Cancer caregiving and health inequity in the West Bank, Palestine: a qualitative study of family caregivers in a conflict-affected health system
This qualitative study of 11 family caregivers in the West Bank reveals how occupation-related structural barriers and resource constraints create significant health inequities in cancer care, leading to recommendations for decentralized services, psychosocial support, and caregiver-inclusive policy reforms.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
Cancer is a disease that touches not just the person diagnosed, but the entire family surrounding them. In many parts of the world, the people who care for a sick relative—often spouses, parents, or adult children—take on a massive burden. They manage appointments, handle medications, provide daily physical care, and offer the emotional strength needed to keep going. This work is rarely paid, and it often falls disproportionately on women. While medical science focuses heavily on treating the tumor, a growing body of research asks a different question: how does the world around the patient and their family make care easier or harder? This question becomes especially urgent in places where the health system is broken by conflict, poverty, or political instability. In these settings, the ability to get to a hospital, afford medicine, or understand a doctor's instructions is not just a matter of personal effort; it is shaped by geography, money, and the rules of the road. When these external forces block access to care, the family is forced to fill the gap, often at great cost to their own well-being.
A new study conducted in the West Bank, Palestine, explores exactly how these difficult conditions shape the lives of family caregivers. The researchers, working from universities in Palestine and Scotland, wanted to understand the daily reality of caring for an adult with cancer in a region defined by occupation, restricted movement, and a fragmented health system. They spoke with thirteen family members who were caring for patients in and around the city of Nablus. Because of security concerns and the difficulty of moving around safely, the team conducted these conversations online over a period of two years, from late 2024 to early 2026. The goal was not just to list the problems these families faced, but to hear their stories and see how they navigated a system that often seemed designed to keep them out.
The researchers found that for these caregivers, the journey to get cancer treatment is not a simple trip to a doctor's office. It is a complex, exhausting ordeal shaped by the landscape itself. The West Bank is geographically divided, with cities separated by checkpoints and restricted zones. To reach a specialist or a chemotherapy clinic, a caregiver might have to drive from a village to a city, pass through a checkpoint where they could be delayed for hours, and then drive again. One caregiver described the cost of a single trip from Tulkarem to Nablus as roughly 70 to 80 shekels, a price that rises when conflict forces drivers to take longer, more expensive routes. These costs add up quickly, competing with money needed for food and rent. The time spent waiting at checkpoints or driving in circles turns a routine medical appointment into a test of endurance. One participant poignantly noted that families often leave before dawn to pray on the road, only to still arrive late for their appointments. In this environment, the ability to get care depends heavily on where you live, how much money you have, and whether you can navigate the political barriers of the day.
Beyond the travel, the study revealed that the health system itself often leaves families feeling invisible and unsupported. Caregivers described arriving at hospitals only to be treated as if they were ghosts, excluded from conversations with doctors and left to interpret complex medical terms on their own. When medication runs out or supplies are missing, families are forced to ration drugs, search for expensive alternatives on the private market, or rely on advice from friends. Some caregivers, particularly those with a background in healthcare or higher education, could use the internet or their professional networks to find answers, but those without these resources were left with uncertainty and fear. The system seemed to expect families to perform tasks like changing dressings or managing tubes without proper training or equipment. This created a situation where the burden of the illness was not just carried by the patient, but was transferred to the family, who had to become the bridge between the patient and a broken system.
The emotional toll of this struggle is profound. Caregivers described a heavy emotional labor where they had to hide their own fear and sadness to protect the patient. They managed family tensions, interpreted the illness through their religious and cultural beliefs, and sometimes experienced a deep sense of grief before the patient had even died. One caregiver, who worked in healthcare, described her medical knowledge as a curse because it allowed her to see the patient's decline coming, yet she lacked the power or resources to stop it. To cope, families built their own informal support networks, using social media, community groups, and word-of-mouth to find information and help. While these networks showed incredible resilience, they were uneven; families with fewer connections were left more vulnerable. Religion played a central role, offering comfort and a sense of duty, but it also made it harder for caregivers to admit they were exhausted or needed help, as self-sacrifice was seen as a moral obligation.
Despite the immense hardship, the caregivers in this study did not just describe their suffering; they offered clear, practical ideas for how to fix the system. They called for cancer services to be brought closer to where people live, suggesting local clinics or mobile teams to reduce the need for long, dangerous trips. They asked for structured training so they could learn how to give medicine, monitor symptoms, and handle emergencies safely, rather than guessing. They also wanted better communication from doctors, asking for a specific nurse or contact person who could explain what was happening and answer questions. Finally, they requested regular, non-judgmental emotional support, such as counseling or peer groups, to help them manage the stress of their role.
The study concludes that cancer care in the West Bank is not just a medical issue, but a matter of fairness. The barriers these families face—distance, cost, lack of information, and emotional strain—are not inevitable parts of having cancer; they are the result of a system that has not adapted to the reality of conflict and fragmentation. The researchers suggest that true health equity requires more than just having hospitals; it requires building systems that reduce the travel burden, train families to care for their loved ones, and treat caregivers as essential partners in the healing process. By listening to the people who do the work of caregiving, health planners can begin to design services that are not only effective but also just.
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