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Az-Zuwayda, Gaza Strip – Ali Humaida’s heart rate quickens as he watches the gauge on the oxygen cylinder sitting in the corner of his tent.
As the needle falls, he looks at his 14-year-old son, Abdulaziz, lying on a mattress in the family’s tent in central Gaza’s az-Zuwayda, worried about how long the remaining oxygen will last – and where he will find more when it runs out.
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Abdulaziz depends on a continuous supply of supplemental oxygen, his father says. One night, when the family’s cylinder emptied before they were able to replace it, his breathing rapidly deteriorated.
“The cylinder suddenly ran out in the middle of the night,” Ali recalled. “The minutes turned into a nightmare. We began fanning him with our hands and pieces of cardboard while watching his face turn blue, terrified he would lose consciousness or slip into a coma right before our eyes, while we stood completely helpless.”
For families caring for oxygen-dependent patients in Gaza, such emergencies have become increasingly difficult to avoid.
Gaza’s Ministry of Health warned on August 15 that only 12 of the strip’s 34 oxygen-generation stations remained operational, while only four of 30 devices used to fill oxygen cylinders were still working. The remaining equipment was overworked with repeated mechanical failures, the ministry said.
These conditions have made obtaining cylinders particularly difficult for patients such as Abdulaziz, who receive much of their care outside hospitals.
“Every minute that passes means the oxygen is running out,” Ali said. “I am constantly asking myself: How much is left in the cylinder? Will it last until morning? And if it empties, where will I get another one?”
Complicated medical history
Abdulaziz has lived with serious health problems since birth. He was born with a congenital heart defect and has underdeveloped lungs.
Since childhood, he has also suffered from hydrocephalus, or cerebrospinal fluid buildup in the brain. Abdulaziz underwent surgery to relieve pressure on his brain by inserting a ventriculoperitoneal (VP) shunt that drains excess fluid.
In addition, he has autism spectrum disorder and requires extensive daily care – something that is extremely difficult in a displaecment camp in Gaza during Israel’s genocidal war.
Before the war, Abdulaziz received regular specialised treatment at a hospital in Israel. That has now stopped, leaving the family dependent on Gaza’s health system, which has been devastated by Israeli attacks.
The cost of caring for Abdulaziz has also increased. His father, Ali, estimates that medicine, diapers and transportation now cost the family between 950 and 1,100 shekels ($315 and $365) a month – double pre-war prices.
“Abdulaziz cannot express pain like other children because of his autism, but I can see the distress in his eyes,” Ali said. “I am not asking for the impossible, all I want is for my son to breathe freely.”
When oxygen runs out
Interrupting supplemental oxygen can be dangerous for patients who depend on the therapy to maintain adequate blood-oxygen levels.
Dr Ghada Hassouna, a physician at al-Aqsa Martyr’s Hospital in Deir el-Balah, said a patient whose oxygen saturation level plummet can develop rapid breathing, a faster heart rate and cyanosis – a bluish discolouration of the skin caused by poor oxygen and blood flows.
Inadequate oxygen can also damage vital organs, particularly the brain and the heart.
Hassouna explained that the brain cells are exceptionally sensitive to oxygen deprivation, and are the most vulnerable to rapid breakdown and damage. In Abdulaziz’s case, any drop in oxygen levels can cause severe or permanent nerve damage.
This is an issue that impacts more than just one family.
According to the Gaza Ministry of Health, the majority of oxygen-generation stations being out of service is the result of a systematic Israeli policy across border crossings.
Israeli authorities continue to restrict and ban the entry of spare parts and specialised lubricants for hospital generators and oxygen plants, as well as blocking new plants meant to compensate for the shortage.
Israel classifies oxygen cylinders, accompanying devices and electrical generators as “dual-use” items, prohibiting their entry or spare parts through closed crossings.
At the same time, the environment of forced displacement imposes an extra layer of suffering.
Hundreds of thousands live in open areas lacking basic proper ventilation, filled with dust and toxic emissions from burning plastic waste and alternative power generators, which doubles the number of patients suffering from acute pneumonia and respiratory ailments such as chronic obstructive pulmonary disease (COPD).
This comes at a time when the Ministry of Health and several hospitals in the strip have completely halted external oxygen cylinder refilling services for patients receiving care at home or in displacement tents.
The decision was a forced measure taken by the health system after nearing collapse, in an effort to preserve remaining oxygen supplies for bed networks in critical hospital departments such as intensive care units, neonatal incubators, and operating rooms.
Facing this complex field reality, medical staff explain that the decision was not an administrative choice, but a response to a catastrophic reality imposed by war conditions and the systematic destruction of health infrastructure.
The United Nations estimates that about 350,000 people in Gaza are living with chronic diseases, with treatments severely disrupted by the war.
Mohammad Abu Salmiya, director of al-Shifa Medical Complex, said Gaza is coping with shortages of half of essential medicines and more than 80 percent of laboratory materials. He estimated that about 21,000 patients and wounded people needed treatment outside Gaza, including more than 4,000 cancer patients and more than 10,000 injured people requiring advanced surgical care.
For now, patients in Gaza have to make do with what is available inside the Palestinian enclave.
Abdulaziz’s family measures time by what remains in his oxygen cylinder.
“We want him to be able to travel and resume his treatment,” Ali said. “Until then, we need a stable supply of oxygen.”
“All we want is for our son to breathe with dignity, without the constant fear that his breathing could stop at any moment.”
