Death by dialysis: The slow death of Gaza's kidney patients

More than four months into Israel's ongoing assault on Gaza, the healthcare system has completely collapsed, leading to "sickening scenes" across Gaza's hospitals, according to World Health Organization's Tedros Ghebreyesus.

At the frontline of this aggression are Gaza's kidney failure patients. The British Medical Journal reports that over 1,100 patients are now at risk due to severe fuel shortages of hospital fuel. 

Amidst the backdrop of Israeli war crimes in Gaza, patients with kidney failure are pleading for life-saving dialysis treatment.

One such patient was Abed El Rahman Abu Dalfa, who wrote on Facebook before his death: "It's my right to have dialysis for four hours, three days a week, regardless of the circumstance. Kidney patients like me are facing a slow death, literally."

"Stopping dialysis can result in death within days or weeks. The main cause of death is hyperkalemia (high potassium) which causes cardiac arrest and/or pulmonary edema which causes breathlessness and hypoxia"

Abed, 40, was diagnosed with kidney failure in early 2022, receiving his first treatment of dialysis in the same year. Abed's kidney failure was a culmination of several illnesses, including type 2 diabetes, diagnosed at 15, and Burger's disease which impacts Abed's blood vessels leading to clots.

"As a result of Burger's disease, Abed suffered from tissue decay which meant his leg was amputated and was given a prosthetic leg," explained Noor, Abed El Rahman's sister-in-law told The New Arab. 

Before October 7, Abed El Rahman had lived in the Al-Karama neighbourhood in the north of the Gaza Strip. The neighbourhood was one of the first targets of the Israeli ground invasion, leading to Abed El Rahman and his family being displaced on five different occasions. 

"Abed's house was burnt down as a result of Israeli mortar shells and artillery. He had to flee along with his wife and children to the Al Mashtal hotel on October 8. He fled without medication, belongings, or clothes," Noor said.

"Later Al-Mashtal received a threat from Israel. Abed El Rahman and his family were displaced again and were forced to find refuge in an apartment in Gaza for a week before moving near Al-Shifa hospital to continue dialysis."

Abed El Rahman was displaced three more times: on October 13 he and his family escaped to Al-Zawayda, which was later classified as a red zone, then to Khan Younis in early November where he continued his dialysis treatment at Nasser hospital, and finally for a fifth time in mid-November to Rafah city.

Draining life from Gaza

"At Abu Yousuf Al-Najjar hospital — the only dialysis centre in Rafah — hundreds of displaced kidney patients are waiting for their dialysis," Noor told The New Arab. "When Abed was able to be seen, doctors would try to schedule additional sessions for him per week due to the dyspnea (shortness of breath) or excess water retention. As his condition worsened, Abed tried to get more sessions at the hospital but he typically received the bare minimum."

"Since his diagnosis, Abed El Rahman's life took a turn for the worse. However, during the war, his life became a living nightmare. He suffered a lot."

"We were blackmailed for survival. The lack of empathy from those exploiting us added to Abed El Rahman's suffering"

Kidney failure patients like Abed El Rahman have to follow a strict diet of nutrient-rich foods like vegetables and fruits, with low protein and sodium intake. During Israel's assault on Gaza, Abed El Rahman and his family had few options. "He mainly ate canned food, which was high in protein, along with bread when he could find it; there was little water. He resorted to eating potatoes out of necessity, despite the doctor advising against it," Noor said. 

"Abel El Rahman was lucky as he had access to leafy vegetables," his sister-in-law continued. "But due to the lack of clean water, he couldn't wash them and they went to waste."

Consequently, Abed El Rahman often chose to abstain from eating altogether, as the food and water available left him drained and fatigued. "The lack of food deteriorated his health condition and weakened his body. He struggled to endure dialysis sessions by the end."

'Blackmailed for survival'

In a desperate attempt to save his life, Abed El Rahman's family received a referral from the hospital to try to help him leave Gaza to get treatment. "He received no response," Noor sighed, "priority was given to cancer patients."

As his condition worsened, his family explored other options such as appealing to the UAE and Egypt. Unfortunately, they were unable to get the referral they needed. As a last resort, they set up a fundraiser to buy him into Egypt.

"The Egyptian broker needed $7500 per person to include Abed El Rahman's name on the border list. We were blackmailed for survival. The lack of empathy from those exploiting us added to Abed El Rahman's suffering." The day after starting the fundraiser, Abed El Rahman passed away in hospital, leaving behind his wife and two children, Mariam, 11, and Khalil, 8, mourning his loss. 

Speaking to The New Arab, Dr. Izar Khan, a nephrologist, explained why kidney failure patients need dialysis at least three times a week for at least four hours per session — double what Abed El Rahman was receiving. "Stopping dialysis can result in death within either days or weeks. The main cause of death is hyperkalemia (high potassium) which causes cardiac arrest and/or pulmonary edema which causes breathlessness and hypoxia."

"If the patient has no urine output they usually die within a few days after stopping dialysis. If Abed El Rahman only had a few hours of dialysis throughout the whole war then it's not surprising that he passed away," Dr. Izar Khan said. "Death from uraemia is not painful usually but patients may suffer dyspnoea from fluid overload. Dialysis patients need a strict renal diet and must avoid malnutrition. They require fluid depending on residual renal function."

Walaa Sabah is a freelance journalist and community outreach and partnership officer at wearenotnumbers.org