At the Mother and Child Clinic in Shija’ia, Gaza, some 40 women sit patiently in the waiting room. Most are wearing black niqabs (the Islamic head–to–toe veil and dress). Many clutch babies in their arms. Others closely monitor their older children, who wander around the crowded room. A few are visibly pregnant. The women have come for the free, first–rate medical care.

A nurse enters the waiting room and calls out the name of the next patient. A woman and her 4–year–old son walk over to the nurse, who escorts them to the examination room. Moments later, the doctor arrives, greets the boy, Muhammad Jendeya, and his mother, Sobhia, with a smile and asks about the boy’s health.

Muhammad suffers from anemia. Two years ago, a medical team from the clinic visited the family as part of its outreach services and diagnosed the disorder.

“We had not followed up with any doctor before the team visited us,” admits Mrs. Jendeya, who studies at the Islamic University in Gaza. She lost her husband in the January 2009 war between Hamas and Israel and now struggles to provide for her family on her own.

Since the diagnosis, the doctor insists upon seeing Muhammad once a month to monitor his condition.

“We give him folic acid and vitamins and he is improving,” says the doctor.

The clinic, run by the Near East Council of Churches (N.E.C.C.) with funds from CNEWA– Pontifical Mission, specializes in pre– and post–natal care and pediatrics. Thanks to CNEWA’s benefactors, the clinic in Shija’ia reopened at its current location in the spring of 2009 after the previous facility, located in the same town, was demolished during the January 2009 war. Though no one was injured, tens of thousands of dollars worth of machinery and supplies were destroyed.

The clinic in Shija’ia is one of three the N.E.C.C. runs in Gaza. Together, they serve close to 200,000 residents in densely populated and underserved areas where access to quality health care is all but absent.

Established in 1952 to help provide humanitarian assistance to Palestinian refugees in Gaza, the N.E.C.C. continues its mission. In addition to the clinics, it provides other vital services, such as education, job training and community development programs.

The council and several other Christian institutions in Gaza serve as a lifeline to its 1.5 million inhabitants, two–thirds of whom are Palestinian refugees. The vast majority of the population is Sunni Muslim. Nevertheless, the Christian–run institutions operating in Gaza provide vital social services each year to hundreds of thousands of residents — regardless of religion.

Since 2001, Israel has imposed a blockade on Gaza, restricting the flow of supplies. In 2007, Egypt and Israel intensified the blockade after Hamas assumed control of the territory. The blockade prevented humanitarian assistance from reaching Gazans. Though Israel eased the blockade in 2010 and Egypt reopened its border with Gaza in 2011, it devastated the already fragile society.

Over the past six years, the humanitarian situation in Gaza has deteriorated significantly. Much of the infrastructure still lies in ruins. Work is scarce and residents rely heavily on humanitarian organizations for the basics, such as food, clothing and household goods.

In June 2011, the United Nations Relief and Works Agency for Palestine Refugees (UNRWA) reported that broad unemployment in the second half of 2010 reached an unprecedented high of 45.2 percent.

These harsh conditions have taken a heavy toll on all Gazans, including Christians. According to Dr. Issa Saleem Tarazi, N.E.C.C.’s executive director, the number of Christians in Gaza in the past five to seven years has declined from 3,000 to less than 1,400 people. “Many have left,” he says, “to study or work.”

The N.E.C.C. operates several vocational training programs in Gaza. In 1952, the council opened its first vocational training center in Gaza City. Each year, the center typically enrolls some 40 teenage boys, ages 14 to 16, and provides professional–level training in carpentry, furniture making and metalwork. In contrast to a similar program run by UNRWA, which admits only refugees, the N.E.C.C. program allows all Gazans to benefit, regardless of religion or refugee status.

Adel Mushtaha, a 15–year–old student at the N.E.C.C. center, says he dropped out of school at age 9, “because I was not good at studying.” Now in a few months, he will graduate with a diploma in metalwork and welding. “I will help my father provide for our family,” says Adel, who recently landed a job at a workshop manufacturing metal furniture.

The N.E.C.C. headquarters in Gaza City also houses vocational training programs in secretarial services and dressmaking.

In one of the facility’s lecture halls, 20 young women, all but one of whom are Muslim and wearing hijabs (Islamic headscarves), sit behind computers. The instructor, Heba Atallah, walks the students through word processing and other software, and teaches how to use the Internet.

The program accepts women of all ages who have completed secondary education. In a conflict zone such as Gaza, many men have died in combat, leaving women to fend for themselves and their families. For this reason, the N.E.C.C. makes it a priority to provide women with job skills that lead to gainful employment.

Tuition is modest, about $300 per year.

For 34–year–old Raeda Abu Khater, secretarial services fit her needs perfectly. The mother of one says she chose it, in part, “because fees are symbolic” and within her family’s budget. She also believes the program offers better employment prospects than comparable university courses since it focuses on developing practical skills for a career in relatively high demand.

Located on the first floor of the N.E.C.C. headquarters, an advanced dressmaking center offers women an intensive 11–month course in clothing design and sewing. The curriculum includes lessons on how to make jackets, skirts, casual dresses and evening gowns.

About 20 young women enroll in the course each year. On average, three or four drop out, usually to get married and raise children.

Najah Hajjaj, the 55–year–old instructor, recalls the time when 60 women signed up for the course each year. Enrollment dropped to its current number when UNRWA stopped covering the cost of transportation for women living near Gaza’s northern and southern borders.

Mrs. Hajjaj graduated from the program in the 1970’s. She and the other instructors in the dressmaking center are women. Sensitive to Gaza’s traditional Muslim values, the N.E.C.C. makes it a policy to group students and instructors of the same sex.

Among this year’s students is Umm Musbah. In 2006, the mother of five graduated from a college in Gaza with a diploma in elementary education. For five years, she hunted for a job in her field without success.

“I decided to join this program to help my husband, who is a tailor,” Mrs. Musbah explains, as she sews a mauve dress at a wooden table in one of the workshops. “My husband can bring me the wives of his clients so we can do business together, improve our lives and guarantee our children’s future.”

She cites the program’s low cost as another factor in her decision. “The fees are not high, only 350 Shekels [$100], and they can be paid throughout the course.”

In another workroom down the hall, ten older women sit at tables, sewing large sheets of fabric. These women participate in a separate project, which employs a limited number of widows and older unmarried women. The women sew curtains, tablecloths and uniforms for a modest income.

“I have been at the N.E.C.C. for 40 years,” says 70–year–old widow Maqboula Al Nounou. “I started with a dressmaking course, but now it is difficult for me to work with needles at this age,” she continues. “Thank God we earn some compensation here and don’t have to beg.”

Founded in 2001 to assist Gazans in the aftermath of the second intifada, the Myrrh Bearers Society of the Orthodox Church supports humanitarian, education and development projects.

The society’s most successful ongoing project is its university scholarship program for Gazan youth. Each year, it covers the tuition and fees for 16 students with high academic standing in Gazan universities.

“This is a project from which Muslims and Christians benefit,” says Adlah Farah, a member of the society’s board of directors.

In 2010, CNEWA–Pontifical Mission raised funds from the Netherlands Lieutenancy of the Equestrian Order of the Holy Sepulchre for the society’s scholarship program. With the money, society awarded full–tuition, four–year scholarships to ten exceptional Christian Gazan students enrolled in universities in Palestine.

Last year, it also provided 49 merit scholarships (ranging from $130 to $230) with funds it received from Caritas Jerusalem.

Though the society has completed major projects in the past, at present it lacks the funding for large–scale activities. Members hope that in the future the society will have the resources to move forward on its plans to build a home for needy elderly Gazans. But for now, it struggles to pay the salary of its secretary — its only employee.

“Due to the siege and the troubled situation,” explains Ms. Farah, “our projects have turned from development to relief.”

Gaza’s current humanitarian and economic crisis also has forced the Al–Ahli Arab Hospital in Gaza City to make tough choices.

Built in 1907 by the Anglican Church, which continues to run it, the hospital is the oldest in the territory. It offers a wide range of services, including internal medicine, surgery, gynecology, maternity, outpatient clinics, pediatrics and physical therapy. Its emergency care unit is open to 24 hours a day, 7 days a week.

At present, however, the hospital operates on a nearly $1.2 million annual deficit. As a result, administrators have had no choice but to cut some services. For instance, they have mandated that inpatients occupy no more than 50 of the 80 beds at any time. And they have suspended training programs outside Gaza for all employees — medical professionals and staff alike.

The blockade also makes it difficult for the hospital to receive new supplies and equipment, as well as repair existing machines. In addition, says Suhaila Tarazi, the hospital’s director, infighting among Palestinian leaders have “added more complications to the transferring of patients from one hospital to another.”

The hospital also absorbs the cost of care for many of its patients. Even patients who qualify for assistance from UNRWA often cannot afford the minimum co–pay.

For instance, the average cost for inpatient service at Al–Ahli is about $127. UNRWA covers up to $90 on condition the patient pays $10. This seemingly small fee, however, equals an average daily income for a family of eight in Gaza.

“We are obligated to treat any patient we receive, even if we did not have enough money to cover it,” explains Ms. Tarazi.

Notwithstanding its financial woes, the Al–Ahli Arab Hospital continues to provide thousands of residents free and low–cost health care. Each year, it treats more than 4,800 inpatients and 42,00 outpatients and provides physical therapy to almost 13,000 patients.

The hospital runs an extensive outreach program. It works closely with 54 local charities to help locate, register and follow up with qualifying individuals. Each year, some 5,800 beneficiaries have access to the full range of the hospital’s services and receive inpatient care in any department free of charge. Doctors examine the patients and provide necessary care, whether it be dispensing medications, recommending further diagnostic tests or admitting them for inpatient services.

“Because some patients cannot afford paying for transportation, we send buses to pick them up and bring them to the hospital,” says Ms. Tarazi. “We also give them light meals while they are here.”

Every Tuesday and Saturday, the hospital hosts a free clinic for women and children. On those days, hundreds from all over Gaza — many living in the unstable areas near the Israeli border — line up for a free consultation and, if necessary, further tests and treatment.

The hospital also runs an innovative women’s emergency health program.

“We noticed that there are many women suffering from chronic diseases, including heart problems and diabetes, and cannot follow up with doctors,” says Ms. Tarazi. “So, we decided to offer them services three days a week.”

In 2009, the hospital launched a breast cancer initiative, screening all women patients over 40 for the disease. That year, doctors at the hospital examined 400 women for breast cancer. The following year, the hospital examined 800 women, and in 2011, 600 women. Ms. Tarazi hopes to increase the number to 2,000 once the hospital secures more funding.

“We offer services to poor families, regardless of ethnic, religious or economic background,” says Ms. Tarazi. “But it is difficult for us to continue our work without more funding.”

Journalist Fares Akram and photographer Eman Mohammed are based in Gaza.