It's no picnic being a kidney patient even in the best conditions. But coming in for dialysis in a place like the Gaza Strip calls for a special kind of patience.
Years of war have placed a constant stress on the health system there. Thanks to a host of factors, Gaza's main hospital, Shifa Hospital, regularly faces supply shortages of medications that kidney patients need to manage nausea and other symptoms.
Dialysis machines are in constant use, and it's tough to get the parts needed to keep all of them working. So many patients have trouble scheduling appointments.
But there's new hope for the many Gazans suffering from kidney problems. Earlier this year, doctors performed the first kidney transplant in the history of the Gaza Strip.
Thanks to help from British doctors, Gaza surgeons are being trained to perform the procedure. It's hoped this ability will ease the huge demand for dialysis at the Shifa Hospital.
The reasons for the supply shortages are many. Israel restricts what can come in and out of Gaza. Humanitarian relief is supposed to get top priority, but the process still causes delays — which means many patients miss their dialysis and can't function normally.
"[Missing dialysis] will affect the brain capacity and the performance of the daily activities, so they will not perform as a normal person," says Dr. Mahmoud Daher of the World Health Organization office in Gaza.
That's why people here are excited about the good news of the first kidney transplant in the history of the Gaza Strip.
The recipient was Dr. Hamad Suleiman Daher, a general practitioner himself. He got a new kidney in January, and a month later, he was feeling the difference.
"I'm feeling better, I feel like normal. I feel like three, four years before because three to four years before I did not have my kidneys problems," Daher says, as he sits in a comfy chair in his living room with his youngest daughter climbing around on his lap.
His surgery was part of an effort by the Royal Liverpool Hospital to train local staff in kidney transplant surgery. It will be a couple of years before Shifa Hospital can manage these surgeries without outside help, and having the ability to do organ transplants here in Gaza will create new problems.
Daher notes that transplant patients need their own special drugs that are often hard to get in Gaza. "They would need immunosuppressants," he says. "They would need medications to maintain the organ, not to be rejected from the body."
Gaza will also have to come up with a fair system for managing organ donations, Daher says. And transplants require lots of follow up.
It's unclear whether Gaza has the infrastructure to deal with the challenge. But for the lucky few, getting a new organ here at home is a lot better than looking for help overseas, or a lifetime of dialysis.
Most kidney patients here will spend four hours, three times a week, hooked up to machines that do what their kidneys can't: remove waste from their blood.
One man named Hafif Handouna sits quietly and watches as a dialysis machine pumps away at his blood. Handouna says, he'd like to get a transplant, but he's had a hard time finding a donor outside Gaza whose tissue matches his.
"In addition to that, I found out it might cost 80 to 90,000 [Israeli shekls] for me, which is a very huge amount for me, I can't afford it," he says.
Handouna might not have any better luck finding a donor in Gaza. But the effort to perform transplants here at home will allow a few patients to avoid dialysis — and even return to work.