The elderly man sits in a wheelchair mounted on a donkey-drawn cart with an oxygen bottle and a small ventilator next to him as he walks from his tent in the Al-Mawasi area to the dialysis center.
“Since January 2024 until now, I have been undergoing dialysis treatment three times a week,” he said. “I suffer much from transportation, traveling in a cart drawn by a donkey under the burning 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 due to the destruction of infrastructure, the lack of transport and the continuing difficult humanitarian conditions in the Strip since the Israel-Hamas war broke out 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, along with restrictions on access to medical supplies, continue to hamper the delivery of health services at a time when patients with chronic diseases need regular, uninterrupted treatment, the WHO said.
Mr. Hajji’s plight mirrors 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 the WHO and other UN agencies.
Hard test for survival
For Mr Hajji, there are still challenges in traveling to and from the centre, where the treatment itself becomes a tough test of survival.
During the journey, his grandson, Saif, has to stop repeatedly to attach 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 rough roads,” said his grandson. “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 trip, his grandson helps him move from his wheelchair to a bed at the dialysis center in the Nasser Medical Complex, where patients queue and wait their turn at the available machines while 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 take a fan with me and I also have to fill the oxygen bottle daily,” Mr Hajji explained.
Lack of equipment
The lack of equipment worsens the patients’ suffering, says Hamza Abu Raya, one of the center’s employees.
“We are under a lot of pressure on the dialysis machines, many of which are worn out,” he said. “We are also suffering from a shortage of treatment materials, including bicarbonate, in addition to the fact that the drug Eprex was not available for a long time, adding to 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 reinforced by reports warning of the continued spread of infectious diseases and the increasing pressure on existing health facilities.
In the meantime, health partners continue to operate services to the maximum extent possible.
Another trip home
After the treatment session, Mr. Hajji is returned to his wheelchair.
Then he waits outside the hospital gate.
He will take the same donkey-led cart back to his tent, in preparation for another journey that is repeated three times each week.
