table of contents - elis
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TABLE OF CONTENTS
ELIS Centre Association ................................................................................... 4
Preface ................................................................................................................... 5
Demographic Situation in Palestine ............................................................ 6
Palestinian Refugee in Palestine 2018 ........................................................ 7
Age Structure ...................................................................................................... 8
Health System in Palestine ............................................................................. 9
Breast Cancer Unit Project ............................................................................ 17
October 2019 Activities ................................................................................... 26
Last Remarks..................................................................................................... 37
References .......................................................................................................... 38
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ELIS Centre Association
Associazione Centro Elis is an Italian NGO eligible for funding by the Italian Agency
for Development Cooperation - AICS and has been operating for over 30 years in 21
Countries all over the world, including Africa, Asia and Latin America.
In the geographical and existential suburbs of Rome and the world, ELIS promotes
sustainable and inclusive development, addressing the most fragile subjects of
society, through initiatives to support women and their health, the integration of
work and entrepreneurship among young people, the rights and protection of
minors, the fight against educational poverty, the socio-economic integration of
migrants and unaccompanied minors.
Kickoff Ceremony of Beit Jala Hospital Breast Cancer Unit, December 9th, 2018
Saint Gabriel Hotel, Bethlehem, West Bank
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Preface
It is a great pleasure to present briefly some of the activities and results of the
Breast Cancer Project in Beit Jala, promoted and implemented by the Ministry of
Health (MoH) and the Italian NGO ELIS Centre Association, in partnership with
Campus Bio-Medico University - UCBM, and financed by the Italian Agency for
Development Cooperation - AICS.
The concept of this Project was born in 2016 during meetings between the
promoters and AICS Office in Jerusalem which wished to complement its large
program for improving the Palestinian Health Care with actions for upgrading the
treatment of the breast cancer. The occurrence of breast cancer in Palestine is
increasing year by year as happened in other Countries in general and in the Arab
countries in particular. The breast cancer ranks first among the cancers that affect
women in Palestine: the incidence is 33% of the total reported cases of cancer in
women (one third of the cases) with an average of 33.4 new cases per year per
100,000 women in Palestine.
This Project started in 2017 and up to day succeeded in achieving the following
results:
✓ Having the first Breast Cancer Unit at Beit Jala Hospital with holistic and
multidisciplinary approach.
✓ Decreasing the Breast Cancer referral of cases out of the Ministry.
✓ Increasing medical and community awareness of breast cancer.
✓ Promoting a long-lasting scientific cooperation between Italy and Palestine
on the study of the disease in Palestine.
This Project, whose main beneficiaries are the Palestinian women, has greatly
increased the possibilities of the breast cancer very early detection and of complete
recovery from the pathology.
Dr Asad Ramlawi
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Demographic Situation in Palestine
In 2018, according to the Palestinian Central Bureau of Statistics (PCBS) estimation,
the population of Palestine was 4,854,013, of whom 2.46 million were males
compared to 2.38 million women, while West Bank had 2.92 million inhabitants,
60.2% of the total population of Palestine of which about 1.48 million were males
compared to 1.43 million women, while the population of Gaza Strip was 1.93 million,
39.8% of the total population of Palestine, of which about 979 thousand were males
compared to 953 thousand were women.
Hebron governorate is the largest governorate in West Bank in terms of population.
The percentage of the population was 14.9% of the total population in State of
Palestine, followed by Gaza governorate with 13.6%, followed by Jerusalem
governorate by 9.1%, while Jericho and Al Aghwar are less Palestinian governorates
in terms of population and recorded 1.0% of the total population in State of Palestine.
14,9
13,6
9,18,1 7,8 7,8
6,9 6,65,7
4,9 4,53,9
3,2
1,6 1,3 1,
0,
4,
8,
12,
16,
Hebron Jerusalem Khan younes Ramallah Dair Al Balah Beithlehem Qalqilia Tubas
Distribution of population / Districts, 2018
7
Palestinian Refugee in Palestine 2018
42.2% of the population in Palestine is refugees, 27.4% of the total population in West
Bank and 66.2% of the total population in Gaza Strip.
27,4
66,272,6
33,8
0,
20,
40,
60,
80,
West Bank Gaza
Proportion distribution of Palestinian population / Refugee
Refugee not refugee
8
Age Structure
The population pyramid in 2018 shows that the Palestinian society is a young society.
The population of the age under 15 years was 38.7% of the total population in
Palestine, 36.7% in West Bank and 41.6% in Gaza Strip.
The individuals of ages 65 years and above were 3.3%, with difference between West
Bank and Gaza Strip, 3.6% in West Bank and 2.8% in Gaza Strip.
Age
Group (years)
Males Women Total
No. % No. % No. %
0-14 961,539 19.8 915,515 18.9 1,877,054 38.7
15-64 1,435,599 29.6 1,383,304 28.5 2,818,903 58.1
65+ 72,024 1.5 86,032 1.8 158,056 3.3
Total 2,469,162 50.9 2,384,851 49.1 4,854,013 100
Distribution of Population by Age Group & Sex, Palestine 2018
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Health System in Palestine
Primary Healthcare Centers (PHC) in Palestine by Health Providers
The number of PHC in Palestine reached to 732 in 2018, of which 585 are in West
Bank and 147 in Gaza Strip.
468 Primary Healthcare Centers belonging to Palestinian MoH, which constitutes
63.9% of the total number of PHC. The number of Primary Healthcare Centers
managed by NGOs reached 182, constituting 24.9% of all Primary Healthcare
facilitates, while the number of UNRWA centers reached 65, and the military medical
centers (PMMS) reached to 17 centers.
Population rate per health centers in Palestine was 6,242 people per health center;
4,506 people per health center in West Bank and 13,149 people per health center in
Gaza.
468; 64%65; 9%
182; 25%
17; 2%
Distribution of PHC by health providers
MOH UNRWA NGOs PMMS
10
PHC by Level
The number of PHC of MoH in Palestine increased from 203 in 1994 to 468 in 2018,
with variation rate of 130.5%.
The MoH classifies PHC into four levels, of which 61 clinics are level one, consisting
13% of total centers of MoH and 246 clinics are level two, consisting 52.6% of total
clinics, 128 clinics were classified as level three, 24.4% of the total centers and 28
clinics are level four; 6% of total centers. In addition, four PHC mobile clinics provide
health services in Tubas, Jerusalem, Bethlehem and Yatta. These four mobile clinics
constitute 1.1% of the total clinics. Distribution the Number of PHC by Level of
service 2018.
61
246
128
285
0
75
150
225
300
Level I Level II Level III Level IV Mobile clinics
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Hospitals by specialty
1. General hospitals
These hospitals provided secondary health care services to their geographical area.
Some of these hospitals have sufficient capacity to provide secondary health care
and some tertiary health care. In 2018 there were 55.8% of the West Bank hospitals.
2. Specialized hospitals
These hospitals provide specialized, advanced and comprehensive services in
secondary and tritely care. in 2018, there were 19.2% in West Bank.
3. Maternity hospitals
These hospitals provide services in the field of obstetrics and gynecology. In 2018
there were 19.2% of hospitals in West Bank.
4. Rehabilitation and Physiotherapy Centers
Medical centers offering rehabilitation and physiotherapy services. In 2018 there
were 5.8 % of hospitals in West bank.
5. Ministry of Health hospitals
The number of hospitals is 27 hospitals, with a capacity of 3,462 beds, or 53.8% of
total number of beds in Palestine. The beds of rehabilitation and physiotherapy
centers are all owned and managed by non- governmental organizations.
There are 14 MoH Hospital in West Bank with capacity of 1664 beds equivalent to
48.2% of the total hospital beds of MoH , while there are 13 MoH hospitals in Gaza
strip 1,794 beds or 51.8% of the total MoH hospital beds in Palestine.
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Cancer in Palestine
3,479 cancer cases were reported in West Bank in 2018, of which 3,102 cases were
diagnosed in 2018, while the other cases were previously diagnosed.
After comparing 3,102 cases diagnosed in 2018 with 2,923 cases diagnosed in 2017, it
turns out that there was a 5.8% increase of cancer cases. In 2018, the reported
crude incidence rate was 117.7 per 100,000 populations.
53,7 64,2 74 79 82,8 83,8 86,4113,7 117,7
0
50
100
150
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019
IR p
er 1
00,0
00
Year
Reported IR /100,000
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Distribution of Reported Cancer Cases by Sex and Age Group
The total number of cancer cases reported among women was 1,565 cases; 50.5% of
total reported cancer cases. In the age above 64 years, 1,046 cancer cases were
reported with 33.7 % of total cases, taking into consideration that this age group
proportion of total population is only 3.6%, while 1,919 cancer cases were reported in
the age of 15-64 years (61.9% of all reported cancer cases), and 137 cases were
reported among under 15 years old (4.4% of all reported cases) where its proportion
of total population is 36.7%.
2,4
27,9
19,2
2
34
15
0,
10,
20,
30,
40,
0-14 15-64 >64
perc
enta
ge
age group & sex
% of reported cancer cases by sex and age group
male female
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Most Common Cancer
Based on the data provided by Cancer registry in MoH, breast cancer is the most
common cancer in Palestine over the last years. In 2018, breast cancer was the
most common cancer with 440 cases reported (14.2% of all cancer cases) with
incidence rate 16.7 per 100,000 populations. While the second most common cancer
was colorectal cancer with 358 reported cases; 11.5 %of all cancer cases with
incident rate 13.6 per 100,000 populations. Lung was the third most common cancer
with 249 reported cases; 8 of all cancer cases with incidence rate 9.4 per 100,000
populations. Among women; breast cancer is the most common as 433 cases were
reported, representing 27.6% of all cancer cases among women, with incidence rate
33.4 per 100, 000 female population.
33,4
11,99,3
7,3 75,1 4,6 3,8 3,2 3,2
0,
10,
20,
30,
40,
Breast Colorectal Thyroid Ueterus Leukemia NDH Brain & Nerv. Ovary Stomach Lung
IR p
er 10
0,00
0 po
p.
IR of top 10 reported cancer among female /100,000 female population WB 2018
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Risk factors for developing breast cancer
Being a woman is the main risk factor for breast cancer. Men can get
breast cancer, but it is very rare.
Getting older: your risk of breast cancer increases as you get older. Most
women who get breast cancer are over the age of 50 (76% of breast
cancer patients are over 50 years old). However, the disease can strike
younger women too.
Having had breast cancer previously: women who have had breast cancer
have an increased risk of getting breast cancer in the other breast or in
another part of the same breast.
Hormone Replacement Therapy (HRT): women on HRT are at an increased
risk of breast cancer. Your risk decreases gradually after you stop taking
it.
The Pill: the contraceptive pill causes a small increase in risk. This risk
gradually returns to normal after you stop taking it.
Starting periods at an early age or having a late menopause: women who
have their first period before the age of 12 years or who have the
menopause after the age of 55 years have a slightly increased risk.
Having no children: women who have no children or who have their first
child later in life have a slightly increased risk.
A strong family history of breast cancer: women with a strong family
history of breast cancer have a higher risk of getting the disease. A strong
family history includes:
Breast cancer and/or ovarian cancer in several close members of
the family.
Breast cancer in a close relative when under the age of 50 years.
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Strategies have been strengthening for prevention purposes
Tobacco control
Alcohol control
Healthy diet promotion
Physical activity promotion
Occupational exposure
Environmental pollution radiation protection food control
Chronic infection control ( Hep.B , Hep C, EBV, Helicobacter )
Chemoprevention
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Breast Cancer Unit Project
The Project is implemented at the public hospital of Beit Jala, indicated by the
Palestinian Ministry of Health. The activities started in March 2017, with a total cost
of about € 1,95 millions, of which € 1,45 millions granted by the Italian Agency for
Development Cooperation – AICS.
The promoters of the Project are, for the Palestinian part, the Ministry of Health and
the Hospital of Beit Jala and; for the Italian part, NGO ELIS Centre Association
and Campus Bio-Medico University Hospital.
A. Infrastructure
Building a Breast Cancer
Diagnosis Facility at Beit Jala
Hospital where cutting-edge
diagnostic services are
provided to women with
suspected breast cancer.
Extension of the onco-
surgical award setting up a
dedicated fully equipped
room with four beds for
women who have gone under
breast surgery.
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B. Equipment and furniture
The Breast Cancer Unit has been furnished and equipped. The main machines
provided as the following:
Mammogram Tomosynthesis and Stereotactic Machine
Cryostat Machine Ultrasound Machine
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C. Training
Local training
Training of Palestinian
doctors on Surgery,
Radiology, Histopathology,
was conducted by Italian
experts at Beit Jala
Hospital.
International training (Italy)
Training of Palestinian
doctors on Surgery,
Radiology, Histopathology
and management of Breast
Cancer Unit by a case manager. The training was conducted at Campus
Bio-Medico University in Rome and at public Hospital in Perugia (Italy).
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D. Awareness Campaigns
For the health institutions it
should be a priority to
promote the Breast Cancer
Awareness aiming at
spreading the culture of
prevention and at letting the
people know about the wide
possibilities of complete
recovery from this disease,
if it is early detected and
adequately treated in a
specialized Unit. These Units are centers for Breast Cancer diagnosis, treatment and
follow up that take care of the patients according to modern international protocols.
In this context the basic concept of the multidisciplinary approach is crucial.
Medical awareness
The Palestinian Ministry
of Health, with the
Project financial support,
implemented several
medical awareness
campaigns for physicians
and nurses from
different health
Palestinian Hospitals.
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Public awareness
Many public awareness
campaigns have been
conducted, addressed to women
from ministries, universities,
women clubs and unions.
In these occasions, women who
have experienced the disease
highlighted the importance of
breast cancer early detection
through the breast self-
examination and the participation to the governmental screening program
supported by the Italian Agency for Development Cooperation – AICS.
Religious leaders promoted as well the breast cancer screening during
the Friday prayers. In these campaigns were involved the national and
local media that broadcasted interviews with policy makers, technical
people. For the purpose original Educational materials, such as leaflets,
posters, booklets, and roll-up were produced and distributed.
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E. Scientific Conferences
Three scientific conferences on breast cancer were organized with the participation
of experts from Italy, Palestine and International Organizations. Two of them were
held in Palestine and one in Rome at Campus Bio-Medico University.
The results of these events were:
Exchanging of experiences between Palestinian and International experts.
Identification of the Palestinian training needs.
Identification of Palestinian focal points for different specialties (oncology,
surgery, radiology, histopathology, and management).
Demonstrating the progressive improvement in breast cancer treatment
with the Project implementation.
Highlighting the improvement of breast cancer burden for the Ministry of
Health related to morbidity, mortality, referral reduction and money
saving.
Staff and patient satisfaction.
Palestinian–Italian Breast Cancer Conference (February 12th -13th, 2018)
Saint Gabriel Hotel, Bethlehem, Palestine
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Italian-Palestinian Conference (April 13th, 2019)
Campus Bio-Medico University, Rome, Italy
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F. Coordination
Various health care providers, such as MoH, UNRWA, NGOs and private operators,
are involved in this important national Project.
Inter – intra sectoral cooperation
The cooperation between various Palestinian Organizations, such as
Ministry of Health, Ministry of Women, Ministry of Education, Ministry of
Media and other national institutions, has increased thanks to this
Project.
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G. Data from Breast Cancer Unit at Beit Jala Hospital, October 2019
26
October 2019 Activities
October is the month of International Breast Cancer Awareness and Prevention,
celebrated every year in all Countries of the world. The events organized help to
spread the knowledge of this disease and to underline the importance of the
screening for the early detection and the appropriate treatment.
In October 2019 the Project awareness campaign on Breast Cancer in Palestine was
intensified targeting the districts of Ramallah, Bethlehem, East Jerusalem and
Hebron.
Main goal of the events
Increase the awareness of women on the importance of early detection and the
appropriate treatment in Breast Units and spread information about the services
provided by the Breast Unit in Beit Jala, set up by the Project.
The objectives to be achieved after this awareness campaigns
Increase women's awareness on the early symptoms of breast cancer.
Increase women’s knowledge on how to do breast self-examination.
Increase women’s awareness on the healthy life-styles in order to
prevent the breast cancer.
Increase women’s awareness on the importance of the mammography
over the age of 40, and on the MoH protocol for breast cancer screening.
Let know the services provided by Breast Cancer Unit at Beit Jala
Hospital.
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The Preparatory phase for implementing the workshops
A. Meeting with partner’s concerns:
Ministry of Health (public health directorate, volunteering department, and
school health department)
UNRWA
Association of breast cancer prevention (Shurouq and Dr. Al Ja'bari,
women unions , and clubs).
B. Printing Educational Materials
1000 aprons
5000 booklets on breast cancer prevention and early detection.
10 Roll-up with different messages about breast cancer prevention and
early detection, as well as healthy lifestyles.
C. Preparing 1000 files with all printing materials: pen and note book to be
distributed during the workshops
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Bethlehem Workshop, October 8th 2019
The workshop was
organized in cooperation
with Bethlehem Women’s
Union at the Union's Hall.
More than 150 women took
part, representing the local
communities and local
health care providers.
The workshop was opened
by the representative of Women's Union, who welcomed the attendees and thanked
AICS and ELIS for their support to the Project. She also highlighted the serious
problem of breast cancer among the Palestinian women.
The Head of Bethlehem Women‘s Union welcomed the attendees, and
thanked AICS and ELIS for their support, asking them to expand their
support to other important topics.
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Italian Expert from ELIS thanked the organizers, highlighting the
importance of the event for raising women's awareness about breast
cancer screening and early. They made a brief presentation of the Breast
Cancer Unit at Beit Jala Hospital where a trained and qualified
multidisciplinary team is providing a full health services almost at the
level of a European Breast Unit.
The former Palestinian Vice Minister for Health did a presentation about
cancer prevention in general, and breast cancer in particular, focusing on
the main risk factors: tobacco and diet. He underlined the national health
policies for salt, sugar and saturated fat reduction.
The Beit Jala Breast Unit Case Manager talked about the prevention and
the importance of self-examination. Subsequently she made a
demonstration with a rubber doll showing the participants how to do the
self-exam. Some women practiced the test on the doll.
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Ramallah Workshop, October 9th 2019
The workshop was organized with the help of Ramallah women federation.
70 women participated in the event.
The representative of
Federation opened the
workshop thanking AICS
and ELIS for their support
and welcoming the women
for their attendance.
Italian expert from ELIS
thanked the organizers and
the attendees and made a
presentation of the Project
and the results achieved.
They also pointed up the
importance of raising
women’s awareness in
regards to breast cancer and the of early detection of the disease.
A nutritionist gave a lecture on the healthy food and the healthy life styles,
underscoring the importance on cancer prevention.
The former Vice Minister for Health did a presentation about cancer
prevention in general and breast cancer in particular, focusing on the main
risk factors.
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The Head Nurse of
community health in the
Ministry of Health talked
about breast cancer
screening protocol,
implemented at PHC
clinics, and the importance
of the early detection of
the desease. She pointed
up that MoH provides breast
cancer screening free of
charge in all PHC clinics.
Then she trained the
participants on the self-
exam using a rubber doll.
The onco-surgeon at the
Beit Jala Breast Cancer Unit
did a presentation about
breast surgery and
reconstruction.
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Jerusalem Workshop, October 23rd 2019
Under the patronage of her
excellency Dr. May Al Kaileh,
Minister of Palestinian Ministry of
Health, UNRWA organized an
educational awareness event in
East Jerusalem, at UNRWA
headquarter. The workshop was
attended by 80 women.
The Head of Medical services at UNRWA opened the meeting welcoming her
Excellency and the attendees, thanking Italy for its support to the workshop.
Her Excellency Dr. May Al Kaileh, on behalf of the Palestinian MoH, welcomed
the organizers and the participants, and took stock of the Palestinian policies
for breast cancer prevention and control. She confirmed that breast cancer
screening and treatment is an integral part of national health policy, ensuring
that governmental health centers for the primary health care provide this
service free of charge to every Palestinian woman.
33
The Head of Nursing sector at UNRWA did a presentation on cancer statistical
data, at regional, national and global level.
The Head of Preventive Medicine Nursing unit at UNRWA presented the
breast cancer policies implemented by UNRWA clinics. She praised the good
cooperation and collaboration between the UNRWA and the Ministry of
Health.
A short documentary film about breast-self-examination was screened.
A successful story of a breast cancer patient was presented.
34
Hebron Workshop, October 26th 2019
The Volunteering Unit at MoH jointly with the Cancer Patient’s Charitable Society
organized a crowded workshop in Hebron/Old City, attended by more than 600
women form many public and private institutions.
The local community covered 90% of the costs, due to:
20 advertising posters placed at Hebron City, inviting women to attend the
event
Lunch for 600 women
Two busses & two vans for women transportation
600 gifts for the attendees
Soft drink and sweets
The Project covered the cost of:
600 apron
Educational materials
Big banners
Accommodation for volunteers
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The agenda of the workshop:
Welcoming remarks by the representatives of:
The Governorate (Deputy Governor)
MoH Direction general of PHC in Hebron (Director)
Cancer patient’s charitable Society (Head)
All speakers thanked AICS and ELIS for their support to the Project and for their
help to the Palestinian women in general, highlighting the role of the governorate,
MoH and the charitable society in breast cancer prevention.
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➢ Technical presentations by:
Dr. Ramlawi – Breast cancer risk factors & prevention
Dr. Al Qawasmeh- Data and statistics
Dr. Al Jibrini- Clinical pictures, diagnosis and treatment
Dr. Salhab – Screening and breast self-examination, and introducing Breast
cancer unit at Beit Jala Hospital
➢ Success history
Two successful stories were presented explaining the suffering of the patients and
the social and financial problems due to the breast cancer. They encouraged all
women attending the event and urged them to take advantage of the governmental
screening services.
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Last Remarks
ELIS is very proud and satisfied with the outcomes of the campaign and workshops
organized during October 2019 for the following reasons:
ELIS had the opportunity to strongly raise awareness of the Breast cancer
problem not only among the Palestinian Women but also among Ministries,
other public Institutions, local NGOs, UNRWA and other international
organizations.
The campaign strengthened the partnership among different stakeholders and
health providers and gave great visibility to its Project for Breast Cancer Unit
at Beit Jala Hospital.
The campaign, important component of the Project financed by the Italian
Cooperation, let many of the Palestinian women to know the advanced health
services offered by the Breast Unit in Beit Jala Unit and prompted the setting
up of other Breast Units in Palestine in order to cover all the Country.
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References
Italian Agency for Development Cooperation - AICS website https://gerusalemme.aics.gov.it/en/home-eng/
World Health Organization website https://www.who.int/
Health Annual Report - Palestine 2018 http://healthclusteropt.org/admin/file_manager/uploads/files/1/Health%20Annual%20Report%20Palestine%202018.pdf
CDC Atlanta https://www.cdc.gov/
Breast Cancer Unit at Beit Jala Hospital –Palestine
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Associazione Centro ELIS
Via Sandro Sandri, 45, 71, 79, 81, 00159 – Rome, Italy
[email protected] http://www.elis.org/
06.45.924.447
Jerusalem Office, Palestinian Territories
2, Mujer Eddin Street - Sheikh Jarrah – Jerusalem
https://gerusalemme.aics.gov.it/
+972 25327447
Ministry of Health - Palestine
http://site.moh.ps/
Università Campus Bio-Medico di Roma
Via Álvaro del Portillo, 21, 00128 – Rome, Italy
https://www.unicampus.it/
06.22541.1
40