The elderly man sits in a wheelchair mounted on a donkey cart, with an oxygen bottle and a small ventilator at his side as he walks towards the dialysis center from his tent in the Al-Mawasi neighborhood.
“Since January 2024 until today, I have been doing dialysis sessions three times a week,” he said. “I suffer a lot from transportation, as I travel in a donkey cart under the blazing sun, and thank God, what can we do? I have no other choice.”
Almost daily ordeal
Access to the hospital has become part of his daily struggle, given the destruction of infrastructure, the lack of means of transport and the still difficult humanitarian conditions in the Gaza Strip since the start of the war between Israel and Hamas in 2023.
Even with the October 2025 ceasefire, Gaza’s health system is still operating at limited capacity, according to the World Health Organization (WHO).
Israeli attacks and extensive damage to health facilities, as well as restrictions on the entry of medical supplies, continue to hamper the provision of health care at a time when patients with chronic diseases need regular, uninterrupted treatment, WHO said.
Mr Hajji’s suffering reflects the reality of 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.
Tough survival test
For Mr. Hajji, the challenges remain traveling to and from the center, where the treatment itself becomes a tough test of survival.
During the trip, her grandson, Saif, has to stop several times to reattach the wheelchair to the cart due to the unpaved roads.
“There is great suffering along the way because of the heat of the sun and the difficult roads,” his grandson said. “We have to stop every fifty meters to adjust the position of my grandfather’s wheelchair, and we arrive at the hospital exhausted and in immediate need of oxygen.”
Limited resources
After a difficult journey, her grandson helps her move from her wheelchair to a bed at the Nasser Medical Complex’s dialysis center, where patients line up waiting their turn at the available machines while medical staff try to cope with growing numbers and limited resources.
The elder Mr Hajji then begins his dialysis session while a health worker monitors his condition during the treatment, which lasts between three and five hours.
“It is very difficult, especially with the high temperatures, so I had to bring a ventilator with me, and I also have to refill the oxygen cylinder daily,” Mr Hajji explained.
Lack of equipment
The lack of equipment exacerbates patients’ suffering, said Hamza Abu Raya, one of the center’s employees.
“We are under great pressure on dialysis machines, many of which are worn out,” he said. “We also suffer from a shortage of treatment materials, especially bicarbonate, in addition to the unavailability of the drug Eprex for a long period, which increases the suffering of patients.”
Shortages of fuel, spare parts and medical supplies are common, according to the latest reports from the United Nations Office for the Coordination of Humanitarian Affairs (OCHA). These problems are compounded by reports warning of the continued spread of infectious diseases and increasing pressure on existing health facilities.
Meanwhile, health partners continue to operate services where possible.
Another trip home
After the treatment session, Mr. Hajji is returned to his wheelchair.
He then waits outside the hospital door.
He will bring the same donkey cart back to his tent, in preparation for another trip that repeats three times a week.
