The elderly man sits in a wheelchair mounted on a donkey-drawn cart, with an oxygen cylinder and a small fan beside him as he makes his way from his tent in the Al-Mawasi area to the dialysis centre.

“Since January 2024 until now, I have been undergoing dialysis sessions three times a week,” he said. “I suffer a lot because of transportation as I travel in a cart pulled by a donkey under the scorching sun, and thank God, what can we do? I have no other choice.”

Near-daily ordeal

Access to the hospital has become part of his daily struggle, given the destruction of infrastructure, the lack of transportation and the continued difficult humanitarian conditions in the Strip since the Israel-Hamas war erupted 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 widespread damage to health facilities, along with restrictions on the entry of medical supplies, continue to impede the provision of healthcare at a time when patients with chronic diseases need regular, uninterrupted treatment, WHO said.

Mr. Hajji’s suffering reflects the reality for hundreds of kidney failure patients in the Gaza Strip, where obstacles facing health facilities have increased pressure on dialysis services, according to WHO and other UN agencies.

Harsh test of survival

For Mr. Hajji, challenges remain travelling to and from the centre, where the treatment itself becomes a harsh test of survival.

During the journey, his grandson, Saif, has to stop repeatedly to re-attach the wheelchair to the trolley due to the unpaved roads.

“There is great suffering along the way due to the heat of the sun and the rough roads,” his grandson said. “We have to stop every fifty metres 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 trip, his grandson helps him transfer from his wheelchair to a bed at the dialysis centre in the Nasser Medical Complex, where patients line up waiting their turn at the available machines while the medical staff try to cope with increasing numbers and limited resources.

The elder Mr. Hajji then begins his dialysis session as 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 fan with me, and I also need to fill the oxygen cylinder daily,” Mr. Hajji explained.

Lack of equipment

The lack of equipment exacerbates the suffering of patients, said Hamza Abu Raya, one of the centre’s employees.

“We are under a lot of pressure on the dialysis machines, many of which are worn out,” he said. “We also suffer from a shortage of treatment supplies, including bicarbonate, in addition to the unavailability of the drug Eprex for a long time, which increases the suffering of patients.”

Shortages of fuel, spare parts and medical supplies are common, according to the latest reports from the UN Office for the Coordination of Humanitarian Affairs (OCHA). They are compounded by reports warning of the continued spread of infectious diseases and the increasing pressure on existing health facilities.

Meanwhile, health partners continue to operate services to the maximum extent possible.

Another journey home

After the treatment session, Mr. Hajji is returned to his wheelchair.

He then waits outside the hospital gate.

He will take the same donkey-led cart back to his tent, in preparation for yet another journey that is repeated three times every week.