#2191 Turbulent topography: managing individuals with renal disease during the conflict of genocidal proportions against Gaza, Palestine

Abstract Prior to the conflict of genocidal proportions, there were approximately 1000 to 1500 Gazans with end-stage-renal-failure (ESRF) requiring hospital haemodialysis across multiple dialysis units. As a consequence of the military aggressions against healthcare establishments, the siege on humanitarian and medical aid, these individuals have been disproportionately, negatively impacted. Due to the destruction of many renal healthcare services, 593 Gazans requiring hospital haemodialysis utilise 24 dialysis machines at Al-Aqsa hospital dialysis unit in southern Gaza. Due to the rationing of renal-replacement-therapy (RRT), dialysis sessions’ length and frequency have been significantly reduced. Often, individuals are disconnected early to accommodate more critically ill patients, admitted with pulmonary oedema or hyperkalaemia. Furthermore, the creation and management of definitive access has been significantly hindered due to the damaged healthcare infrastructures and those requiring RRT commencement or suffer fistula failure are initiated on RRT via semi-permanent lines. Unsurprisingly, there has been an increase in the incidence of line-related infections and central stenosis. Additionally, fistulas are at an added risk of dehydration-related thrombosis and traumatic injury. Majed Abu Maaheel was one such individual, he was Palestine's first Olympian, a coach, a runner and a father of five. He died aged 61, because he was unable to access dialysis due to disrupted power supplies secondary to the siege. An unnecessary and preventable death. Similarly, other displaced individuals on ESRF, living in tents, were unable to access dialysis and without the necessary anticipatory medications suffered significantly in the last weeks, days and hours of life secondary to severe uraemic symptoms. The aggressions on healthcare services and restrictions on medications have led to a colossal breakdown in primary-care services and a rise in individuals attending the emergency department with newly diagnosed end-stage-renal-failure due to undiagnosed and/or untreated hypertension and diabetes. Hypertensive emergencies presenting with systolic blood pressure readings greater than 220 mmHg leading to pulmonary oedema and cerebral haemorrhage are multiple times a week occurrence. Life-threatening and life-taking hyperkalaemia is an alternate-day happening. Managing the significant escalation in critically ill patients is further challenged by the lack of necessary medical paraphernalia to deliver basic, not even standard or good care. On a daily occurrence there is no access to ECG leads or paper, portable chest X-rays or standard bloods: albumin, troponin, ketones. No access to calcium gluconate or potassium binders. Irrespective of the conflict, the most vulnerable in society must be protected. Healthcare services, personnel and service users must be protected as part of preserving international humanitarian law and man-made healthcare catastrophes of this nature must not be permitted to happen again. The forward solution is for Gazan renal patients is unimpeded medical missions, humanitarian and medical aid to help restore healthcare services and facilities, with a view to restoring dialysis units, interventional radiology and transplant services.