Inside the Ramallah hotel housing Gaza’s cancer patients | Israel-Palestine conflict

Ramallah, occupied West Bank — For more than 16 months, loss and grief have stalked the granite-floored corridors of the Retno Hotel.

On the evening of October 6, 2023, the family-run hotel was close to full occupancy. A few of the 70 or so guests were Palestinian Americans but most were from Gaza. Expecting to return home soon, they had brought just enough clothes for a week’s stay.

Among them were Ahmed Ayyash, a 72-year-old civil engineer from Gaza City, and his 62-year-old wife, Maha. Forty-four-year-old Shadia Abu Mrahil from Deir el-Balah was there with her 25-year-old son, Karam.

Like most of the guests from Gaza, they were regular visitors to the modest limestone building with its 45 double- or triple-bedded rooms. It wasn’t the quiet north Ramallah street that drew them there, nor the small courtyard out front with its plastic tables and chairs, although on sunnier days, the guests would sometimes sip their coffee there near a canopy of bright pink bougainvillaeas.

They were there to receive medical treatment – for cancer, heart problems and developmental disorders – that was unavailable in Gaza. Both Ahmed and Shadia have leukaemia.

They would travel via the Beit Hanoon crossing, managed by the Israeli army and known to Israelis as Erez, in northern Gaza to Ramallah. For a few days at a time, they would stay at the hotel while they received their treatment and then return home to Gaza. Relatives would often accompany them. Some had been doing this for years. For Ahmed and Maha, these medical trips also offered an opportunity to visit Al-Aqsa Mosque in occupied East Jerusalem and to eat kunafa with friends in Nablus, 50km (31 miles) away.

October 6, 2023, was a quiet day, a Friday. Most businesses in Ramallah were closed and many guests at the Retno Hotel took a break from their treatments. Ahmed went out to pray at a nearby mosque with Maha, his wife of 44 years. They had arrived in Ramallah the previous day and bought bread, cheese, chocolate, fruits and vegetables for their stay. When they returned to the hotel that evening, they ate dinner in the dining hall, and spoke to fellow guests before going to bed.

When they woke up the following morning, everything had changed. In the days that followed the Hamas-led attack on southern Israel, Israel launched a massive bombardment of the Gaza Strip and cut off food, water and electricity. The Palestinian American guests at the hotel fled. Those who stayed, hospital patients and their family members, waited anxiously for news from Gaza. The phone service was down and many were unable to reach their loved ones back home. Some crowded into the hotel owner’s office to watch the developments on television, wondering what the fast-escalating war would mean for their families and for their treatments.

Ahmed stayed in his room watching the news and scrolling through Telegram updates from journalists in Gaza. Guests who managed to contact loved ones during the sporadic moments when the phone service returned, shared whatever they learned with others. Others never got through.

“Some of the guests lost their children in the first month of the war, and I heard news of the martyrdom of many members of my family, such as the children of my cousin and his wife, and my cousin and her husband … and their children, and some friends,” Ahmed recalled.

“The bad news was constant.”

Clouded thoughts of the future

Since 2017, the Retno Hotel has housed patients and their family members from Gaza during their medical visits to Istishari Hospital, a 10-minute taxi ride away.

It is among a network of accommodations — mostly hotels, but also lodgings including UNRWA facilities — housing Palestinians granted temporary permits by Israel to leave Gaza to receive medical treatment in West and occupied East Jerusalem and the occupied West Bank. The treatment is covered by the Palestinian Authority’s (PA) Ministry of Health.

Over the years, Nawaf Hamed, the 66-year-old owner and manager of the Retno, has tried to keep the place cheerful. The common areas were often filled with music – everything from Western folk to classical Arabic. Guests would sometimes play the instruments – a tabla, guitar, qanun (a Middle Eastern string instrument) – that Nawaf kept around the lobby. “We would sing, and we [would] dance!” he reminisced wistfully. Those joyful nights stopped with COVID lockdowns, and never quite returned.

When the war began, the permit arrangements for patients from Gaza quickly broke down. Those in hospitals in Jerusalem had to leave, fleeing to the occupied West Bank where they scrambled to register with the PA and find a new hospital. None were able to return to Gaza.

“The people [were] very afraid of the future,” recalled Nawaf of his guests.

Today, 400 patients from Gaza are currently registered with the PA with some staying in Ramallah as well as in Hebron, 60km (37 miles) to the south, and Nablus and Jenin, less than 100km (62km) to the north.

Over the months, more patients have moved into the Retno. Today, it is a temporary home to 33 adult and 14 child patients, and 37 family members. Seven patients at the hotel have died of their illnesses since the war started. As the others continue to fight their health battles, their family members have been killed, and their homes and former lives destroyed.

On a November afternoon, Shadia was sitting on a light grey couch in the corner of the hotel lobby where many guests gather. “What the war has done to my family, to my home, to my Gaza, kills me more every day than the cancer ever will,” she said, sighing.

As frail residents emerged from the lift, they greeted one another before heading to the hospital in shared taxis. A shuttle bus would bring them back later in the day.

Karam – his hair coiffed and beard well-groomed – sat beside his mother with his hands gently clasped in his lap. Nearby, Ahmed, dressed in a blue sweater and green button-down shirt, slouched in his chair, while Maha smiled warmly at fellow residents as they passed by. Other guests stopped to ask the front desk attendant, a woman in her 30s, for fresh towels or to grumble about the noise coming from their neighbour’s room at night.

“Our feelings are [in Gaza], and it impacts every moment in our lives,” said an exhausted Shadia. “I am tired and sick already from the cancer treatment. And our thoughts of the future, of continuing day after day, are clouded not only by our own life-threatening illnesses, but the total destruction that sweeps our homes and families and communities in Gaza.”

They cry at night

Nawaf, a stout man often with reading glasses on a cord around his neck, goes about his days running the family business while stopping to chat with guests.

When inside his small office, just next to the lobby, Nawaf will peer through the glass doors to see who is there and beckon them to come inside for a coffee. He has positioned the black leather couches in his office in a semicircle around a table to make the place more inviting. Guests come by to discuss their treatments, or to watch the news on television. On cold, winter nights, they come to sit by the fireplace. Some want to talk late into the night, others want to sit in silence.

On one sunny afternoon, when Nawaf was sitting in the courtyard, sipping Arabic coffee, Ahmed approached. He called out to the older man and shook his hand as he asked: “How are you, my friend?”

“Peace be upon you,” Ahmed replied with a faint smile before heading inside.

“May you have good health,” Nawaf called after him.

“That man was a great civil engineer in Gaza!” Nawaf declared, gesturing at Ahmed as he disappeared through the entrance door.

As other guests walked by, Nawaf bellowed a hearty “hello” and shook their hands.

Nawaf and his father, Nayef, started building the hotel in 2000 and opened it four years later. They ran the place together until Nayef passed away two years ago. Nawaf’s 11 siblings are all involved in the family business, as are his two daughters, in their 20s and early 30s, who help with administrative tasks.

Most hotels in the occupied West Bank are all but empty these days with the war bringing tourism to a standstill and restricting travel. The Retno is a rare exception. But even with all the occupants, the hotel is under financial strain. Although the PA covers the patients’ accommodation costs, these payments became erratic when Israel began withholding the PA’s tax revenues last April, says Nawaf. “Every week, we struggle to figure out how to pay the bills the next week,” he explained as he sat in the courtyard lined with potted citrus trees. “We don’t know what to do, how to spend money for breakfast. [Since June], the workers don’t have their [regular] salaries,” he said, referring to his 20 employees.

From the time breakfast is served, Nawaf tries to keep hotel operations humming as he listens to residents’ concerns, like complaints of a broken bulb or a problem with the toilet in their room.

Over time, he has seen some guests grow restless. Some get aggressive. Others worry that after 16 months of living in a hotel for free, the arrangement won’t last.

“Some of them don’t let us clean their rooms,” Nawaf explained. “They think we are just going to use it as an excuse to actually kick them out.”

He has tried to put the patients at ease, occasionally bringing representatives from the PA or NGOs to offer psychosocial services or even theatre sessions. “Usually, we don’t speak about politics,” he said. Sometimes he half-jokingly suggests to single male patients to get married, saying they will be less lonely. “If nothing else, maybe the [PA] will distribute [wives] to them,” he added with a laugh.

Nawaf often tries to cheer up his guests with humour. When, on February 4, the Israeli military came to the area of Ramallah where the hotel is located, he asked me over the phone: “What do you think they want? Falafel or shawarma?”

But as the war continued, the despair grew among Nawaf’s guests. “They are under stress, because they always wait [for] sad news,” he reflected, his tone becoming sombre. “Nobody even speaks about happy things. Just — they are crying.”

Nawaf leaned back in his chair and looked out at the empty street. “At night, in corridors, you walk, it’s quiet, and you only listen to people crying,” he said slowly, taking a sip of his coffee. He let out a sigh. “It is a really difficult experience.”

Though he tries to stay positive, when the mood in the hotel gets too heavy, “I sometimes go to my office, [and] I close the door just so I can laugh,” Nawaf explained. He won’t laugh at anything in particular; it is just how he copes with the stress. Then, he might play some Mozart to try to unwind.

‘He’s everything in my life’

Shadia and Karam have done their best to make their shared room at the Retno feel more like home. A small donated carpet, darkly coloured with geometric patterns, sits in the middle of the three-by-three-metre (10-foot-by-10-foot) room. On top of a dresser, an electric kettle waits – full of water – to prepare Arabic coffee. But it is a long way from their home near the beach in Deir el-Balah. Just a year old before the war began, it had marble floors, chandeliers and brand-new furnishings.

“Around our house were palm trees and olive trees,” recalled Shadia who was sitting next to Karam on his bed. “The people next to us planted cabbage, peas and cauliflower. And when we would look outside, all you would see would be green spaces and all this beauty.”

Now, at the Retno, shutters block the view of Ramallah’s limestone apartment buildings, empty lots and back roads.

In Gaza, Karam spent time outdoors in the family’s garden and on the nearby beach.

An only child, he has always been close to his mother. “Her and my father, that’s all, that’s who I have,” said Karam.

“I don’t feel like she’s only my mother,” he added softly. “She’s my friend and my brother. We hang out together. In Gaza, we went to the beach together. I spent more time with her than even my friends.”

Shadia looked at her son and smiled. She suffers from joint pain, nausea, fatigue and dizziness, and often speaks in an anxious voice, but she brightens when talking about her son.

“Karam is not only my son,” said Shadia. “He is my father, my friend, my sister, my brother. He’s everything in my life, and I can’t imagine my life without Karam.”

In 2014, Shadia began to experience intense pain in her back and joints. For years, doctors kept misdiagnosing her ailments, at different points saying she had a bulging disk, or even that she was imagining the crippling pain. “The painkillers they gave me numbed the pain for a little while, but then it would only come back much stronger,” she recalled.

Finally, in 2022, she was diagnosed with leukaemia. “It came as a lightning bolt to [Karam] and to me,” said Shadia, “because to think that I could lose my life and leave him alone, especially because he doesn’t have a brother or sister to take care of him, put me in an extreme depression for over a year.”

Shadia started coming to Ramallah for treatment. Her sister and Karam would take turns accompanying her. She has had to undergo various treatments to try to find the right one, and suffered kidney failure and other organ dysfunction. Beginning her oral chemotherapy regimen just a few months before the war started, Shadia is supposed to maintain a strict diet that limits what she can eat to fruits and vegetables and requires her to avoid food two hours before and after taking her twice-daily medication.

Even as she came to terms with her illness, the stress from the war has made everything harder, Shadia admits.

“Any bad news from Gaza, I could feel the pain in my body,” she said. The debilitating pain means she moves slowly when sitting or standing.

“Of course, the medicine does not [work] as it should, and the [medical] test [results] are bad because of what the war on Gaza does to me.”

‘Dying slowly in our alienation’

Last August, an Israeli rocket destroyed the family’s home. Karam’s father, Hani, had already fled. Karam recalled how his mother “broke down crying and refused to receive any calls from her family in Gaza”.

“She sat in her room for a week, not speaking to anyone because our house was destroyed.”

Shadia refused to leave even for her hospital visit. Karam stayed with her, trying to cheer her up by showing her funny videos on his phone and making sure she ate.

“It didn’t only happen to us,” Karam told his grief-stricken mother, trying to comfort her. “It’s good that we didn’t lose any of our children or a partner, everything.”

“The most important thing is your health,” he kept telling her. “Everything is easy if your health is good. We have to accept it, and God willing, we will have something better.”

“This, we kept repeating to ourselves,” said Shadia.

Seventeen members of Shadia and Karam’s extended family have been killed in this war.

Hani and the families of Shadia’s sisters whose homes were also destroyed have been living in tents in the Nuseirat refugee camp.

Throughout the war, Shadia has remained for days at a time in her and Karam’s room, nauseous from chemotherapy and overwhelmed with anxiety.

“I became homeless and I am sick, and I am unable to bear these difficult circumstances,” she said.

Without any improvement to her condition, Shadia, like many other residents, is looking at possible options for asylum or medical visas in Europe.

Although Shadia often stays indoors, she and other patients feel confined with outings mostly limited to shuttling between the hotel and Istishari Hospital. Many struggle with boredom.

“It feels like we’re in a prison,” Maha explained.

Since the residents have Gaza IDs, they cannot cross Israeli checkpoints in the occupied West Bank to enter other cities without risking detainment by Israeli forces, effectively trapping them in Ramallah.

Though residents say they try to keep each other company, they talk about their communities back home with a sense of longing, finding it easier to share memories of Gaza before the war than to talk about the situation today.

“The barbecues and picnics on the beach together!” exclaimed Karam one day in the lobby as others nodded enthusiastically.

“Mashallah! Everyone was just so kind and friendly,” added a gleaming Maha.

Even the usually restrained Ahmed cracked a smile. “In our neighbourhood of Remal [in Gaza City], there was such a friendly atmosphere,” he chimed in. “People would always invite each other over to their houses, even strangers. It’s very different from Ramallah, where everyone just comes here to work.”

The displacement eats away at them all, particularly Shadia. “As a patient, you think of your treatments, your routines, the staff and doctors you get to know, and then you think of Gaza, and you can’t help but feel this alienation, this foreignness, even in Ramallah,” she said heavily. “We are dying slowly in our alienation.”

Worked ‘hard to raise my children right’

The hotel provides a suitable breakfast for the patients that includes bread, fruits and vegetables. For lunch, Shadia and the other guests have received the exact same meal of rice and chicken provided by the PA at the hotel every day for months. It is a topic that elicits headshakes and sighs among the residents. Some patients struggle to eat this food or keep it down. “Someone who is doing chemotherapy cannot eat this,” said Shadia. But residents also feel guilty knowing that their family members in Gaza could for a long time only dream of eating a full meal, let alone meat.

The residents receive infrequent stipends from the PA, but they rarely have spare money, sending what they can to their families in Gaza. “Before the war, the restaurant in the hotel was working,” said Nawaf, who had to lower the cost of coffee from seven shekels to three for his guests. “People came for lunch. But now the [guests], their wallets are tight, so they buy a sandwich, not a meal.”

“We’re barely surviving, and we cannot even help [our families],” Shadia said. She and Karam often save food from breakfast to eat at dinner.

With patients generally too sick to work, family members like Karam have tried to find work in Ramallah to support their families. While some have found employment with the PA, local businesses are largely wary of hiring Palestinians from Gaza, fearing trouble if there is an unexpected Israeli military raid. “I’ve gone to restaurants, supermarkets, anywhere I thought I could get a job, but they all refused,” Karam explained.

Throughout, many grapple with what and who, should it become possible for them to travel, awaits them in Gaza. They worry, too, that if they are able to return, they will lose access to medical care.

Mohammed al-Assali, a portly 59-year-old, often shuffles around the lobby joining conversations among guests to talk about the Egyptian football he avidly follows, or crack jokes.

He sat down slowly on one of the couches in the lobby. Prayer beads dangled from his stiff left hand.

Mohammed has no one left in Gaza to return to. His entire family was killed during the war, leaving him alone in the world.

Mohammad had come to Israel as a labourer to paint houses just two days before the war started. When the war started, he fled across the Green Line to the occupied West Bank. He registered with the PA’s Ministry of Labour, which placed him in cheap student housing in Jericho.

In November 2023, his family fled their home in Gaza City’s Remal neighbourhood to take refuge in a house they believed to be safer. Then, that house was bombed, killing his wife, their seven children, and all 10 of his siblings.

Upon learning the devastating news, Mohammad had a stroke. He was rushed to the emergency room and then transferred to Istishari Hospital, where he had surgery.

“I underwent open heart surgery due to the intense grief after my family was killed,” Mohammed said.

The stroke left Mohammad with slight paralysis in his left hand and leg, which has prevented him from resuming work or wandering outside the hotel much. He spends the day in his room or speaking with other guests.

As the war proceeded, Mohammed, guests in the hotel say, would tell others that when there was a ceasefire, he would hand out sweets in the street. But when the deal between Israel and Hamas was reached, Mohammed stayed in his room for two days straight, crying in grief.

“I worked really hard to raise my children right and make good people out of them. Three of them were engineers, and two were lawyers,” he explained in his calm, deep voice. “But now, they are all martyred, our houses are destroyed, and I have nothing there.

“I don’t know why I would go back to Gaza.”

‘Built for the whole society’

Ahmed spends his days in Ramallah in his and Maha’s room pouring through an engineering book, drafting plans to rebuild Gaza, and visiting the mosque.

When the couple first arrived at the Retno, Ahmed kept to himself with Maha doing the talking for the couple. But spending more than a year living under the same roof with other guests has forced him to interact during encounters at breakfast, in the hotel lobby, or while sharing taxis and buses to and from the hospital.

“You have a lot of interactions that you are forced to engage with, and to make pleasantries,” said Ahmed, shrugging his shoulders. “And so I was forced to engage and be part of a community.”

“Some of the people I like, and you get to talking about family or news or sports,” he mused. “Other people are annoying, loud or needy. But you just learn to deal with them.”

But most of the time, he likes to be on his own, studying mathematics and physics. “I don’t like to read literature or science fiction,” Ahmed said pointedly. “I like to deal with reality.”

Even as a child, Ahmed dreamed of building structures that could benefit people.

In each of the four wars between 2008 and 2021 to befall the besieged Gaza Strip, Ahmed played a pivotal role in reconstruction. He spearheaded the building of infrastructure like al-Shifa Hospital’s surgical wing, Gaza City’s sanitation system and buildings along al-Rashid Street in an area which has since been levelled completely to create the Netzarim Corridor, a heavily fortified Israeli military zone built during the war that until recently effectively separated northern Gaza from southern Gaza.

“The saddest moment in my life wasn’t my own home being destroyed,” said Ahmed, referring to the recent war. “It was when they destroyed these major public places that I helped build — schools and hospitals. Those were built for the whole society, not just for me.”

Throughout the war, Ahmed has battled a rare form of leukaemia affecting his stomach. He requires an injection which he can only get in Ramallah.

Still, Ahmed and Maha are among those who yearn to return to Gaza, even if they have little faith in the ceasefire holding past its first phase, which finished on March 1. There is still no coordination by authorities to facilitate a return to Gaza for Palestinians stuck in the occupied West Bank, and it is unclear if or when it will become possible.

“I want to go back, and I am not hesitant to say that,” said Maha firmly shortly after the ceasefire deal was announced on January 15, as she and Ahmed sat alone one evening in the lobby. “It’s just our destiny if anything happens to us after that. But we need to go back.”

While people were celebrating on Ramallah’s streets — waving flags, chanting and handing out sweets — the reaction in the hotel was muted.

Key sticking points between Israel and Hamas — including who will administer the Gaza Strip in the future — were left to be resolved in negotiations during the envisaged three-part ceasefire. Israeli Prime Minister Benjamin Netanyahu has said Israel reserves the right to resume the war, calling the first phase a “temporary ceasefire”.

“This war is not going to end,” said Ahmed. “Both sides are going to keep [fighting]. But no one goes back to Gaza thinking that all things just end. They don’t.”

“This is how life is in Gaza,” said Maha, a mother of five children and grandmother to 19, with a wistful smile and a shrug of her shoulders.

‘Born to rebuild Gaza’

Maha and Ahmed’s home in Remal was once the gathering place for their tightly knit family and Maha would prepare feasts of kabsa, maqlooba, and maftool.

During the war, the couple’s house was destroyed along with those of their five children who survived the bombardment with their families.

The long separation has been painful. “The most difficult thing is living without the children, because they are our only hope,” Maha said, her voice cracking.

She is desperate to live in a home again. “If you stay in a hotel for more than a week, you’re going to go crazy,” exclaimed Maha as she threw up her hands in exasperation. “I just want to be in a home. This is not a home!”

Maha has tried to cope with the separation and displacement by focusing on helping her husband. In October 2021, doctors at An-Najah Hospital in Nablus told Ahmed’s brother that “there was no benefit from treatment and that it was better for me to stay with my family and await death,” Ahmed recalled. At the time, he was so weak he could barely walk.

But Ahmed kept trying different treatments, eventually discovering the injections. He says the war in Gaza has only motivated him to get better. “It motivates me more to go back and rebuild,” he explained.

Despite the doctors’ earlier prognosis, Ahmed’s condition has improved and stabilised. He is walking well and now mostly goes to the hospital on his own.

Meanwhile, Ahmed’s mind has turned to rebuilding Gaza. He is part of an international network of engineers discussing and mapping out how to reconstruct the enclave, with 69 percent of all structures destroyed or damaged.

For now, his health prevents him from leaving the Retno Hotel, but he is determined to beat his illness.

“I was born to rebuild Gaza,” Ahmed said matter-of-factly. “It’s what I’ve always done.”