Gaza's dental crisis: Families forced to choose between treating their teeth and feeding their children

For many families in Gaza, a visit to the dentist is no longer simply about treating a painful tooth. It has become a question of whether they can afford to pay for treatment or whether that money is needed for food, shelter and other basic necessities as Israel's genocidal war continues across the Strip.

As a dentist, I see this every day at the International Dental Centre in Al-Nuseirat refugee camp, one of Gaza's busiest and most crowded camps, where displaced Palestinians are supposed to be safe.

One of the patients I see is 38-year-old Maha El Masry, a mathematics teacher who previously worked on a temporary contract with UNRWA.

When I examine her painful teeth, I can see the exhaustion on her face. But instead of asking whether her teeth can be saved, she asks me one question: how much will the treatment cost?

Maha lost her job after UNRWA contracts were suspended during Israel's war. She has also been displaced from Sheikh Radwan to Deir al-Balah, while several of her teeth have begun causing her severe pain.

"My family partly relies on financial assistance from one of my siblings abroad. But restrictions on banking services and money transfers mean that the money may arrive only once every six months. When it does, it may cover little more than two months of the family's expenses," Maha tells ​​​​​​The New Arab. 

I know that Maha's teeth can still be saved through root canal treatment followed by crowns, but the estimated cost is around $1,200.

For her, that is far beyond what she can afford. "I am forced to consider a cheaper alternative: extraction," Maha notes. 

'My daughters come first'

Maha's situation is similar to that of many other patients in Gaza. They come to the clinic needing treatment, but the cost forces them to think about what else their families need before deciding whether they can afford to save a tooth.

Forty-year-old Mahmoud Al Ataar from Al-Nuseirat lost his front teeth, from canine to canine, as a result of the war and needed urgent dental treatment.

He required dental implants, which cost around $4,000, or a fixed bridge costing about $1,650, but neither option was possible for him.

When Mahmoud learned how much the treatment would cost, he knew he had to put his family first.

"My daughters come first, and keeping a roof over their heads to shelter and protect them is all that matters to me," he says. 

In the end, Mahmoud chose a removable denture costing around $165. Its quality does not match that of a fixed bridge, but it improved his appearance and helped him eat. It was the option he could afford in his family's circumstances.

Even getting the denture was not straightforward. One of the few dental laboratories still operating needed plaster and acrylic, two materials that have become very difficult to obtain. It took about two weeks just to find them.

Before Israel's war, the same denture cost around $100 and could be completed in about five days.

The problems Mahmoud faced with his teeth are also part of a much wider struggle. His house was damaged in a previous bombardment, and he suffered an injury that led to the amputation of several of his fingers.

After part of his home was destroyed, Mahmoud initially moved into a tent. The harsh conditions eventually led him to repair what he could of the house and cover it with tarpaulins.

"They provide my family and me with much better protection than staying in a fragile tent," Mahmoud explains. 

Mahmoud has two daughters, ages 7 and 13, and four sons. With the family struggling financially, he says much of his time is now spent moving between organisations and charities looking for basic assistance.

"I spend my entire days moving between organisations and charities, trying just to secure a food coupon to feed my family," Mahmoud adds. 

For him, paying for dental treatment was another expense to weigh against his family's basic needs.

"The choice was not between treating my teeth or leaving them; it was a critical choice between treating myself or meeting the basic needs of my daughters and family," he says. 

'My grandchildren need milk first'

The same problem is visible with other patients around the besieged enclave, who sometimes choose to treat only the tooth causing the most pain while leaving other dental problems untreated.

One of those patients is 50-year-old Um Ahmed, who needed three dental crowns costing around $500. She did not have enough money to pay for them.

Um Ahmed called her son, Ahmed, before deciding what to do. He told her that the family could not afford the full cost and asked her to treat only the tooth causing her pain, at the lowest possible cost.

She followed his advice and treated just one tooth after her circumstances were taken into account and the price was reduced.

The single tooth was saved, but her other dental problems were left untreated.

For Um Ahmed, the family had more urgent needs. She has been a widow for five years, and her home was bombed during the Israeli invasion of Deir al-Balah, forcing her to flee.

"I didn't have a single shekel to treat my teeth. At the same time, my son Ahmed was struggling to provide milk for his infant and desperately needed to buy a tarpaulin to cover our tent and protect us from the upcoming winter rains. How could I think of my teeth when my grandchildren need milk first?" Um Ahmed shares. 

Um Ahmed now lives in a tent inside a shelter in Al-Nuseirat with her eldest son, Ahmed. Her three married sons all lost their jobs during the war and now rely on working at street stalls to provide for their families.

She has no income herself and relies entirely on the charity of others.

Smiles hidden behind masks

For younger patients, the same financial pressure seems to affect their decisions about dental treatment.

One of them is 30-year-old Fedaa, who needed cosmetic fillings costing around $330. When she learned the price, she decided she could not afford the treatment.

"When they told me the cost, I was shocked. This amount would require about two months of hard, continuous work for me to save. My siblings are far more important than my teeth and my appearance. Putting them before myself is not a sacrifice; it is my duty. Now, I prefer to wear a mask all the time to hide my smile rather than deprive them of anything," Fedaa says.

Fedaa lost both of her parents during the war and is now responsible for her younger siblings. She lives in a tent in the Mawasi Khan Younis area with three of them, aged between 14 and 20.

She does not have a high school diploma, so she found work at a hairdresser's to help support her siblings.

She receives some limited assistance from her uncle, who also supports his own family. This means the money Fedaa earns from working is spent on feeding and clothing her siblings.

For Fedaa, spending money on cosmetic dental treatment is therefore not something she can justify.

A severe shortage of supplies in clinics

The stories of Maha, Mahmoud, Um Ahmed, and Fedaa show how difficult it has become for families to afford dental care. But the problem is not only the lack of money.

Inside Gaza's dental clinics, I am also dealing with shortages of materials, damaged facilities and rising costs.

Since Israel's war began, I have watched the cost of dental treatment rise sharply at my dental centre in Al-Nuseirat camp.

The rise in treatment costs is directly linked to the severe restrictions on the import of dental materials into the Gaza Strip.

Since the beginning of the war, new supplies of dental materials have been largely blocked by Israeli authorities from entering the Strip, leaving dentists to rely on what was already available before.

The supplies have also been affected by poor storage conditions, damage to dental supply warehouses and the destruction of facilities.

Together, these problems have reduced the amount of usable material by nearly half.

This shortage is evident in the cost of even basic dental treatment. A filling that once cost between $23 and $33 now costs between $66 and $83, while root canal treatment has risen from around $33 to approximately $100.

As prices have gone up, fewer patients have been able to afford treatment. The number of patients coming to my clinic has fallen to around a quarter of what it was before Israel's war. 

The financial pressure has also affected the dental centre itself. I struggle to pay staff salaries, while some dentists have left their jobs to look for other sources of income.

The dentists who have stayed have also seen their share of earnings fall. In some months, fixed prosthetic treatments had to be halted because dental laboratories could not operate or obtain materials such as zirconia, acrylic, and dental plaster.

The clinic itself has also been damaged. A nearby bombing damaged the premises, leaving dental chairs and other equipment unusable.

These shortages affect the treatment patients receive. What their teeth need is only part of the decision; what they can afford has become just as important.

The remaining supplies are also being used by licensed dentists and dental students from Al-Azhar University and the University of Palestine.

With so many people relying on the same limited stock, the materials have become increasingly hard to find.

Some dentists have tried to bring supplies in from outside the Gaza Strip. But these materials often have to be obtained through expensive arrangements, and suppliers sell them to dentists at prices far higher than before the war.

The higher cost then reaches patients. Dentists have to pass on a significant part of the increase, which pushes up treatment fees and makes procedures that were once routine too expensive for many people.

The result is a chain of problems: restrictions limit supply, shortages drive up prices, and patients end up bearing the financial burden.

Ultimately, as a dentist working in Gaza, I see how the war has turned dental care from a basic need into a luxury, with patients delaying treatment, choosing cheaper options or living with pain because food and shelter come first, leaving me to see not only damaged teeth but also the economic and psychological scars of war.

For many of these patients, the shortage of dental materials and rising costs are forcing them to live with problems that could otherwise be treated, as families are left choosing between looking after their health and simply having enough to survive.

Dr Liza Hassouna is a dentist and writer based in the Gaza Strip. She has previously worked with UNRWA and now practices at a dental centre. She has also written for Al Jazeera Blogs, documenting the human toll of the war on healthcare in Gaza