Ahmed Ayad was unfortunate to fall sick while living under what Israel and its allies in the west are defining as the "ministries of terror".

The 42-year-old Palestinian father of five began kidney dialysis at a hospital in Gaza City six weeks ago at just about the time Israel’s blockade of the Gaza Strip and international sanctions against the Hamas government began to bite in the health ministry.

The resulting shortages of drugs and others supplies have forced Shifa hospital to cut back Mr Ayad’s dialysis treatment.

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"The day they reduced my treatment I was so so tired. I’m afraid they will reduce it more. Look at my face. I feel like a dead person," he said.

But Mr Ayad has been lucky. Shifa hospital says four people receiving dialysis have died over the past three weeks because of the shortages. It is the same in the cancer ward, where there is a diminishing supply of chemotherapy drugs, and other parts of the hospital where even basic antibiotics have not arrived for a month.

Mr Ayad is also fortunate that there is someone to treat him. None of the medical staff at Shifa has been paid for the past two months. It is the same for the rest of the Palestinian Authority’s 160,000 workers whose wages usually come from a mix of foreign aid and customs duties now frozen by Israel with increasingly serious consequences for the 1 million Palestinians – one in four of the population – supported by government salaries.

The World Bank warned this week that its earlier predictions of a 50% rise in poverty in the occupied territories this year, driven by a sharp fall in personal income and a 23% increase in unemployment, may have been "too rosy", because it underestimated the extent of western sanctions against Hamas and the Israeli blockade.

"The recession has already begun, with March and April’s public sector salaries so far unpaid and with signs of food and gasoline shortages manifesting in Gaza," the Bank said.

"If the Palestinian Authority remains unpaid/minimally paid for several months, it may cease to function …

"A protracted period in which the PA is disabled might result in the unravelling of a dozen years of donor efforts to build the responsible, accountable institutions needed for a future Palestinian state."

Dr Nasser al-Atar still goes into Shifa’s dialysis unit every day.

"I was last paid two months ago but I still come to work. It’s my duty as a human being," he said.

But he is disturbed at what lies ahead. New filters for the dialysis machines finally arrived on Monday but they are designed for use on children and only provide for a part of the treatment required by other adults.

The blockade and aid cuts mean there are still none of the required drugs, forcing a cut back on treatment for the 160 outpatients, including 24 children, from three times to twice a week.

"Before long we will have to cut back the number of treatments again. Some more patients will die," said Dr Atar. "Look at the patients now. They look sick. Reduction in treatment means more anaemia. They are weaker."

Physicians for Human Rights – Israel, an independent medical charity, warned yesterday that the Palestinian health system faced collapse if aid continued to be withheld.

"Ending the funding to the health system will lead to the death of thousands of people in the short term and to extensive morbidity in the long term," it said.

Mr Ayad is one of those whose life may depend on what western governments decide.

"Please save my life. I have three boys and four girls. If you do not want to save my life for me, save it for my children," he said.