Inside the Ramallah hotel housing Gaza’s cancer patients

In Ramallah, in the occupied West Bank, a shadow of loss and sorrow has hung over the granite-laid hallways of the Retno Hotel for more than 16 months. The family-run hotel was nearly full on the evening of October 6, 2023. Of the roughly 70 guests, a handful were Palestinian-Americans, but most were from Gaza. They expected to return home soon, bringing only enough clothes for a week.

Among them were 72-year-old civil engineer Ahmed Ayyash from Gaza City and his 62-year-old wife, Maha, as well as 44-year-old Shadia Abu Murrahil from Deir al-Balah and her 25-year-old son, Karam. Like most of the guests from Gaza, they were regulars at the unassuming limestone building, which houses 45 rooms with double or triple beds. What drew them in wasn’t the quiet streets of northern Ramallah, nor the small courtyard out front, furnished with plastic tables and chairs, although on sunny days, guests would sometimes drink coffee there near the bright canopy of bougainvillea.

They came to receive medical care unavailable in Gaza, including treatment for cancer, heart conditions, and developmental disabilities. Both Ahmed and Shadia suffered from leukemia. They would travel from northern Gaza to Ramallah through the Beit Hanoun crossing (known to Israelis as the Erez crossing), which is managed by the Israeli military. They would stay at the hotel for a few days, receive treatment, and then return to Gaza. Relatives often accompanied them. Some had been doing this for years. For Ahmed and Maha, these medical trips also provided an opportunity to visit the Al-Aqsa Mosque in occupied East Jerusalem and enjoy knafeh with friends in Nablus, 50 kilometers (31 miles) away.

October 6, 2023, was a quiet day, a Friday. Most businesses in Ramallah were closed, and many of the Retno Hotel’s guests paused their treatments. Ahmed and Maha, married for 44 years, went to a nearby mosque to pray. They had arrived in Ramallah the day before, purchasing bread, cheese, chocolate, fruits, and vegetables to sustain them during their stay. After returning to the hotel that evening, they ate dinner in the restaurant and chatted with the other guests before going to sleep.

When they woke up the next morning, everything had changed. In the days following the Hamas-led attacks in southern Israel, Israel launched a massive bombardment of the Gaza Strip and cut off supplies of food, water, and electricity. The Palestinian-American guests at the hotel fled. Those who remained, including the hospitalized patients and their families, anxiously awaited news from Gaza. Phone service was disrupted, and many were unable to reach loved ones back home. Some huddled in the hotel owner’s office watching televised developments, wondering what the rapidly escalating war meant for their families and their treatments. Ahmed stayed in his room watching the news and scrolling through updates from journalists in Gaza via Telegram. In the sporadic moments when phone service was restored, guests who managed to reach relatives would share what they learned with the others. Others were never able to get through.

“During the first month of the war, some of the guests lost their children, and I heard news about the martyrdom of many of my family members, like my cousin and the children of my wife, and my cousin and her husband … and their children, and some friends,” Ahmed recalled. “Bad news kept coming.”

Since 2017, the Retno Hotel had been providing accommodation for patients from Gaza and their families who were receiving medical visits at the Istishari Hospital, located just a 10-minute taxi ride away. It was part of a network of accommodations, mainly hotels, but also residences such as facilities run by the United Nations Relief and Works Agency (UNRWA), that housed Palestinians who had obtained temporary Israeli permits to leave Gaza for medical treatment in the West Bank, occupied East Jerusalem, and occupied West Bank. The costs of treatment were covered by the Palestinian Authority (PA) Ministry of Health.

For years, Nawwaf Hamed, the 66-year-old owner and manager of the Retno Hotel, had tried to maintain a cheerful atmosphere at the place. The common areas were often filled with music, ranging from Western folk to classical Arabic. Guests would sometimes play instruments that Nawwaf kept in the hotel lobby, including a tabla drum, a guitar, and a qanun (a Middle Eastern stringed instrument). “We would sing, we would dance!” he recalled wistfully. Those joyful evenings had stopped with the COVID-19 lockdowns and never fully returned.

After the war began, the permit arrangements for Gazan patients quickly collapsed. Patients in Jerusalem hospitals had to leave, fleeing to the occupied West Bank, where they scrambled to register with the PA and find new hospitals. No one was able to return to Gaza. “People were very afraid of the future,” Nawwaf recalled of his guests.

Today, 400 patients from Gaza are registered with the PA, some of whom are staying in Ramallah, as well as Hebron, 60 kilometers (37 miles) to the south, and Nablus and Jenin, less than 100 kilometers (62 miles) to the north. Over the months, more and more patients moved into the Retno Hotel. Today, it is the temporary home of 33 adult and 14 child patients, as well as 37 family members. Since the start of the war, seven hotel patients have died from their illnesses. As others continue to struggle with their health, their family members have been killed, and their homes and former lives destroyed.

On an afternoon in November, Shadia sat on a light gray sofa in the corner of the hotel lobby, where many of the guests congregated. “What the war has done to my family, to my home, to my Gaza, pains me more every day than the cancer,” she sighed.

As frail residents emerged from the elevator, they greeted one another before heading to shared taxis that would take them to the hospital. A shuttle would drop them back off later in the day. Karam, his hair neatly combed and his beard trimmed, sat beside his mother, his hands resting gently in his lap. Nearby, Ahmed, wearing a blue sweater and a green button-down shirt, slouched in a chair, while Maha smiled warmly at passing residents. Other guests stopped to ask the front desk attendant, a woman in her 30s, for clean towels or to complain about the noise coming from neighboring rooms at night.

“Our emotions are all [in Gaza], and it affects every moment of our lives,” a weary Shadia said. “I’m already tired and sick from the cancer treatment. Our thoughts about the future, about continuing day after day, are overshadowed not only by our own life-threatening illnesses but also by the utter destruction that has befallen our homes, our families, and our community in Gaza.”

Nawwaf, a stout man who often wears reading glasses attached to a lanyard, runs the family business each day, pausing to chat with his guests. When he is in his small office, which is just off the lobby, Nawwaf peers through the glass door to see who is there and motions for them to come in for coffee. He has arranged the black leather sofas in his office in a semicircle around a table to make the place more inviting. Guests come to discuss their treatments or watch the news on television. On cold winter nights, they come to sit by the fireplace. Some want to chat late into the night, while others want to sit in silence.

On a sunny afternoon, as Nawwaf sat in the courtyard drinking Arabic coffee, Ahmed walked over. He greeted the older man, taking his hand and asking, “How are you, my friend?” “May you be well,” Ahmed replied with a faint smile, before heading inside. “May you have good health,” Nawwaf called after him. “That man is a great civil engineer from Gaza!” Nawwaf said, gesturing toward Ahmed’s disappearing figure in the entranceway. As other guests walked by, Nawwaf boomed “Hello” and shook their hands.

Nawwaf and his father, Nayef, began building the hotel in 2000 and opened it four years later. They ran the hotel together until Nayef passed away two years ago. All 11 of Nawwaf’s siblings are involved in the family business, as are his two daughters, who are in their 20s and early 30s, who help with administrative tasks. With the war grinding tourism to a halt and restricting travel, most hotels in the West Bank are nearly empty. The Retno Hotel is a rare exception. But even with all the occupants, the hotel is facing financial pressures. Although the PA covers the costs of accommodation for the patients, Nawwaf said that these payments have become erratic since Israel began withholding tax revenues from the PA last April. “Each week, we are struggling to figure out how to pay the bills for the next week,” he explained, sitting in the courtyard, which is filled with potted citrus trees. “We don’t know what to do, how to buy money for breakfast. The workers haven’t received [normal] salaries [since June],” he said, referring to his 20 employees.

Starting with the serving of breakfast, Nawwaf juggles the operation of the hotel while listening to the residents’ concerns, such as a broken lightbulb or a problem with the toilet in their room. Over time, he has seen some of the guests grow restless. Some have become aggressive. Others worry that, after 16 months of free lodging, the arrangement won’t last. “Some of them don’t let us clean their rooms,” Nawwaf explained. “They think we are just using this as an excuse to actually kick them out.”

He tries to reassure the patients, occasionally bringing in representatives from the PA or nongovernmental organizations to provide psychosocial services or even drama classes. “Usually, we don’t talk about politics,” he said. Sometimes he jokingly suggests that single male patients get married, saying they wouldn’t be so lonely. “If it doesn’t work out, maybe [the PA] will allocate them [a wife],” he added with a laugh.

Nawwaf often tries to lift his guests’ spirits with humor. On February 4, when the Israeli army came to the Ramallah neighborhood where the Retno Hotel is located, he asked me over the phone, “What do you think they want? Sharafat or Shawarama?” But as the war has continued, desperation has grown among Nawwaf’s guests. “They are under a lot of pressure because they are always waiting for [bad] news,” he reflected, his tone growing somber. “No one is even talking about happy things. It’s just — they are crying.”

Nawwaf leaned back in his chair and gazed out at the empty street. “At night, in the hallways, you are walking, and it is quiet, and you only hear people crying,” he said slowly, taking a sip of his coffee. He sighed. “It’s really a hard experience.” While he tries to stay positive, when the atmosphere at the hotel becomes too heavy, “I sometimes go to my office, [and then] I close the door, just to laugh,” Nawwaf explained. He isn’t laughing at anything in particular; it’s just his way of coping with the stress. Then, he might put on some Mozart to relax.

Shadia and Karam have done their best to make their shared room at the Retno Hotel feel more like home. A small donated rug, dark in color and featuring geometric patterns, sits in the center of the three-meter-by-three-meter (10-foot-by-10-foot) room. On the dresser, an electric kettle waits, filled with water, to prepare Arabic coffee. But it is a far cry from their home near the beach in Deir al-Balah. It was only a year old before the war, with marble floors, chandeliers, and brand-new furniture. “There were palm trees and olive trees around our house,” Shadia recalled, sitting on Karam’s bed. “The people next to us planted cabbage, peas, and cauliflower. When we looked outside, you would only see green spaces and all the beauty.” Now, at the Retno Hotel, the blinds block the view of Ramallah’s limestone apartment buildings, vacant lots, and back roads.

In Gaza, Karam spent time in the family garden outside and at the nearby beach. As an only child, he has always been close to his mother. “It’s her and my father, and that’s it, that’s what I have,” Karam said. “I don’t feel that she is just my mother,” he added softly. “She is my friend and my brother. We go out together. In Gaza, we would go to the beach together. I spend more time with her than even my friends.” Shadia looked at her son and smiled. She speaks often in an anxious voice, suffering from joint pain, nausea, fatigue, and dizziness, but she becomes radiant when talking about her son.

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

In 2014, Shadia began experiencing severe pain in her back and joints. For years, doctors misdiagnosed her condition, saying at different points that she had a slipped disc or even that she was imagining the debilitating pain. “The painkillers they gave me temporarily numbed the pain, but then it would only come back more intensely,” she recalled. Finally, in 2022, she was diagnosed with leukemia. “It was like a lightning bolt hit [Karam] and me,” Shadia said, “because the thought that I might lose my life and leave him alone, especially considering he has no siblings to take care of him, threw me into a state of extreme depression for more than a year.”

Shadia began coming to Ramallah for treatment. Her sister and Karam took turns accompanying her. She had to undergo various treatments to try to find the right one and suffered from kidney failure and other organ dysfunction. Starting a regimen of oral chemotherapy months before the war, Shadia was supposed to maintain a strict diet, limiting the fruits and vegetables she could eat, and needed to avoid eating for two hours before and after taking the medication twice a day.

Shadia admitted that even though she had come to terms with her illness, the stress of the war has made everything more difficult. “Any bad news that comes from Gaza, I feel it as physical pain,” she said. The debilitating pain means that she moves slowly when sitting or standing. “Of course, the medication is not [working] as it should, and the [medical] tests [results] are bad because of the impact the war in Gaza has had on me.”

Last August, an Israeli rocket destroyed their family home. Karam’s father, Hani, had already fled. Karam recalled his mother “crying hysterically and refusing to answer any phone calls from her family in Gaza.” “She sat in the room for a week, not talking to anyone, because our house was destroyed.”

Shadia refused to leave, even to go to her hospital appointments. Karam stayed with her, trying to cheer her up by showing her funny videos on his phone and making sure she ate. “It’s not just happening to us,” Karam tried to console his grief-stricken mother. “We didn’t lose any children or a partner, and everything is fine.” “The most important thing is your health,” he kept telling her. “If your health is good, everything is easy. We have to accept it, and God willing, we will have something better.” “We have been repeating these words to ourselves,” Shadia said.

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 have also been destroyed) have been living in tents in the Nuseirat refugee camp. Throughout the war, Shadia has spent days at a time inside her and Karam’s room, feeling nauseated from the chemotherapy and overwhelmed by anxiety. “I became homeless, and I am sick, and I can’t endure these difficult circumstances,” she said.

With her condition showing no signs of improvement, Shadia, like many of the other residents, is looking into the possibility of obtaining asylum or a medical visa in Europe. Although Shadia often stays inside, she and the other patients feel confined, with outings mainly limited to trips between the hotel and the Istishari Hospital. Many struggle with boredom. “It feels like we are in prison,” Maha explained.

Because the residents hold Gazan IDs, they cannot travel through Israeli checkpoints in the occupied West Bank to other cities without the risk of detention by the Israeli military, effectively trapping them in Ramallah. While the residents say they try to keep one another company, they speak of their communities back home with a sense of longing, finding it easier to share memories of prewar Gaza than to talk about the current situation. “Barbecues and picnics together on the beach!” Karam exclaimed one day in the lobby, as others nodded enthusiastically. “God bless! Everyone was very kind and friendly,” a radiant Maha added.

Even the normally reserved Ahmed cracked a smile. “In our neighborhood of Rimal in Gaza City, there was a very friendly atmosphere,” he interjected. “People were always inviting each other to their homes, even strangers. It’s very different than here in Ramallah, where everyone is just coming to work.”

This sense of displacement gnaws at them all, especially Shadia. “As a patient, you think about your treatment, your daily routine, the staff and doctors you know, and then you think about Gaza, and you can’t help but feel this sense of alienation, this sense of being a stranger, even in Ramallah,” she said heavily. “We are slowly dying in alienation.”

The hotel provides the patients with a suitable breakfast, including bread, fruits, and vegetables. For lunch, Shadia and the other guests receive the exact same meal of rice and chicken provided by the PA at the hotel each day, a situation that has been going on for months. It’s a topic that elicits headshakes and sighs from the residents. Some patients have a hard time swallowing the food or keeping it down. “People undergoing chemotherapy can’t eat this,” Shadia said. But the residents also feel guilty because they know that their families in Gaza can only dream of having a full meal, let alone meat, for a very long time.

The residents receive stipends from the PA on an irregular basis, but they rarely have any money to spare and send what they can to their families in Gaza. “Before the war, the hotel’s restaurant was open,” Nawwaf said, adding that he had to lower the price of coffee from 7 shekels to 3 shekels to accommodate his guests. “People would come for lunch. But now [the guests’] wallets are tight, so they buy a sandwich instead of a meal.” “We are barely surviving and can’t even help [our families],” Shadia said. She and Karam often save food from breakfast to eat for dinner.

Because the patients are often too sick to work, family members like Karam have tried to find work in Ramallah to support their families. While some have found jobs with the PA, local businesses are mostly wary of hiring Palestinians from Gaza, fearing trouble in the event of an unexpected Israeli military raid. “I have gone to restaurants, supermarkets, anywhere I thought I could find work, but they all refused,” Karam explained.

All the while, many have been grappling with what and who awaits them in Gaza, should they ever have the opportunity to travel. They also worry that if they are able to return, they will lose access to health care.

Mohammed Assali, a heavyset 59-year-old, often paces the lobby, joining conversations among the guests to talk about his passion for Egyptian soccer or to crack jokes. He slowly lowered himself onto a sofa in the lobby. Prayer beads dangled from his stiff left hand.

Mohammed has no family left to return to in Gaza. His entire family was killed in the war, leaving him alone in the world. Mohammed had come to Israel two days before the war to work as a laborer painting houses. After the war began, he crossed the Green Line to flee to the occupied West Bank. He registered with the PA’s Ministry of Labor, which housed him in a cheap student dormitory in Jericho.

In November 2023, his family fled their home in the Rimal neighborhood of Gaza City to take shelter in a house they thought was safer. Then, that house was bombed, killing his wife, their seven children, and all 10 of his siblings. After learning the devastating news, Mohammed suffered a stroke. He was rushed to the emergency room and then transferred to the Istishari Hospital, where he underwent surgery. “Because of the extreme grief after my family was killed, I had open-heart surgery,” Mohammed said.

The stroke left Mohammed with slight paralysis in his left hand and leg, making it impossible for him to return to work or to get around outside the hotel. He spends his days inside his room or talking with the other guests. Guests at the hotel said that as the war dragged on, Mohammed would tell others that when there was a ceasefire, he would hand out sweets in the street. But when Israel and Hamas reached an agreement, Mohammed stayed in his room for two days, crying inconsolably.

“I worked so hard to raise my children and make them good people. Three of them were engineers, and two were lawyers,” he explained in a calm, low voice. “But now, they are all martyrs, and our house is destroyed, and I have nothing there.” “I don’t know why I would return to Gaza.”

During his days in Ramallah, Ahmed has been spending his time in his and Maha’s room poring over an engineering textbook, drafting plans to rebuild Gaza, and going to the mosque. When the couple first arrived at the Retno Hotel, Ahmed kept to himself, with Maha doing the talking for the couple. But living under the same roof as the other guests for more than a year has forced him to interact with them at breakfast, in the hotel lobby, or in the taxis and buses to and from the hospital. “You have a lot of forced interactions and have to say polite things,” Ahmed said with a shrug. “So I was forced to participate and be part of the community.”

“Some people I like, and you start talking about family, the news, or sports,” he said thoughtfully. “Others are annoying, loud, or need help. But you just learn to deal with them.” But most of the time, he prefers to be alone, studying math and physics. “I don’t like to read literature or science fiction,” Ahmed stated plainly. “I like to deal with reality.”

Even as a child, Ahmed dreamed of building structures that would benefit people. During the four wars that struck the besieged Gaza Strip between 2008 and 2021, Ahmed played a critical role in the reconstruction. He spearheaded the building of infrastructure such as the surgical wing of Shifa Hospital, the sanitation system in Gaza City, and buildings along Rashid Street, an area that has since been completely razed to create the Netzarim Corridor, a heavily guarded Israeli military zone built during the war that until recently effectively separated northern Gaza from southern Gaza. “The saddest moment of my life wasn’t when my own home was destroyed,” Ahmed said, referring to the recent war. “It was when they destroyed these major public places that I helped build — the schools and the hospitals. These were built for the entire society, not just for me.”

Throughout the war, Ahmed has been battling a rare form of leukemia that affects his stomach. He requires an injection that is only available in Ramallah. Still, Ahmed and Maha are eager to return to Gaza, even though they have little confidence that the ceasefire will last beyond the first phase, which ended on March 1. Authorities have not coordinated to facilitate the return of Palestinians stranded in the occupied West Bank to Gaza, and it is unclear if and when that will be possible.

“I want to go back, and I say this without hesitation,” Maha said firmly shortly after the ceasefire agreement was announced on January 15, as she and Ahmed sat alone in the lobby one evening. “If something happens to us after that, it is just our fate. But we need to go back.”

While people celebrated in the streets of Ramallah — waving flags, chanting slogans, and handing out sweets — the reaction at the hotel was subdued. The key sticking points between Israel and Hamas — including who will govern the Gaza Strip in the future — were left to be resolved in negotiations during the envisioned three-part ceasefire. Israeli Prime Minister Benjamin Netanyahu has said that Israel reserves the right to resume the war, calling the first phase a “temporary ceasefire.” “This war will not end,” Ahmed said. “Both sides will continue [fighting]. But no one who is returning to Gaza thinks that everything will be over. They won’t.” “This is the life in Gaza,” Maha, a mother of five and a grandmother of 19, said with a wistful smile, shrugging her shoulders.

Maha and Ahmed’s home in Rimal used to be a gathering place for their close-knit family, where Maha would prepare feasts of kabsa, maqluba, and maftoul. During the war, the couple’s house, along with those of their five surviving children and their families, was destroyed. The prolonged separation has been agonizing. “The most difficult thing is life without the children because they are our only hope,” Maha said, her voice cracking.

She longs to live in a house again. “If you stay in a hotel for more than a week, you will go crazy,” Maha exclaimed, throwing up her hands in exasperation. “I just want to live in a house. This is not a home!”

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

But Ahmed has been trying different treatments and eventually found an injection that has been working. He said that the war in Gaza has only motivated him to get better. “This is more of an incentive for me to go back and rebuild,” he explained. Despite the earlier poor prognosis from doctors, Ahmed’s condition has improved and stabilized. He walks well and now goes to the hospital on his own most of the time.

Meanwhile, Ahmed’s thoughts have turned to rebuilding Gaza. He is part of a network of international engineers who are discussing and planning how to reconstruct the enclave, where 69 percent of buildings have been destroyed or damaged. For now, his health prevents him from leaving the Retno Hotel, but he is determined to overcome his illness. “I was born to rebuild Gaza,” Ahmed said matter-of-factly. “This is what I have always been doing.”