Hendra Wijaya
At Al-Aqsa Martyrs Hospital in Deir el-Balah, central Gaza, the laboratory department operates under conditions that its director, Bassem Hassan, describes with grim practicality. His team is responsible for producing the test results that physicians across the hospital depend on to identify conditions ranging from kidney failure to diabetes. Without those results, doctors are left guessing at diagnoses and treatment plans, a situation that has become routine as the enclave's medical infrastructure continues to deteriorate under Israel's war and siege.
The laboratory's ability to function has been eroded on multiple fronts. Blood gas testing, a procedure considered indispensable for cardiac and intensive care patients, has been suspended entirely. Blood-collection tubes, the basic consumable required for clinical chemistry panels, are in critically short supply. Automated clinical chemistry analysers, which laboratories depend on to process more than 60 percent of their tests, have stopped working. Even the equipment needed to keep the lab running at a basic level, including sterilisation units and refrigerators for storing blood and plasma, has failed.
Faced with these constraints, Hassan explained that his department has adopted a triage system for testing itself, not just for treatment. Tests are allocated based on the severity of each patient's condition, with priority reserved for kidney, cancer and heart patients, along with those in intensive care. The logic is unavoidable but painful: with limited reagents and functioning machines, every test given to one patient is a test withheld from another.
The consequences of this rationing ripple directly into clinical decision-making. Laboratory results allow doctors to calculate correct medication dosages, track how patients are responding to treatment, and make rapid judgments in emergencies. When those results are unavailable, physicians lose a critical piece of the diagnostic picture, one that can determine whether a patient survives or dies. The absence of data does not pause the progression of disease; it simply removes the tools clinicians need to intervene effectively.
The scale of the collapse is documented in stark figures. As the third anniversary of the war approaches, more than three-quarters of medical imaging equipment in Gaza is out of service. Shortages of laboratory testing materials stand at 87 percent, and there is a 74 percent deficit in the essential consumables required for laboratory and diagnostic testing. These are not marginal shortfalls but systemic gaps that affect nearly every aspect of patient care.
Gaza's ministry of health has warned that continued equipment breakdowns and supply shortages could force blood banks and laboratories to shut down altogether. Such a closure would fall hardest on patients with critical conditions, including electrolyte imbalances, elevated potassium levels, impaired kidney function and heart disease, all of which require regular monitoring to manage safely.
Marwan Al-Azaiza, who heads the cardiology department at Al-Aqsa Martyrs Hospital, said the shortages in public hospitals have pushed some doctors to refer patients to private laboratories when they can afford the additional cost. For patients who cannot pay, he said, physicians fall back on clinical examinations, electrocardiograms and whatever other indicators are available. That approach, he acknowledged, is not a complete substitute for the tests needed to confirm or rule out specific diagnoses, leaving room for error in cases where precision matters most.
Medical teams are attempting to fill some of the gaps by coordinating with charities, health organisations and relief institutions, hoping to widen access to care for Gaza's population. But these efforts cannot compensate for the loss of equipment and supplies on the scale described.
Imaging services have been hit particularly hard. Only five of Gaza's 18 CT scanners are still operational, and those remaining machines are being run beyond their intended capacity. Magnetic resonance imaging, or MRI, is no longer available anywhere in the enclave after nine machines were destroyed in Israeli attacks. The loss of MRI capability removes an entire diagnostic modality from the options available to physicians, further narrowing their ability to detect and characterise disease.
Mohammed Abu Salmiya, director of al-Shifa Hospital in Gaza City, said medical teams have been compelled to restrict laboratory tests, X-rays and CT scans to only the most urgent cases. In his description, this reality forces doctors into difficult choices between patients, deciding whose test must happen immediately and whose can be postponed. While he described the approach as necessary under current conditions, he noted that it leaves large numbers of patients on waiting lists, with diagnostic tests delayed even when those tests are needed to identify a condition or monitor ongoing treatment.
For patients with chronic illnesses, the uncertainty is a constant companion. Yousef al-Athamneh, 57, from Deir el-Balah, suffers from kidney failure and depends on dialysis three times a week. He told Al Jazeera that he worries about shortages of bicarbonate, bloodlines, dialysis machines, intravenous fluids and other materials required for his sessions. What frightens him most, he said, is the prospect that supplies could run out or that a machine could break down with no replacement parts available, cutting off the treatment that keeps him alive. His plea was simple: that the most basic necessities of medical care be available, so patients can attend dialysis sessions with some assurance that they will receive care.
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