Palliative Care in Palestine

Four-year-old Karim smiles, giggles and fidgets in his chair while receiving a recent chemotherapy infusion. Photo by Ben Gray / LWF

         “I couldn’t stand to watch him suffering,” Ikram said as tears welled in her eyes and her voice choked. “He’s my youngest and I love him beyond explanation. I decided to stop his treatment, there was nothing else I could think to do.”

         Karim, 4, had undergone treatment for a cancerous tumor in his kidney, but following treatment he relapsed and cancer was found in his lungs. He was now undergoing more aggressive second-line treatment and the side effects were devastating the family.

         Karim was in pain, he required blood and platelet transfusions, his hospital stays were longer and longer to give him time to recover from the chemotherapy. Sometimes he wouldn’t eat for two weeks and had to be admitted to the hospital for intravenous fluids and nutrients. Even when he was at home in the West Bank town of Ramallah, he had to be kept isolated from his three siblings because his immunity was so low.

         Ikram and her husband made one more trip to Augusta Victoria Hospital from their home in Ramallah to meet with doctors and let them know about their decision to end Karim’s treatment. When they arrived, the team at AVH had a better idea.

         Dr. Rami Zahran, head of palliative care, called a team of physicians, oncologists and social workers to meet with the family. They spoke to the family about how they would change Karim’s treatment protocol to spread the chemotherapy over a longer period of time which would reduce the intensity and number of side effects. They found ways for Karim to receive minor treatments and tests at a hospital near his home to reduce the travel. They provided psychological support to the family. 

         “With the new treatment, he’s smiling! Look at him, he’s beautiful!” Ikram said.

         As Karim sat curled up in a chair watching a video during a recent chemotherapy infusion he smiled, giggled and fidgeted like any other four-year-old.

         “That’s what we hope for always… pain free, happy children, regardless of the outcome,” Dr. Zahran said as he smiled in Karim’s direction. “We want this experience to be the least troublesome possible.”

“Nothing is harder than dealing with a family that is suffering. It’s already hard to be treating a child, but it’s even harder to treat a child whose family is also suffering.”

         Augusta Victoria Hospital is leading the way in palliative care in Palestine. This approach has the goal of improving the quality of life for both the patient and their family as they undergo treatment for major illnesses. With palliative care, the patient’s pain, physical stress and mental stress are all considered and treated along with the illness.

         The Lutheran World Federation has secured the permits necessary and will begin construction of the Elder Care and Palliative Medicine Institute (ECPMI) in 2019. This 144-bed facility on the Mount of Olives will nearly double the capacity of AVH and continue to bring the crucially needed palliative medicine to the Palestinian community.

         In addition to leading through the example of their work at AVH, the hospital’s staff is introducing palliative care to other hospitals in the Palestinian healthcare system through seminars and training.

         As for Ikram, she no longer counts the number of treatments Karim has left because he is no longer miserable.

         “The palliative care that has been provided has made a huge difference because the hospital is giving care not only to Karim, but to the family as a whole… socially, psychologically,” she said. “Now, instead of going through this journey with pain, we go with less pain, less suffering.” 

         When evening comes and the children in the pediatric ward go to sleep, the mothers share their emotions. Ikram now uses these evenings to council other mothers and share her experiences.


Palliative care is a holistic approach to improve the quality of life for patients who are facing life-threatening illness and for their families. It is similar to Hospice, but is not limited to patients who are terminally ill.