Gaza Clinic a Lesson In Anatomy of Chaos

Habbash, a pale man with a blaze of short red hair, spent his morning in the cancer ward with a group of gunmen. A harrowing and increasingly common aspect of the health care system here, the gunmen demanded that a woman with stomach cancer be transferred to Egypt for treatment. The Health Ministry had rejected the request for a lack of money.

"Security inside the hospital is terrible," Habbash said. "I can't emphasize this enough."

Signs posted at hospital entrances and along corridors warn that weapons are prohibited. But like many other rules here, the ban is neither heeded nor enforced. In the ward for respiratory disease, a visitor smoked cigarettes a few yards from suffering patients.

The lime-green corridor turns a corner into the cancer ward, where a young man draped with the black-and-white scarf of the al-Aqsa Martyrs Brigades stood outside a room shared by three patients. The man grew angry when asked to explain his AK-47 assault rifle.

Samira el-Akluk, 52, the woman for whom the gunmen sought a transfer, moaned from a corner cot. Her yellow hands lay crossed over her stomach and a pair of yellow feet appeared from beneath the thin blanket.

The gunmen, part of the mob that accosted Habbash earlier in the day, remained to press demands that Akluk be sent to Egypt for treatment. But doctors said she was near death and did not have the proper documents to enter Israel en route to Egypt even if she qualified for transfer.

"Don't worry about this. It is not a problem," a family member said with a smile.

Downstairs, a line formed outside the dialysis ward, full as usual. Eight blood-cleaning machines were attached to elderly men and women in varying states of consciousness -- some covered from head to toe in sheets, others sprawled in recliners and close to sleep.

A cabinet along one wall contained a shrinking supply of blood lines, the plastic tubes that run from a patient's arm to the dialysis machine where the blood is filtered. There were enough to accommodate patients -- about 60 of whom receive treatment each day -- for another two days.

A drug that increases hemoglobin in the blood had already run out, forcing dialysis patients such as Fawzia Jundiah to undergo more frequent transfusions.

But the hospital could no longer afford to supply blood for her twice-monthly treatments. So Jundiah, 57, now heads from her house to the police station before each transfusion to seek an officer, clerk or prisoner who will give her his blood.

"From where else will I get blood every 15 days?" said Jundiah, a coil of crimson-filled plastic running from her arm to the dialysis machine. "I needed this other medicine that strengthened my blood. But should I just die without it?"

As drug supplies shrink, treatment at the clinic has become improvisational.

For Hodgkin's disease, a form of lymphatic cancer, patients are receiving three of the four medications they need. The fourth ran out last week, and Habbash said a lack of money and the crossing closures had prevented supplies from arriving.

To prolong reserves, dosages have been reduced for everything from pain medications to hormone therapy.

"This has been the worst," said the clinic's chief nurse, Saed al-Masri, who was trained at Jerusalem's prestigious Hadassah-Ein Kerem Hospital. "We've run short on antibiotics before. But this time we're running out of it all."

When the hospital's only functioning elevator reached the second-floor surgery department, its door remained shut, squeaking against a hidden obstacle. A hefty nurse squeezed his fingers into the small opening and yanked the door aside.

Tea was being served in the waiting room, filled with anesthesiologists, surgeons and nurses on break. Schedules have been cut back as elective surgery is put off to preserve anesthesia for emergency cases, 70 percent of the volume in the violent strip.

"It's not that bad delaying nonessential procedures," said Mohammed Sawaf, an anesthesiologist.

But Sawaf worried about other recent factors that have complicated emergency surgical cases. The hospital, he said, was out of drugs that help revive surgery patients from sedation. The department was also short on sutures, prosthetic hips and other supplies that have not been getting through because of border closures and the financial crisis.

"There's not much you can do on some cases without them," Sawaf said.

Another problem looms. Early this week the Palestinian Authority paid 150,000 employees and trainees their February salaries, more than two weeks late. But how the authority will cover its $115 million monthly payroll at the end of the month, after Hamas is scheduled to install its cabinet, is unclear.

Mazen el-Aloul, Shifa's director of nursing, said the government would soon perform its own triage.

"They'll pay the army," he said. "But who knows about the doctors and nurses and all the things we need here."