GAZA CITY, Gaza Strip -- The shelves at Shifa Hospital's pharmacy are half-empty. A shortage of anesthesia means surgeons can do only emergency operations. The kidney unit has cut back on dialysis because it's low on filters, and four of the unit's patients have died from a lack of medicine, officials say.

The West's economic boycott of the Hamas-led regime has brought the perpetually strained Palestinian health-care system to the brink of disaster, international aid workers and government officials say. They warn of an epidemic of preventable deaths if money is not found soon.

The cash crisis also could lead to the collapse of the Palestinian sanitation and sewage systems, raising the threat of cholera and other diseases breaking out, municipal officials say.

Western nations say they continue to provide humanitarian assistance to Palestinians, just not to the regime led by the Islamic militants of Hamas. Aid officials insist that is no substitute for keeping a functioning government going.

"If we can't continue our work, then disease will break out everywhere, and these diseases will not stop at borders," Health Minister Bassem Naim said.

No dialysis filters

The Health Ministry, which runs the vast majority of Palestinian hospitals and clinics, normally spends about $9 million a month. Now it is broke, and the entire system will break down in two months if money doesn't come in, Naim said.

Shifa, the main hospital for the Gaza Strip's 1.3 million people, is already feeling the crunch.

In the dialysis unit, more than a dozen women in robes and traditional headscarves sat quietly on tattered easy chairs on a recent day as tubes carried blood from their arms into blue machines for filtering.

Samiha Harb, 52, has been on dialysis for 22 years, but her health has rapidly deteriorated in the two months since she stopped getting a cocktail of hormones, vitamins and medicines that help her survive without working kidneys.

Her level of hemoglobin, the blood component that carries oxygen throughout the body, has plunged, and she is so weak that she rarely leaves home -- except to get her treatment.

"I want to just stay in bed and not move," she said.

Abdel Nasser, a pharmacist in charge of the hospital's supply of drugs and medical equipment, said Shifa is already in debt to pharmaceutical companies and medical suppliers and can't afford the vital drugs for kidney patients.

It also can't get spare parts to fix six broken dialysis machines, leaving only 22 working, Nasser said. The supply of adult filters is dwindling, so workers are using smaller children's filters.

Limiting surgeries

The result is a cut in dialysis sessions to twice a week from the standard three, and occasionally workers have had to turn away kidney patients -- some of them children -- with no treatment at all, Nasser said.

Hospital officials said four dialysis patients have died in recent weeks because of the shortage of medicines.

In the cancer unit, the drug shortage has forced chief oncology nurse Sayed al Masri to send increasing numbers of leukemia patients home without chemotherapy, and many have stopped coming.

At the hospital pharmacy, the shelves are becoming bare.

With little anesthesia left, the hospital is limiting surgery to emergencies. "I am afraid that after two weeks, we won't even be able to do these," said Dr. Juma Al Saqqa.

Gaza City Mayor Maged Abu-Ramadan, who is also a physician, warns of a looming breakdown in vital municipal health services, including garbage collection and sewage pumping.

The city budget is mainly funded by municipal fees, but with Gaza residents unsure of their financial futures, the collection rate dropped from 60 percent two months ago to less than 20 percent, he said.

With the city broke, it has already been forced to cut garbage collections to save fuel, he said. He fears what will happen as rotting garbage piles up and sewage flows through the streets when the city runs out of fuel for its pumping station.

"There will be diseases. There will be an epidemic ... maybe cholera, and I'm sure this will not be limited to Gaza," he said.