Deir el-Balah, Gaza Strip – Al Aqsa Martyrs Hospital, the only hospital still functioning in the central Gaza Strip, reached full capacity days ago. Injured people lie on the hospital floors, medical tents and mattresses holding patients occupy the space outside the building, while dead bodies continue to arrive at the facility.

Thousands of displaced Palestinians have taken refuge here, squeezing themselves in corridors and waiting rooms. Meanwhile, many patients with chronic diseases who were being treated at hospitals in the north of the besieged enclave are now at Al Aqsa Martyrs, having fled their homes after evacuation orders from the Israeli military.

For kidney patients, dialysis treatment is a matter of life and death.

Before the latest Israeli offensive began on October 7, the hospital had 143 patients requiring dialysis. Now, the number of patients has more than doubled to about 300, including 11 children who all have just 24 dialysis machines between them.

Iyad Issa Abu Zaher, the hospital’s director general, said the facility is overwhelmed.

“We have resorted to rationing of all resources and medical supplies,” he told Al Jazeera. “A kidney dialysis patient now undergoes treatment once or twice a week for an hour or two, but before they used to come in three times a week.”

Even before the war, Gaza’s health ministry had warned that the lives of 1,100 kidney failure patients, including 38 children, were at risk due to a lack of fuel and an acute shortage of the necessary medical supplies needed for dialysis.

Last month, Alaa Helles, the director of the Hospital Pharmacy Department at Gaza’s Ministry of Health, said the territory’s hospitals provided 13,000 dialysis sessions every month.

This requires more than 13,000 filters, 13,000 blood collection tubes and 26,000 blood cannulas per month, but since Israel and Egypt control the territory’s border crossings, even before the war patients were often left to wonder whether there would be enough supplies to treat them.

The Gaza Strip has been under an Israeli blockade for 16 years with the movement of goods severely curtailed by Israel and Egypt. The blockade has only tightened since October 7, following an attack by the armed wing of the Palestinian group Hamas in southern Israel. So far, only several dozen aid trucks have been allowed in – a “drop in the ocean” in terms of the aid needed. Before the war, some 450 trucks entered daily with supplies.

Breaking point

Abu Zaher said the Gaza Strip’s healthcare system has reached a breaking point, echoing the health ministry’s statement on Tuesday regarding the remaining operating hospitals.

Already, 12 hospitals and 32 health centres have been forced to stop functioning, the ministry statement said. “And we fear that more will stop due to the Israeli targeting and the lack of fuel,” it added.

But keeping the doors of the remaining hospitals in the Gaza Strip open does not in itself mean these facilities are able to treat the wounded who flock to them, the statement said, saying that many medicines and medical supplies have already run out in hospitals.

Abu Zaher said that without fuel, patients in operating rooms, intensive care units, babies being kept alive in incubators and others who rely on lifesaving machines are all at risk.

“Patients are stacked outside operating rooms as we don’t have enough beds,” he said. Meanwhile, others recovering after operations have been moved to the outdoor tents – “a field hospital of sorts,” he explained.

But Abu Zaher also stressed that recovery for patients who have been treated is not guaranteed given that the overcrowded environment and lack of medical supplies can lead to serious infections.

“The outbreak of disease is inevitable,” he said. “There will be a humanitarian disaster after the war ends.”

‘Exhausted from this reality’

Manar Shreir from the Zeitoun neighbourhood in Gaza City used to go to the Al-Quds Hospital for kidney dialysis.

She and her family fled the intense Israeli bombardment of the city and made their way to Deir el-Balah in the central Gaza Strip, where her sister lives, after the Israeli military ordered 1.1 million Palestinians from the north to evacuate to the south.

The Al-Quds Hospital also received warnings from the Israeli military to evacuate, indicating that it could be targeted, the Palestinian Red Crescent has said. The hospital’s director responded to the Israeli military saying a large-scale evacuation would be possible only if Israel provided buses to transport the 12,000 people taking shelter at Al-Quds – including patients – to the southern Gaza Strip and ensured a safe space for them there. The Israeli official reportedly hung up.

But even those like Shreir, who have managed to make it to the south, face a struggle to get treatment.

“My sister’s house [in Deir el-Balah] is close to Al Aqsa Martyrs Hospital, but I still have to queue for hours since the early morning, just waiting [for] my turn,” said Shreir as she sits up in a hospital bed with a red blanket around her legs.

Shreir has been on dialysis since 2015, going to the hospital three times a week for four-hour sessions. Now, she is lucky if she can get dialysis twice a week, for up to two and a half hours per session.

“It’s a huge difference,” she said. “The session is barely enough to get the toxins and accumulated fluids out of my blood. I have to watch what I eat and drink, and I barely let water pass my lips because I don’t want to have shortness of breath or swelling.”

After her last treatment, Shreir was on her way back to her sister’s house when Israeli air attacks hit the street parallel to the one she was on.

“It’s terrifying,” she said. “Even when you are in the hospital you’re scared. Windows have shattered before, the destruction is all around you, not to mention the horrific sound of the bombs. Inside, it’s not any better, with bodies of people killed piled up, blood on the floor, people missing limbs.

“We are exhausted from this reality. Enough criminality, enough war.”

‘Not enough’

Hajj Salah al-Din Ahmed Suleiman Abu Iyadeh, 61, a displaced patient from Gaza City receiving dialysis at Al Aqsa Martyrs Hospital, said that without regular treatment, patients will suffer from severe fatigue and swelling.

“Dialysis that is two and a half hours once or twice a week is not enough,” he said.

“These are toxins in the body which can’t be allowed to stay. Right now, we are making do, but if this war continues, there will be serious problems due to the capacity and immense pressure the hospital is under.”

According to the health ministry, Israeli air attacks have killed 5,791 Palestinians in 18 days, including 2,360 children and 1,292 women. More than 16,000 others have been wounded.

About 1,500 people are trapped under rubble, including 830 children, according to the health ministry.

The Al Aqsa Martyrs Hospital alone has received 2,850 injured people and the bodies of almost 1,000 Palestinians, Abu Zaher said.

“Most of the casualties are men, women and children who were killed inside their own homes after an Israeli air raid targeted their building,” he said.

Staff at the hospital work under constant, tremendous pressure due to the overwhelming health situation as well as their personal circumstances.

“Some of our staff have received news that their families were targeted or killed in Israeli air attacks,” he said. “No hospital in the world operates like this.”