olivia-hartono
At Al-Aqsa Martyrs Hospital in Deir el-Balah, central Gaza, the laboratory department has become a gatekeeper to survival. Bassem Hassan, who heads the unit, oversees tests that determine how doctors will treat conditions ranging from kidney disease to diabetes. Without those results, physicians lose the essential data they need to choose medications, adjust dosages and decide which patients require immediate intervention.
The problem is not a lack of skill or commitment. It is a lack of almost everything else. According to Hassan, the laboratory has suspended all blood gas testing, a service that is especially critical for cardiac and intensive-care patients. Shortages of blood-collection tubes have undermined routine clinical chemistry work, while automated analysers that laboratories depend on for more than 60 percent of their testing have stopped functioning. Sterilisation equipment and refrigerators used to store blood and plasma have also failed.
The result is a system of triage that extends far beyond the emergency room. Hassan explained that tests are now allocated according to the severity of each case, with kidney, cancer and heart patients, along with those in intensive care, receiving priority. Everyone else risks being pushed to the back of a queue that never seems to move forward.
Marwan Al-Azaiza, who leads the cardiology department at the same hospital, described the practical consequences. When public hospitals cannot provide the necessary tests, doctors sometimes refer patients to private laboratories, but only if those patients can afford the added cost. In other cases, physicians fall back on clinical examinations, electrocardiograms and whatever indicators remain available, even though these methods cannot fully replace the tests needed to confirm or rule out a diagnosis.
The scale of the damage is staggering. As the third anniversary of the war on Gaza approaches, more than three-quarters of medical imaging equipment in the enclave is out of service. Laboratory testing materials face an 87 percent shortage, and there is a 74 percent deficit in essential consumables required for laboratory and diagnostic work. Only five of Gaza’s 18 CT scanners remain operational, and those that still function are being pushed far beyond their intended capacity. No magnetic resonance imaging services exist at all, after nine MRI machines were destroyed in Israeli attacks.
Gaza’s ministry of health has warned that blood banks and laboratories risk shutting down entirely if equipment continues to break down and supplies remain unavailable. Such a collapse would hit hardest those with electrolyte imbalances, dangerously high potassium levels, impaired kidney function and heart disease — patients whose survival often depends on rapid, accurate test results.
Mohammed Abu Salmiya, director of al-Shifa Hospital in Gaza City, said medical teams have been forced to restrict laboratory tests, X-rays and CT scans to the most urgent cases. He described a reality in which doctors must choose between patients, deciding whose test cannot wait and whose can be postponed. Although this approach is unavoidable under current conditions, he noted, it leaves many patients on waiting lists with diagnostic delays even when testing is needed to identify their condition or monitor their treatment.
For patients with chronic illnesses, the uncertainty is a daily companion. Yousef al-Athamneh, 57, from Deir el-Balah, suffers from kidney failure and needs dialysis three times a week. He worries constantly about shortages of bicarbonate, bloodlines, dialysis machines, intravenous fluids and other supplies required for his sessions. His greatest fear, he said, is that dialysis materials will run out or a machine will break down while replacement parts are unavailable, leaving him unable to access the treatment that keeps him alive.
The human cost of these shortages is measured not only in delayed diagnoses but in the erosion of trust between patients and a health system that can no longer promise reliable care. Doctors know that laboratory results are essential for determining correct medication dosages, tracking how patients respond to treatment and making urgent medical decisions. Without that information, they are left without a key part of the puzzle that can determine whether a patient lives or dies.
Medical teams are trying to coordinate with charities, health organisations and relief institutions to broaden care for Gaza’s population. But these efforts cannot substitute for a functioning diagnostic infrastructure. The suspension of blood gas testing and the failure of clinical chemistry analysers mean that even common conditions can go unmonitored until they become emergencies.
The implications extend beyond individual cases. When diagnostic capacity collapses, hospitals cannot reliably track disease outbreaks, manage chronic conditions or conduct the routine surveillance that protects public health. Cancer patients may miss the tests needed to assess whether treatment is working. Cardiac patients may receive medications without the laboratory data that would allow doctors to fine-tune dosages. Kidney patients may arrive for dialysis without knowing whether their electrolyte levels are dangerously unbalanced.
For now, doctors in Gaza are making impossible choices with the tools they have left. They prioritise the sickest patients, hope that equipment holds together for another day and ask relief organisations to fill gaps that grow wider by the week. Al-Athamneh’s plea reflects the broader reality: patients are not asking for advanced medicine, only for the basic necessities that would allow them to receive care with some assurance that they will survive it.
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