treatment and then poor availability of palliative care. Cancer patients will continue to suffer if the root causes of these structural constraints are not addressed.
Language	English
Publishing date	2023-03-16
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2023.1120783
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Article ; Online: Structural racism and the health of Palestinian citizens of Israel.

Tanous, Osama / Asi, Yara / Hammoudeh, Weeam / Mills, David / Wispelwey, Bram

Global public health

2023 Volume 18, Issue 1, Page(s) 2214608

Abstract: Palestinian citizens of Israel (PCI) constitute almost 20% of the Israeli population. Despite having access to one of the most efficient healthcare systems in the world, PCI have shorter life expectancy and significantly worse health outcomes compared to ...

Abstract	Palestinian citizens of Israel (PCI) constitute almost 20% of the Israeli population. Despite having access to one of the most efficient healthcare systems in the world, PCI have shorter life expectancy and significantly worse health outcomes compared to the Jewish Israeli population. While several studies have analysed the social and policy determinants driving these health inequities, direct discussion of structural racism as their overarching etiology has been limited. This article situates the social determinants of health of PCI and their health outcomes as stemming from settler colonialism and resultant structural racism by exploring how Palestinians came to be a racialized minority in their homeland. In utilising critical race theory and a settler colonial analysis, we provide a structural and historically responsible reading of the health of PCI and suggest that dismantling legally codified racial discrimination is the first step to achieving health equity.
MeSH term(s)	Humans ; Arabs ; Israel ; Systemic Racism ; Racism ; White People
Language	English
Publishing date	2023-05-18
Publishing country	England
Document type	Journal Article ; Review
ZDB-ID	2234129-8
ISSN	1744-1706 ; 1744-1706
ISSN (online)	1744-1706
ISSN	1744-1706
DOI	10.1080/17441692.2023.2214608
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Article ; Online: The hidden burden of dysmenorrhea among adolescent girls in Palestine refugee camps: a focus on well-being and academic performance.

Ghandour, Rula / Hammoudeh, Weeam / Stigum, Hein / Giacaman, Rita / Fjeld, Heidi / Holmboe-Ottesen, Gerd

BMC public health

2024 Volume 24, Issue 1, Page(s) 726

Abstract: Background: Dysmenorrhea (painful menstruation) is a condition that may have a profound effect on adolescent girls' health status and well-being. It can impede their engagement in daily activities and hamper their regular school attendance. This study ... ...

Abstract	Background: Dysmenorrhea (painful menstruation) is a condition that may have a profound effect on adolescent girls' health status and well-being. It can impede their engagement in daily activities and hamper their regular school attendance. This study aims to explore the relationship between dysmenorrhea, well-being, and academic performance among adolescent girls living in Palestine refugee camps in the West Bank and Jordan. Methods: We conducted a household survey between June and September 2019, with a total sample of 2737 adolescent girls 15 to 18 years old. Dysmenorrhea severity was assessed using the Working Ability, Location, Intensity, Duration of pain Dysmenorrhea scale (WaLIDD). The WHO-5 scale was used to evaluate the girls' overall well-being. Menstrual academic disruption (MAD) was measured using a self-reported scale. Multiple linear regression models were employed to evaluate the association between dysmenorrhea, well-being, and academic performance. Directed Acyclic Graphs (DAGs) were employed to identify variables for control in regression models. Results: The mean dysmenorrhea score was 6.6 ± 2.6, with 37.9% and 41.2% expressing moderate and severe symptoms, respectively. The mean WHO-5 score was 58.7 ± 25.1, and 34.9% reported a low well-being status. The mean MAD score was 3.1 ± 3.3. 26% reported missing school due to dysmenorrhea, 36% said dysmenorrhea impacted their ability to concentrate, and 39% were unable to study for tests, and complete homework. The first regression analysis showed a reduction of 1.45 units in WHO-5 score for each unit increase in dysmenorrhea. The second regression analysis showed a non-linear increase in MAD score for increasing dysmenorrhea. For each dysmenorrhea score less than 4 (mild) there was a modest increase in MAD scores (coefficient 0.08, p-value = 0.006), and for each dysmenorrhea score above 4 there was a stronger increase in MAD scores (coefficient 0.95, p < 0.001). Conclusion: Dysmenorrhea poses significant challenges to the well-being and academic performance of adolescent girls living in Palestine refugee camps. Collaborative efforts and multifaceted approaches are crucial to address dysmenorrhea effectively. This involves research, targeted interventions, culturally sensitive strategies, and fostering a supportive environment that empowers girls to thrive academically and beyond.
MeSH term(s)	Female ; Humans ; Adolescent ; Dysmenorrhea/epidemiology ; Refugee Camps ; Academic Performance ; Arabs ; Health Status
Language	English
Publishing date	2024-03-06
Publishing country	England
Document type	Journal Article
ZDB-ID	2041338-5
ISSN	1471-2458 ; 1471-2458
ISSN (online)	1471-2458
ISSN	1471-2458
DOI	10.1186/s12889-024-18219-0
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Article ; Online: Because its power remains naturalized: introducing the settler colonial determinants of health.

Wispelwey, Bram / Tanous, Osama / Asi, Yara / Hammoudeh, Weeam / Mills, David

Frontiers in public health

2023 Volume 11, Page(s) 1137428

Abstract: Indigenous people suffer earlier death and more frequent and severe disease than their settler counterparts, a remarkably persistent reality over time, across settler colonized geographies, and despite their ongoing resistance to elimination. Although ... ...

Abstract	Indigenous people suffer earlier death and more frequent and severe disease than their settler counterparts, a remarkably persistent reality over time, across settler colonized geographies, and despite their ongoing resistance to elimination. Although these health inequities are well-known, they have been impervious to comprehensive and convincing explication, let alone remediation. Settler colonial studies, a fast-growing multidisciplinary and interdisciplinary field, is a promising candidate to rectify this impasse. Settler colonialism's relationship to health inequity is at once obvious and incompletely described, a paradox arising from epistemic coloniality and perceived analytic challenges that we address here in three parts. First, in considering settler colonialism an enduring structure rather than a past event, and by wedding this fundamental insight to the ascendant structural paradigm for understanding health inequities, a picture emerges in which this system of power serves as a foundational and ongoing configuration determining social and political mechanisms that impose on human health. Second, because modern racialization has served to solidify and maintain the hierarchies of colonial relations, settler colonialism adds explanatory power to racism's health impacts and potential amelioration by historicizing this process for differentially racialized groups. Finally, advances in structural racism methodologies and the work of a few visionary scholars have already begun to elucidate the possibilities for a body of literature linking settler colonialism and health, illuminating future research opportunities and pathways toward the decolonization required for health equity.
MeSH term(s)	Humans ; Indigenous Peoples ; Health Equity ; Colonialism
Language	English
Publishing date	2023-07-11
Publishing country	Switzerland
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2023.1137428
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Article ; Online: Because its power remains naturalized

Bram Wispelwey / Osama Tanous / Yara Asi / Weeam Hammoudeh / David Mills

Frontiers in Public Health, Vol

introducing the settler colonial determinants of health

2023 Volume 11

Abstract	Indigenous people suffer earlier death and more frequent and severe disease than their settler counterparts, a remarkably persistent reality over time, across settler colonized geographies, and despite their ongoing resistance to elimination. Although these health inequities are well-known, they have been impervious to comprehensive and convincing explication, let alone remediation. Settler colonial studies, a fast-growing multidisciplinary and interdisciplinary field, is a promising candidate to rectify this impasse. Settler colonialism’s relationship to health inequity is at once obvious and incompletely described, a paradox arising from epistemic coloniality and perceived analytic challenges that we address here in three parts. First, in considering settler colonialism an enduring structure rather than a past event, and by wedding this fundamental insight to the ascendant structural paradigm for understanding health inequities, a picture emerges in which this system of power serves as a foundational and ongoing configuration determining social and political mechanisms that impose on human health. Second, because modern racialization has served to solidify and maintain the hierarchies of colonial relations, settler colonialism adds explanatory power to racism’s health impacts and potential amelioration by historicizing this process for differentially racialized groups. Finally, advances in structural racism methodologies and the work of a few visionary scholars have already begun to elucidate the possibilities for a body of literature linking settler colonialism and health, illuminating future research opportunities and pathways toward the decolonization required for health equity.
Keywords	settler colonialism and native dispossession ; indigenous health ; health equity ; structural racism ; logic of elimination ; social determinants ; Public aspects of medicine ; RA1-1270
Subject code	306
Language	English
Publishing date	2023-07-01T00:00:00Z
Publisher	Frontiers Media S.A.
Document type	Article ; Online
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Article ; Online: Reassembling the Pieces: Settler Colonialism and the Reconception of Palestinian Health.

Asi, Yara M / Hammoudeh, Weeam / Mills, David / Tanous, Osama / Wispelwey, Bram

Health and human rights

2022 Volume 24, Issue 2, Page(s) 229–235

MeSH term(s)	Humans ; Arabs ; Colonialism ; Human Rights
Language	English
Publishing date	2022-12-12
Publishing country	United States
Document type	Editorial ; Comment
ZDB-ID	1223919-7
ISSN	2150-4113 ; 1079-0969
ISSN (online)	2150-4113
ISSN	1079-0969
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Article: Menstrual characteristics and dysmenorrhea among Palestinian adolescent refugee camp dwellers in the West Bank and Jordan: a cross-sectional study.

Ghandour, Rula / Hammoudeh, Weeam / Stigum, Hein / Giacaman, Rita / Fjeld, Heidi / Holmboe-Ottesen, Gerd

Archives of public health = Archives belges de sante publique

2023 Volume 81, Issue 1, Page(s) 47

Abstract: Background: Women and girls experience menstruation throughout their reproductive years. Normal adolescent menstrual cycles gauge current and future reproductive health. Dysmenorrhea (painful menstruation) is the most prevalent menstrual disturbance in ... ...

Abstract	Background: Women and girls experience menstruation throughout their reproductive years. Normal adolescent menstrual cycles gauge current and future reproductive health. Dysmenorrhea (painful menstruation) is the most prevalent menstrual disturbance in adolescents that can be debilitating. This study examines the menstrual characteristics of adolescent girls living in Palestinian refugee camps in the West Bank of the Israeli-occupied Palestinian territory and Jordan, including estimates of dysmenorrhea levels and associated factors. Methods: A household survey of 15 to 18-year-old adolescent girls was conducted. Trained field workers collected data on general menstrual characteristics and dysmenorrhea level using Working ability, Location, Intensity, Days of pain Dysmenorrhea scale (WaLIDD), in addition to demographic, socio-economic, and health characteristics. The link between dysmenorrhea and other participant characteristics was assessed using a multiple linear regression model. Additionally, data on how adolescent girls cope with their menstrual pain was collected. Results: 2737 girls participated in the study. Mean age was 16.8 ± 1.1 years. Mean age-at-menarche was 13.1 ± 1.2; mean bleeding duration was 5.3 ± 1.5 days, and mean cycle length was 28.1 ± 6.2 days. Around 6% of participating girls reported heavy menstrual bleeding. High dysmenorrhea levels were reported (96%), with 41% reporting severe symptoms. Higher dysmenorrhea levels were associated with older age, earlier age-at-menarche, longer bleeding durations, heavier menstrual flow, skipping breakfast regularly, and limited physical activity patterns. Eighty nine percent used non-pharmacological approaches to ease menstrual pain and 25% used medications. Conclusion: The study indicates regular menstrual patterns in terms of length, duration, and intensity of bleeding and a slightly higher age-at-menarche than the global average. However, an alarmingly high prevalence of dysmenorrhea among participants was found that tends to vary with different population characteristics, some of which are modifiable and can be targeted for better menstrual health.This research emphasizes the need for integrated efforts to assist adolescents with menstrual challenges such as dysmenorrhea and irregular periods to achieve informed recommendations and effective actions.
Language	English
Publishing date	2023-03-30
Publishing country	England
Document type	Journal Article
ZDB-ID	1117688-x
ISSN	2049-3258 ; 0778-7367 ; 0003-9578
ISSN (online)	2049-3258
ISSN	0778-7367 ; 0003-9578
DOI	10.1186/s13690-023-01059-6
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Article ; Online: Menstrual characteristics and dysmenorrhea among Palestinian adolescent refugee camp dwellers in the West Bank and Jordan

Rula Ghandour / Weeam Hammoudeh / Hein Stigum / Rita Giacaman / Heidi Fjeld / Gerd Holmboe-Ottesen

Archives of Public Health, Vol 81, Iss 1, Pp 1-

a cross-sectional study

2023 Volume 12

Abstract: Abstract Background Women and girls experience menstruation throughout their reproductive years. Normal adolescent menstrual cycles gauge current and future reproductive health. Dysmenorrhea (painful menstruation) is the most prevalent menstrual ... ...

Abstract	Abstract Background Women and girls experience menstruation throughout their reproductive years. Normal adolescent menstrual cycles gauge current and future reproductive health. Dysmenorrhea (painful menstruation) is the most prevalent menstrual disturbance in adolescents that can be debilitating. This study examines the menstrual characteristics of adolescent girls living in Palestinian refugee camps in the West Bank of the Israeli-occupied Palestinian territory and Jordan, including estimates of dysmenorrhea levels and associated factors. Methods A household survey of 15 to 18-year-old adolescent girls was conducted. Trained field workers collected data on general menstrual characteristics and dysmenorrhea level using Working ability, Location, Intensity, Days of pain Dysmenorrhea scale (WaLIDD), in addition to demographic, socio-economic, and health characteristics. The link between dysmenorrhea and other participant characteristics was assessed using a multiple linear regression model. Additionally, data on how adolescent girls cope with their menstrual pain was collected. Results 2737 girls participated in the study. Mean age was 16.8 ± 1.1 years. Mean age-at-menarche was 13.1 ± 1.2; mean bleeding duration was 5.3 ± 1.5 days, and mean cycle length was 28.1 ± 6.2 days. Around 6% of participating girls reported heavy menstrual bleeding. High dysmenorrhea levels were reported (96%), with 41% reporting severe symptoms. Higher dysmenorrhea levels were associated with older age, earlier age-at-menarche, longer bleeding durations, heavier menstrual flow, skipping breakfast regularly, and limited physical activity patterns. Eighty nine percent used non-pharmacological approaches to ease menstrual pain and 25% used medications. Conclusion The study indicates regular menstrual patterns in terms of length, duration, and intensity of bleeding and a slightly higher age-at-menarche than the global average. However, an alarmingly high prevalence of dysmenorrhea among participants was found that tends to vary with ...
Keywords	Menstruation ; Menstrual characteristics ; Dysmenorrhea ; Adolescent refugees ; Jordan ; West Bank of the occupied Palestinian territory ; Public aspects of medicine ; RA1-1270
Subject code	360
Language	English
Publishing date	2023-03-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Life conditions and quality of life of Palestinians living in the Biddu Enclave: a qualitative study.

Nasr, Shiraz / Heneiti, Ahmad / Hammoudeh, Weeam

Lancet (London, England)

2021 Volume 398 Suppl 1, Page(s) S41

Abstract: Background: Palestinians have been exposed to long-term violence, displacement, and conflict since the 1940s. Continued expropriation and fragmentation of the region has affected people's quality of life. The Biddu Enclave communities, located northwest ...

Abstract	Background: Palestinians have been exposed to long-term violence, displacement, and conflict since the 1940s. Continued expropriation and fragmentation of the region has affected people's quality of life. The Biddu Enclave communities, located northwest of Jerusalem, are behind a barrier wall that detaches them from Jerusalem and the rest of the West Bank other than by access through a tunnel controlled by the Israeli authorities. The enclave is fully or partially under Israeli administration. We explored the effects of socioeconomic and geographical transformations and isolation on the quality of life of these communities, specifically on daily uncertainty, stress, and overall wellbeing of residents. Methods: We included four communities-Beit Iksa, Qatanna, Biddu, and Beit A'nan-that have varied characteristics and circumstances. Between early October, 2018, and the end of November, 2019, we did in-depth interviews with 20 key informants, such as mayors, village council members, municipality employees, and teachers, and 16 residents older than 20 years and from a range backgrounds, including activists, retirees, and housewives. We also did two focus groups involving young adults from all four communities. Questions were asked about living conditions and consequences of the socioeconomic and geographic transformations in the study area. We analysed the data by repeated readings to identify patterns and themes. Findings: We found poor overall quality of life, characterised by chronic daily uncertainty, insecurity and heightened vulnerability, leading to stress and reduced wellbeing. The main negative determinants of quality of life were poor infrastructure, dependence on work in the Israeli labour market, a precarious permit system, increasing land expropriation and expansion of Israeli settlements, separation from Jerusalem, and marginalisation by the Palestinian National Authority. Community characteristics, such as social solidarity and active community organisations were important in mediating some of these effects. Other variations in the characteristics of the communities, such as topography, having relatives living in the USA, levels of education, unemployment rate, and proximity to Israeli settlements seemed to play a role in the abilities of residents to endure conditions. Interpretation: Our findings highlight the importance of political and socioeconomic transformations in the wellbeing of residents in the Biddu Enclave. Sustained insecurity and uncertainty, marginalisation, and isolation of the communities have negative effects on quality of life. More research focusing on these communities is needed to better understand the mechanisms by which these factors affect health and how they may lead to ill health and disease in the long term. Funding: Arab Council for Social Sciences.
Language	English
Publishing date	2021-07-06
Publishing country	England
Document type	Journal Article
ZDB-ID	3306-6
ISSN	1474-547X ; 0023-7507 ; 0140-6736
ISSN (online)	1474-547X
ISSN	0023-7507 ; 0140-6736
DOI	10.1016/S0140-6736(21)01527-0
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Article: Social and political determinants of health in the occupied Palestine territory (oPt) during the COVID-19 pandemic: who is responsible?

Hammoudeh, Weeam / Kienzler, Hanna / Meagher, Kristen / Giacaman, Rita

BMJ global health

2020 Volume 5, Issue 9

MeSH term(s)	Arabs ; Armed Conflicts ; Betacoronavirus ; COVID-19 ; Communicable Disease Control/organization & administration ; Coronavirus Infections/epidemiology ; Female ; Health Services Accessibility ; Humans ; Male ; Mental Health ; Middle East/epidemiology ; Pandemics ; Pneumonia, Viral/epidemiology ; Politics ; SARS-CoV-2 ; Social Determinants of Health
Keywords	covid19
Language	English
Publishing date	2020-09-25
Publishing country	England
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ISSN	2059-7908
ISSN	2059-7908
DOI	10.1136/bmjgh-2020-003683
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