Hanin al-Hilo was screaming at the nurses at the main Gaza hospital, Al Shifa: "If I called and said I was the son of Mr. Somebody, some big shot, I'd have a place!" 

But with a third of the hospital's dialysis machines awaiting repair and spare parts, Mr. Hilo, a policeman, and his father, sitting weakly in a wheelchair, had to wait in the corridor. Even those using the machines are not being given the normal dose of hormones and minerals, a nurse explained, because the hospital has run out. "Soon they're going to need blood transfusions instead," she said.

With a sudden shortage of everything from disposable needles and adhesive tape to vital drugs, Gaza's once impressive public health system is running down fast under the dual pressure of aid cutoffs and the closing of the Karni crossing point with Israel.

Already, says Al Shifa's general director, Dr. Ibrahim al-Habbash, the hospital can no longer provide chemotherapy for many forms of cancer, has only a few days' supply of important surgical drugs like atropine, adrenaline, heparin and lidocaine, and has used up its strategic three-month cache normally kept for a health crisis.

In addition, armed men have been forcing their way into the hospital demanding preferential treatment for relatives, clan members or friends, and authorization to travel outside Gaza for medical treatment.

"We've suffered in the past, of course, but in the last month, the problems have really increased," Dr. Habbash said. "There are shortages of medications and disposables in all departments, we're trying to limit the operating list and people are suffering, even dying, because of these shortages."

Dr. Habbash hands over his list of urgent needs that he has passed on to the financially troubled Palestinian Ministry of Health. It includes numerous drugs and antibiotics, as well as plaster of Paris, syringes, disposable bed sheets and intravenous solutions, surgical gloves, suture sets and blood-testing needles.

Mr. Hilo's anger, he admitted later, was increased by the frustration of a second month without salary, a situation suffered by every employee of the Palestinian Authority — Gaza's largest employer — including the hospital's 1,400 staff members, and many of the families of the patients.

But his anger is a sign of the mounting frustration over the gaps in health care here, which are a result of a double crisis: the budget deficit in the Palestinian Authority — which has worsened significantly since Israel stopped transferring tax collections, and the United States and the European Union cut off aid after the Hamas government took over — and the inability to get goods into Gaza through the main crossing point at Karni, which the Israelis keep closing whenever there is a security alert.

Since Jan. 1, Karni has been shut half of the time, according to James D. Wolfensohn, the former envoy of the international community, and an average of only 23 truckloads a day have left Gaza in that period, compared with a target of 150 a day. Produce has rotted, but crucial imports have also been held up. Though the lack of funds is a significant problem for the Palestinian health care system, supply shortages are less severe on the West Bank, where cargo crossings are less of an issue. 

The Palestinian Authority is in part the author of these problems, for failing to stop attempted attacks on Karni, though Israel has been criticized by Mr. Wolfensohn and the European Union, and more quietly by the United States, for keeping the crossing closed. 

Even before the Hamas victory, the authority was running a debt of $75 million a month because it raised salaries last summer and hired thousands of young armed men, causing the World Bank to cut off budget support. After the Hamas victory, Israel stopped handing over tax payments, and after Hamas took office, Washington and the Europeans suspended aid because Hamas refuses to recognize Israel and forswear violence.

Both the United States and the European Union say humanitarian aid will get through — but Washington does not consider government salaries to be humanitarian aid. There has been discussion of a new structure to funnel aid to health and education departments or individual Palestinians that would somehow bypass the Hamas government, but nothing has been decided.

The results are severe in Gaza.

A recent internal report by the World Health Organization, provided to The New York Times, portrays a crisis that is bound to worsen as the economic siege of the Hamas-run Palestinian Authority continues. The report forecasts a "rapid decline of the public health system towards a possible collapse" and "no access or limited access to preventive programs" like immunization for a large part of the population.

Although some 70 percent of Gaza's 1.4 million people are refugees or their descendants, who get primary care from the United Nations Relief and Works Agency for Palestinian Refugees, the organization runs only clinics, not hospitals. 

According to another report, by Physicians for Human Rights/Israel, the Palestinian Authority provides 64.5 percent of general health needs, 77 percent of emergency hospital treatment and 76 percent of the needs of women and midwives. It also pays for the treatment in Israel and abroad of many difficult cases like those in pediatric oncology and pediatric heart operations, as well as various cancer and orthopedic treatments.

"Lack of funding for this system will lead to the deaths of thousands of people in the short term and extensive morbidity in the long term," the report says. The group, like the European Union, urges Israel to pay the Palestinians the $50 million or so a month it collects in tax receipts for the authority and to ease "the policy of closure and curfew" that is undermining the Palestinian ability to deliver services to people.

Mark Regev, a spokesman for Israel's Foreign Ministry, said there had been no special restrictions on transferring medical supplies since Hamas took over. "Israel wants to do all it can to avoid suffering among Palestinians," he said. "But we have legitimate security concerns with an administration run by Hamas, which espouses terrorism against Israel." 

The relief and works agency is the second largest employer in Gaza, and although it is paying salaries, "We cannot substitute for or replace the Palestinian Authority," said its Gaza director, John Ging. "We already expect accumulating strains on our current services," as refugees who work for the authority and have no salary turn to the agency.

"We're concerned about more instability, more insecurity, more poverty and more dependency" on the agency, he said. The agency, he added, was trying "to meet basic human needs at a subsistence level, but we can't provide the health, education and security services of the P.A." 

The agency is already paying $78,000 a month for rent on shipping containers stuck at Karni, because the export blockage in Gaza means that once the limited cargo allowed into Gaza is unloaded, the empty containers may not return to Israeli territory, he said. "We'd rather use the money for food."

In the dialysis ward of Shifa Hospital, Ahmed Shabat, 51, sits in fraying clothes. He must come every other day. "This is my work," he says, then shows the swollen veins on his arms caused by a lack of mineral supplements normally provided. "What is the relationship between humanitarian and political aims here?" he asked. "The United States is the mother of democracy. What is political about salaries to teachers and nurses? Please," he said, "please don't mix humanitarian help with politics. Please separate the two."

Ismail Siam is watching over his sister, Asma al-Saidi, 53, who has metastatic breast cancer. She had radiation therapy, but a Tel Aviv hospital returned her to Gaza before chemotherapy because the Hamas-run government could not pay for it. Al Shifa does not have the required drugs, and so provides only analgesics to ease her pain.

Mr. Siam, who works for the authority, alternates days here with his brother. Both live in Khan Yunis, farther south in the strip, and they are borrowing the $10 a day needed to travel here and back. Because the hospital lacks disposables, they also spend $100 every four days, he said, on laxatives, urine bags, catheters, anticonvulsives, feeding tubes and adhesive tape for their sister.

"I borrow from friends and have no more credit at the grocery store," Mr. Siam said. "Unfortunately, the whole world has chosen to punish us for our vote for Hamas. And I also blame everyone who calls himself a Muslim and who does not help us."