The elderly man sat in a wheelchair attached to a donkey-drawn cart, with an oxygen cylinder and a small fan beside him as he walked from his tent in the Al-Mawasi area to the dialysis center.
“From January 2024 until now, I have had dialysis three times a week,” he said. “I suffered greatly from transportation as I traveled in a donkey-drawn cart under the scorching sun, and thank God, what could we do? I had no other choice.”
Almost daily trials
Access to hospitals has become part of his daily struggle, given the destruction of infrastructure, lack of transportation and difficult humanitarian conditions in the Gaza Strip since the Israel-Hamas war erupted in 2023.
Even with a ceasefire in October 2025, Gaza’s health system is still operating at limited capacity, according to the World Health Organization (WHO).
Israeli attacks and widespread damage to health facilities, as well as restrictions on the entry of medical supplies, continue to hinder the provision of health services at a time when patients with chronic diseases require regular and uninterrupted care, WHO said.
Hajji’s plight reflects the reality faced by hundreds of kidney failure patients in the Gaza Strip, where obstacles facing health facilities have increased pressure on dialysis services, according to the WHO and other UN agencies.
A tough test to survive
For Mr Hajji, challenges remain in traveling to and from the health center, where treatment itself becomes a tough test of survival.
During the journey, his grandson, Saif, had to stop repeatedly to put his wheelchair back on the trolley because the road was not paved.
“There was great suffering along the way because of the hot sun and rough roads,” said his grandson. “We had to stop every fifty meters to adjust my grandfather’s wheelchair, and we arrived at the hospital exhausted and in desperate need of oxygen.”
Limited resources
After a difficult journey, his grandson helped him transfer from a wheelchair to a bed at the dialysis center at the Nasser Medical Complex, where patients queued up to wait their turn at available machines as medical staff struggled to cope with increasing numbers and limited resources.
The older Mr Hajji then began his dialysis session while health workers monitored his condition during the treatment, which lasted between three and five hours.
“It’s very difficult, especially with the high temperatures, so I have to bring a fan, and I also need to fill the oxygen cylinder every day,” explained Pak Hajji.
Lack of equipment
The lack of equipment exacerbates patients’ suffering, said Hamza Abu Raya, one of the center’s employees.
“We have a lot of pressure on dialysis machines, many of which are outdated,” he said. “We are also suffering from a shortage of medication supplies, including bicarbonate, in addition to the prolonged unavailability of the drug Eprex, which adds to the suffering of patients.”
Shortages of fuel, spare parts and medical supplies are common, according to a recent report from the UN Office for the Coordination of Humanitarian Affairs (Ocha). This is exacerbated by reports warning of the continued spread of infectious diseases and increasing pressure on existing health facilities.
Meanwhile, health partners continue to provide services as much as possible.
Another trip home
After the treatment session, Mr Hajji was returned to his wheelchair.
He then waited outside the hospital gate.
He would ride a donkey-led cart back to his tent, in preparation for another journey repeated three times each week.
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