Dr Hassan Deed Suleiman stares at the three pieces of ricketymachinery that stand between him and a meltdown in Gaza's hospital network.
"We do not have back-ups for any of the essential components of our largest blood bank," he says, shaking his head. "If - when - one of them breaks, we will not be able to do proper blood transfusions in much of Gaza. The flow of blood to our hospitals will stop. The effects will be terrible."
Dr Suleiman is the director of Shifa Blood Bank, which supplies 60 per cent of the blood needed in Gaza, for everything from Caesarean sections to bomb victims to haemophiliacs. He talks over the low, unhealthy hum of the battered pieces of old equipment: the refrigerator that stores blood until it can be processed; the centrifuge that separates blood into its components; and the incubator that keeps the resulting platelets warm.
"All of these machines have been in continuous use since 1996," he says. "How much longer can they last?"
Gaza's blood banks have been crumbling for years. The Israeli siege made it extremely hard to get machine parts into this congested strip of land, that is home to one-and-a-half million people. Then the international boycott that followed the election of Hamas cut off the funds that Shifa used to purchase even simple equipment, such as blood bags and testing kits. Earlier this year the blood bank ran out of hepatitis C testing kits.
"If things carry on deteriorating," Dr Suleiman warns, "soon we will have to make a terrible choice - stop screening blood for diseases like HIV and hepatitis, or stop putting out blood altogether."
Blood has long been a bleak symbol of Palestinian life. The area has an unusually strong tradition of donating blood. Dr Randa Khoudary of the Ministry of Health says: "After an Israeli attack we invariably get a huge flood of donors at the hospitals. It is something even very poor people can do to show solidarity. But we have to turn away hundreds, because we do not have the capacity to process so much at one time."
The Central Blood Bank Society collects a quarter of the blood for Gaza's hospitals but its offices are being repossessed, the electricity is cut off and its staff go unpaid. Standing outside the offices, Bassim Shaban, the chief of the laboratory, says: "We are deep in debt. We owe $150,000 and the Palestinian Authority has no money to bail us out because of the international boycott."
Mr Shabban's offices in Khan Younis and Rafah have been sold. When the power supply was cut off, the blood that the society has collected warmed and went bad. Its mobile collection unit, which does have working, safe medical equipment, is rusting in the garage, its engine long since dead. Instead the society is forced to collect blood from the back of an old van. "It is not safe," Mr Shabban says. "It is not safe."
One group has been trying to support the Palestinian doctors holding together their collapsing blood service: the medical agency Merlin, one of the three charities being supported by this year's Independent Christmas Appeal.
Christian Bunyan, head of the charity's projects in Gaza, says: "Since the summer, Merlin has been working to ensure that the Ministry of Health is able to offer a more dependable service. That means shipping in key equipment like a refrigerated centrifuge, donor chairs and HIV test kits. As an international organisation we are more able to get these supplies in and out of the Strip than Gazans, who face so many restrictions."
Thanks to Merlin the doctors in Gaza can continue collecting blood and screening it. It is providing parts to repair existing machinery and keep it running as long as possible.
The charity hopes that by the new year it will be able to provide a new blood-collection vehicle, helping to increase safe collection throughout the Strip, a move that the doctors here say would be "amazing, literally a life-saver".
Back in the Shifa Blood Bank, Dr Suleiman adds: "Blood is not an optional add-on to the functioning of our health system. It is a necessity. We have enough problems with blood in Gaza. We do not need this too."Reuse content