On the third night of our most recent displacement, caused by the war that began in October 2023, I sat next to my 20-year-old cousin, who was curled up in a thin tent pitched on a cracked patch of land in Gaza. He was silent, trembling, almost unable to breathe. The pain, sharp and familiar, pierced his abdomen. It was another attack of a genetic disease that has been haunting his body all these years: familial Mediterranean fever (FMF). This time, however, the attack came without colchicine, the only drug that controls the inflammation. He long ago ran out.
As the war drags on, famine tightens its grip on Gaza. Even a piece of bread can be unavailable for days. The price of a single kilo of flour fluctuates wildly — reaching $25-$30 on some days, and as high as $70-$90 on others — making it inaccessible for most. The internet may show flattened buildings and injured bodies, but it rarely captures the hollow ache of hunger or the quiet desperation of waiting hours for something as simple as a crust of bread.
But hunger does not stop other medical conditions. In addition to food, Gaza needs medicine.
FMF is an inherited autoinflammatory disorder most commonly affecting people of Mediterranean descent, including Palestinians. It causes recurrent episodes of fever, abdominal and chest pain, joint inflammation, and sometimes a characteristic rash. The attacks are unpredictable and debilitating, especially in children and young adults. If untreated, FMF can lead to serious complications, most notably amyloidosis — a potentially fatal buildup of protein in vital organs such as the kidneys — especially in children and young adults.
Colchicine is not a painkiller; it is a lifesaving treatment that prevents FMF attacks and long-term damage. Patients typically rely on a daily dose to manage symptoms and avoid irreversible complications. Without it, even a single attack can escalate rapidly and become life-threatening.
Before the current war, colchicine was at least intermittently available in Gaza despite the longstanding blockade. Now, the situation has reached catastrophic levels. In Gaza, thousands suffer from FMF. Although accurate figures are difficult to obtain due to the collapse of health care infrastructure, local medical sources told me that at least 8,000 to 10,000 people across the Strip have been diagnosed with the condition — most of them children. According to the Ministry of Health in Gaza, more than 60% of essential medicines, including colchicine, have been unavailable since the war began in October 2023 due to the ongoing blockade and bombardment. This shortage has turned manageable conditions into life-threatening crises.
On a normal day, FMF is painful but survivable. In Gaza, however, “normalcy” died a long time ago. Amid chronic shortages of medications, recurring power outages disrupting refrigeration, and an almost total collapse of medical infrastructure due to ongoing war, patients are forced to endure their suffering silently. Those who are able to get a small supply of colchicine must ration their pills, splitting a week’s supply to last a month, knowing each skipped dose brings them closer to another agonizing attack.
Living without colchicine means navigating each day with that looming dread of another flare-up. My cousin tries to avoid triggers like physical exertion, certain foods, or emotions such as fear or excitement. But in a war zone, such avoidance is impossible. The overcrowding, the displacement, the constant drone noise, and the grief from loss all fuel the fire of inflammation within him. FMF attacks have become more frequent, more painful, and more humiliating as he endures them in shared, exposed spaces like tents or temporary shelters.
Making this reality even worse is how invisible it is. While the world watches the bombs fall and the bodies pile up, it barely notices what it means to live with chronic conditions that become unbearable in wartime. FMF is too mundane for headlines. It is slow, inward, silent — like the suffering of so many in Gaza.
Doctors in Gaza are doing their best, but they are overwhelmed. The handful who specialize in genetic or autoimmune diseases work under near-impossible conditions. There are no checkups, no functioning labs, no referrals. Just receiving an FMF diagnosis, which should be straightforward, can take years in Gaza’s crumbling health care system, even before this war began. Meanwhile, untreated inflammation silently damages kidneys and other organs, creating lifelong consequences for patients who survive the war.
This is what chronic illness under siege looks like: a daily bargaining with pain, uncertainty, and neglect. My cousin doesn’t want pity. He wants to work, to study, to love without worrying that his body will betray him at any moment. He wants the basic assurance that he won’t have to face his next attack alone, in the dark, without the medication that could spare him hours of agony.
One of the most painful aspects of living with FMF in Gaza is the lack of awareness surrounding the disease. Many people, including extended family members and neighbors, dismiss it as “just stomach pain” or assume that he is exaggerating. There’s little understanding of how debilitating the attacks can be, or that the condition is genetic and requires lifelong treatment. This lack of visibility breeds shame, particularly among young men who feel pressured to appear strong. I’ve watched my cousin refuse help, not because he doesn’t need it, but because he fears being seen as weak.
The psychological burden of FMF, especially during displacement, can be as crushing as the physical pain. My cousin often tries to hide his suffering to avoid drawing attention or worrying others. The lack of privacy in overcrowded shelters exacerbates this distress, making it harder for patients to manage their symptoms with dignity. In these conditions, both the illness and the war conspire to strip away one’s sense of control and self-worth.
Gaza’s medical crisis cannot be measured only in trauma wounds and amputations. It includes the silent collapse of care for those with chronic but equally urgent conditions. Diseases like FMF should not become death sentences in conflict zones.
Because in Gaza, surviving the bombs is only the beginning. The real test comes in the days and weeks after, when patients like my cousin must face their illnesses without treatment, without care, and without hope — unless the world decides their survival matters, too.
Asil Almanssi is a Palestinian writer and field researcher from Gaza focusing on health, war, and survival.
