Quality of life and access to healthcare among hemodialysis patients during wartime: cross-sectional insights from Gaza

Abstract

Background: The war in the Gaza Strip and the accompanying blockade have rendered health services largely inaccessible and ineffective. Consequently, patients who rely on regular hemodialysis (HD) are at risk of morbidity and increased mortality due to medical complications related to inadequate healthcare. This study examines the war's impact on regular dialysis patients in the Gaza Strip and their health-related quality of life (HRQOL) during the war.

Methods: In November 2024, this cross-sectional, multicenter study employed a stratified sampling method, stratified by gender and HD center, to recruit 260 dialysis patients from the four centers still operating in the Gaza Strip through a self-reported survey. IRB approval and participant written consent were obtained. The study collected sociodemographic and clinical data and examined the war's impact on the participants. HRQOL was evaluated using the Kidney Disease and Quality of Life™ (KDQOL™-36) questionnaire. Following descriptive statistics, inferential analysis investigated the relationship between certain study variables and the various KDQOL™-36 domains. Statistical analysis was performed using R software.

Results: Most participants were unemployed and lacked a consistent income. The most common comorbidities included hypertension, cardiovascular disease, and diabetes mellitus. Participants had been receiving regular HD for a median duration of 3.4 years. Nearly half had two or fewer weekly sessions over the past month, with each session averaging three hours. Additionally, the dialysis patient population had decreased to 629 at the time of the study, down from 1100 in 2023. Most participants (81.92%) reported needing to seek healthcare outside their residential areas, and 35.00% consistently felt that accessing healthcare providers was a danger. Moreover, 41.54% experienced significant interruptions in dialysis, with a median interruption length of 8.5 consecutive days without HD. The mean scores for the Physical Component Summary (PCS), Mental Component Summary (MCS), Burden of Kidney Disease (BKD), Symptoms and Problems of Kidney Disease (SPKD), and Effects of Kidney Disease on Daily Life (EKD) domains of the KDQOL™-36 were 34.78, 34.37, 38.97, 62.50, and 50.83, respectively. Factors associated with lower scores in some or all domains included male gender, cardiovascular disease, hypertension, diabetes mellitus, osteoarthritis, having three or more weekly sessions, access via central venous catheter, HD interruptions, feeling unsafe when accessing healthcare facilities, and needing to seek healthcare outside the participants' residential areas.

Conclusion: The ongoing war in Gaza has had a devastating impact on patients with end-stage kidney disease (ESKD) undergoing regular HD, leading to disrupted treatment, high mortality, and severely impaired HRQOL. This study underscores the urgent need for coordinated humanitarian action to restore dialysis services, ensure access to essential medications, and safeguard vulnerable patient populations in conflict zones.

Keywords: Armed conflict; Gaza strip; Healthcare access; Hemodialysis; Humanitarian crisis; Resource-limited settings.