Ghada, a 23-year-old mother of three, gazes down at her youngest child Bara, a large piece of gauze still covering the sleeping infant's chest following her recent open-heart surgery. Only two weeks earlier, Bara had been rushed from a hospital in the West Bank town of Nablus to the Paediatric Cardiac Intensive Care Unit (PCICU) at Occupied East Jerusalem's Makassed Charitable Hospital.

While Ghada was able to accompany her new-born daughter to Occupied Jerusalem, Bara's father was denied permission by Israeli authorities on security grounds; leaving him to stay in Nablus with the couple's two other children.

Only a few years ago, Bara's complex heart condition may have meant that she would live no longer than a few days. Today, she is just one of the more than 500 children who have received cardiac care at Makassed since 2003.

Established in November 2006, the PCICU was spearheaded by the Palestine Children's Relief Fund (PCRF), through support from a variety of sources including the UAE Red Crescent Authority and UAE-based donors.

Although the unit has only been operational since 2006, international volunteer surgical teams have been working at Makassed through PCRF since August 2003, using the hospital's other facilities. Previously, in the absence of the capacity to carry out such care, children were transferred abroad or to Israel for medical care.

Potential for self-reliance

Despite the isolation of Occupied East Jerusalem, the project is working to maintain contiguity between the city and the West Bank, as well as to provide vital medical care to Palestinian children, the unit's paediatric cardiologist, Dr Mahmoud Nashashibi told Weekend Review.

Those involved with the PCICU say they also view the unit as an example of the potential self-sufficiency of the Palestinian healthcare system.

A number of Israeli NGOs work to provide paediatric cardiac care to Palestinian children, "in the name of peace", Nashashibi said.

"There is a degree of competitiveness in this regard, but we feel it is our obligation to provide top-class care to Palestinian children.

"Given the situation, many Palestinians have lost their self-confidence, but this unit has given us confidence in our abilities, which has been a driving factor in building up the unit. We have to prove that we can do it and that we can rely on our own expertise and not be dependent," he said.

Throughout the week, Nashashibi travels the length of the West Bank screening patients, supported by PCRF international volunteer cardiologists. The team also conducts missions to remote areas cut-off from major population centres, and to Gaza when possible.

One volunteer who has become a fixture at Makassed is paediatric cardiac surgeon Dr Alan Kerr, who has been travelling from New Zealand to Palestine around three times a year since 2001, with the help of the PCRF. Six years on from his first trip, he is in the midst of a six-month stint with the unit.

According to Kerr, his main objective has been training Palestinian staff, both nurses and surgeons, to create a sustainable programme. Dr Vivian Bader, 30, from Hebron is training as a paediatric cardiac surgeon and "practically lives at Makassed," joked Kerr.

But, why is the unit seen as so vital? "Normally if we take international figures. For every one million people there are about 100 cardiac patients per year," Kerr said. "So in Palestine, we should have around 400-450 cases per year. But in reality, it is around twice this number."

Despite this, the mortality rate among the unit's 500 cases is only 3 per cent which, according to Kerr, is not far from European standards.

Dr Bassam Abu Libdeh, deputy director at the hospital, said that for years, they relied on donations from countries including the UAE, before moving under the authority of the Palestinian Ministry of Health following the establishment of the Palestinian National Authority in 1994.

However, following international sanctions against the Hamas-led government in 2006, the Ministry of Health ceased payments to the hospital for services not available in the public health system.

"Over the past 14 months, we, like other hospitals, have been on the verge of collapse," Abu Libdeh said.

However, according to him, this is not only the hospital that is under threat.

"[Occupied] Jerusalem is being attacked by Israel in a nasty and aggressive way," he said.

"Two thirds of our staff are from the West Bank and we have to fight to get permits to allow them to work. We have to fight to get patients here through the checkpoints, as well as actually fight diseases, which should be our focus."

However, despite the many challenges and the need for additional support for the PCICU, the high demand has necessitated an expansion of the unit; good news for families of paediatric cardiac cases like tiny Bara's.

As she begins to open her eyes, waking up, her doctors say that she will have to undergo further operations in the coming months. "When she was born I had no idea that she had a defect," Ghada said. "I cried a lot, but now it is up to God and I pray that she will get better."