GAZA CITY, Gaza Strip -- The director of Shifa Hospital, which with 600 beds is the largest in Gaza, has an abrupt bedside manner when it comes to describing the ailments of his institution. Offering no comfort, promising no silver linings, Dr. Ibrahim el Habbash matter-of-factly listed the hospital's growing list of problems.
Doctors there are rationing their dwindling stocks of anesthetics by postponing all elective surgeries, said Habbash. Nurses have nearly run out of bandages. Breast cancer patients are receiving just two of the three chemotherapy drugs they need for treatment. The hospital is turning away other patients for lack of appropriate drugs.
"We have a big list of shortages," Habbash said, running his fingers across his short red hair. "We have about two weeks to go. After that, we face complete collapse."
He added almost as an afterthought that Shifa's 1,400 doctors, nurses and staff members have not been paid in two months. For lack of money to buy gasoline or pay bus fare, some no longer come to work.
He mentioned, too, that guns have become a common sight, the weapons brandished by desperate families and militants who roam the hospital grounds roughing up doctors and nurses to compel them to provide treatment.
Shifa's jumble of whitewashed buildings and small palm-tree-shaded gardens occupies a full city block in the heart of Gaza City, just off a throbbing street of kebab stands and honking taxis. Although surrounded by high walls, the hospital also is a portrait in miniature of the increasing turmoil here, in which health care has become one of the victims of the financial crisis within the Palestinian Authority, the government controlled by the Islamic militant group Hamas.
The Palestinian Authority, cut off from most international aid, can no longer pay its 150,000 employees, including the staff at Shifa. That problem is compounded by Israel's keeping more than $50 million a month in tax receipts that belong to the authority. Israel also has kept the entrance points into Gaza mostly closed, rendering normal commerce impossible, including the shipment of medical supplies.
Although the United States and the European Union have pledged to continue humanitarian aid, they are still searching for ways to deliver it without working with Hamas. "They must look for some other options to take medicine inside the Gaza Strip - otherwise people will start dying," said Maskit Bendel, a spokeswoman for Physicians for Human Rights-Israel, a nongovernmental organization. In a recent study of Shifa, the organization found serious shortages of medicines and supplies.
Patients and their relatives are becoming desperate. Last week, angry relatives stormed into the health ministry and took the minister of health hostage, to make their point that because of budget cuts patients are no longer being sent to Jordan or other countries for necessary treatment. Hamas militiamen rescued the minister after a brief gunbattle.
Even in relatively good times, Gaza's health system was hobbled by a lack of money and equipment, poorly trained and overworked medical staff and frequent border closings.
The level of care would be unacceptable in most of the developed world. Gaza has one hospital bed for every 614 residents; in Israel, the figure is one bed for every 145 residents. A significant part of the Palestinian Authority's budget was spent each year to send patients to hospitals to Jordan, Egypt and Israel for cardiac care and eye surgery, as well as for relatively common tests.
Opened in 1946 by the Egyptian government, Shifa began as a two-room clinic and by 1967 had grown to include a surgery department and maternity ward. After capturing Gaza in the 1967 Arab-Israeli War, Israel took control of the hospital, gradually adding laboratories, satellite clinics, physical therapy services and a dialysis center, before turning over the hospital to the Palestinian Authority in 1994.
In 1997, doctors at Shifa performed open-heart surgery. But conditions deteriorated drastically during five years of violence that began in 2000, forcing patients to seek care abroad.
A visitor can find significant shortcomings in nearly every room.
In Shifa's cancer ward, on the second story of one of the older buildings, Ismail Syam was doing his best to comfort his sister, Asma Saeede, 53, a breast cancer patient. Since the hospital no longer had her prescribed chemotherapy drugs, she was receiving drugs that her doctors cautioned would not be as effective.
Half-conscious, Saeede moaned in her simple metal-frame bed in the corner of a dimly lighted room. Syam shifted a pillow beneath her head and pulled up a blanket around her neck.