Hatem Jadallah gathers what strength he has left to play with his youngest child.
Mohammed is three and a half, and he runs at his father the moment he returns from his most recent dialysis session at Nasser Medical Complex in Khan Younis, after four hours on the machine. The boy locks his arms around his father's neck, kisses him, and tries to climb him.
Hatem, 44, pretends to hold steady. He is exhausted. He has just walked 300 metres from where the shared car drops him and the other patients to his tent in al-Mawasi.
He lies down almost at once on a worn mattress inside the tent he built himself from wood and thick nylon, after the family's last displacement from central Khan Younis in May 2025. His daughters take over. Mariam is ten, and Leen is eight, and they draw their little brother away to play so their father can rest.
He watches the three of them on the sand outside and thinks about how his health has collapsed.
Hatem was a security guard before Israel's genocide began. He knew he had kidney atrophy and lived with it, managing through a strict diet and a precise drug regimen.
During the war, he lost both, and so began dialysis in August 2024.
"Then I was deprived of most of the medication for my kidneys, my blood pressure, my heart," he tells The New Arab.
"My condition deteriorated. But the greater fear is what happens when they cut the dialysis hours every few months. Imagine that my life is threatened because a substance used to run the dialysis machines is not available."
Two weeks ago, his sessions were cut from four hours to two, and from three a week to two. Normal service resumed only days ago.
He holds up a bag of empty medicine packets. He cannot replace any of them in government or private pharmacies. He has also lost access to filtered water, which helps preserve what kidney function he has left, and sometimes drinks the same untreated water as the rest of his family.
He stops speaking, covers his face, and begins to cry.
His wife Hala, 39, steps in to calm him. She has offered him one of her kidneys. The tests required to establish whether she is a match are not available in Gaza, and neither is transplant surgery. She is waiting for a chance at treatment abroad that she does not expect to come.
"We do not want to lose my husband, and we will care for him by any means," she says. "But the medical capacity in Gaza is limited. He has gone into a coma more than once. His blood dropped to five, and we nearly lost him."
She constantly looks for his medicines but cannot find them. Months pass without him taking them, and the effect is immediate. He cannot move, cannot eat, is permanently exhausted, and faints.
Hala graduated from Al-Aqsa University in Gaza in 2010 with a degree in social studies. When the drugs do appear in commercial pharmacies, she cannot afford them. The family home was destroyed, and their income from farming is gone.
Inside the ward
At Nasser Medical Complex, the same crisis presents differently.
Eman Abu Hattab lies on the dialysis chair, exhaustion across her face, while the nurse Rasha Muhanna checks her blood pressure and adjusts her sodium levels.
She has been given blood units first so that her body can withstand the session, but her haemoglobin has fallen to 4.9. The hormone that maintains it has not been available in Gaza for roughly a year because Israel has not permitted it in. She has also stopped taking her kidney, blood pressure and heart medication.
Eman began dialysis in 2018. Although she is 54, she looks older. Her husband was killed in an Israeli strike on 27 December 2023, and her home was destroyed. She has been displaced from place to place since, and now lives beneath a ruined building.
She describes her present condition as the worst since she started dialysis, because she has come close to dying more than once during the war when the machines could not run for the hours she needed.
"It has happened recently, and it lasted about two weeks," Eman tells The New Arab. "We are exposed to the same scenario again, and to coming close to death again. Shortened dialysis means the toxins stay in our bodies. It is a gradual destruction."
She shares with The New Arab that she sold her gold to pay for a tent and its fittings. "I lost my money trying to have my three other children, and I lost my health with it," she says, crying.
"Now I dream only of keeping them and caring for them, especially my youngest son Ibrahim, who is 14, and my eldest daughter Umayya, who is 32. Both have disabilities."
What she wants is for the sessions to run without the threat of being halved, and for the drugs that hold her condition steady to be allowed in.
"To be a kidney patient in Gaza means you could die at any moment," she says. "There is no alternative to dialysis, and dialysis is not regular."
Twelve hours, then six
Fifty-two-year-old Nahed al-Darhali, a driver until his kidneys failed, began dialysis in December 2023. He has five children: the eldest, Ali, 30, and the youngest, Mahmoud, 15. He is sheltering in a school west of Khan Younis.
"The machine is my life, and if it stops, it means my death," he tells The New Arab. "Reducing the hours or the number of sessions means my condition deteriorates as the toxins build up. That is what happened when my fluid retention passed twelve kilograms, until they put me on emergency sessions to save my life."
He is angry, and his question is direct. "Why does the [Israeli] occupation prevent the entry of the substance that runs the dialysis machines? Is it plausible that it threatens their security? Why do we as patients pay for their decisions with our lives?"
During the months of starvation, he could not obtain the food his condition required. Some of it is in the markets now, and he cannot afford it because he has not worked since he began dialysis.
At Al-Shifa Medical Complex in Gaza City, the numbers are documented.
Dr Ghazi al-Yazji, consultant and head of nephrology and kidney transplantation, shut down 29 of the hospital's 51 dialysis machines two weeks ago because the sodium bicarbonate needed to run them had run out. They restarted recently, with enough of the substance for one month.
To manage, sessions were reduced from three a week to two, and from four hours to two. That applies to 237 patients who are still rotating through the machines. Weekly dialysis time fell from twelve hours to six.
The consequences, he says, are toxin accumulation, fluid in the heart muscle and lungs, loss of appetite and wasting, and all of it raises the death rate.
He is also warning that the current supply will run out in a month because Israel has repeatedly blocked the substance at the crossings.
The rest of the list is long. Too few machines. No spare parts, so any machine that breaks stops permanently. Shortages of consumables and drugs.
"Foremost among them is erythropoietin, which maintains haemoglobin," Dr Ghazi tells The New Arab. "Without it, patients become anaemic, so we are forced to transfuse, which carries its own harm. That hormone has not been available for about a year."
Thyroid medication, calcium, diabetes, blood pressure and heart drugs are all intermittent, all for the same reason.
Dr Ghazi says 700 kidney failure patients remain in Gaza, after 40 percent of the total died during the war. The causes include hospitals going out of service, dialysis stopping altogether, patients being besieged, and continuous displacement.
Kidney transplantation began in Gaza in 2014, through cooperation between local and foreign teams; 135 transplants were performed before Israel’s war on Gaza. All have stopped due to a lack of operating theatres, consumables, drugs, and equipment. Travel out of Gaza is severely limited, so the people waiting are dying while they wait.
"We can barely keep kidney failure patients alive," Dr Ghazi adds.
He is also recording something else. New cases of kidney failure are appearing at a higher rate than before the war, a direct result of chronic disease medication disappearing, weak medical follow-up, and displacement without end.
Mohamed Solaimane is a Gaza-based journalist with bylines in regional and international outlets, focusing on humanitarian and environmental issues
This story was published in collaboration with Egab