Five neatly arranged children's beds lie in a small, dimly lit room inside Tikur Anbesa Teaching Hospital, on Yared St. Each was occupied by young patients undergoing long-term recovery following complex surgeries. The space buzzes quietly with gentle conversations, parents murmuring comfort, and doctors softly explaining treatment plans.

Near the entrance, on the left side, rests a notably small girl with a thin tube running beneath her nose. Her large eyes, stark against her frail frame, seem to say everything her voice cannot. This is Belena Asnake, a 10-year-old second-grader who has spent the last month and a half in the hospital after kidney surgery. The operation intended to repair kidney damage instead left her unconscious for seven anxious days. Her mother, Adena Ayele, now waits anxiously for another surgery, as the first failed to produce positive results.

Belena's experience with illness has been painfully long. She was first admitted eight years ago, and for the past six years, her condition has stagnated at stage three kidney disease. Life worsened dramatically when her father died from malaria last year, leaving a vacuum both emotional and financial. Adena, once a clothes vendor in Asko Lomi Meda, had to abandon her work, while Belena’s elder sister sometimes misses school to assist at the hospital.

"I can't let her remain alone," Adena said softly, a statement filled with resolve and quiet despair.

Though the hospital and health insurance cover much of the medical costs, essential medications often remain unavailable, forcing Adena to depend on charity from relatives and friends. Belena’s kidney troubles trace back to a nerve disorder diagnosed when she was only two.

A few beds away, five-year-old Leul Alemayehu tried to find relief after two intense days of hospital care. Leul’s kidney failure began at age one due to an untreated urinary infection. His mother, Lekeshen Gebremikael, recounted her battle against mounting medical bills, which worsened after she was compelled to close her small hair salon to care for him. Leul’s father, a government employee, now shoulders all household financial responsibilities.

"There are medicines and laboratories that are simply unavailable," said Lekeshen, detailing expenses of about 1,200 Br daily on medicines, on top of fortnightly medical costs.

The common tragedy linking Belena and Leul is dialysis, a life-saving treatment both urgently require but seldom receive.

According to Handsome Dakisios (MD), a paediatric kidney specialist at the hospital, each month, upto three children tragically die due to insufficient dialysis access. Tikur Anbesa sees around 25 new child kidney failure cases annually; last week, more than 20 have been subjected to intense follow-ups.  The lack of adequate equipment and specialist doctors compounds their vulnerability.

"The most heartbreaking aspect is the situation facing adults," Handsome said grimly. "People appeal for financial assistance as there is some hope, yet nobody does so for children as there is little belief in their chances."

Handsome hopes to see enhanced facilities and equipment in the sector. He recounted instances where doctors had left paediatric kidney specialities feeling helpless. Alarmingly, he noted that the number of children identified as needing emergency dialysis has increased from 22 over three years to 11 in the last six months. Clinical practice focuses on emergency treatments rather than a sustainable approach to dialysis.

At Tikur Anbessa, 77 patients have been admitted for kidney failure treatment, while the outpatient section has recorded 1,957 patients for consultations, including many repeat visits, over the past six months.

"I can't fault those doctors who have left the field," he said. "They don't wish to bear the burden of delivering bad news."

Children with kidney failure frequently suffer from congenital issues or genetic conditions. Yet, an already dire situation worsens amid the ongoing economic downturn, which has inflated import prices and medical costs. Dialysis, requiring disposable materials, has become prohibitively expensive, with private centres now charging 3,000 Br to 6,000 Br a session, while vital medications such as blood thinners surged fivefold in price.

Mesfin Aseres, president of the Tesfa Kidney Patients Association, shared an especially harrowing story. He helplessly watched a child die awaiting dialysis, despite preparations for a transplant abroad.

"He died before my eyes," Mesfin recounted, recalling the brutal reality faced by many.

Hope briefly emerged with a new law permitting organ donation from deceased persons, but complications persist due to limited public awareness and inadequate family matching. Organ donations still largely rely on immediate family, leaving many patients without viable matches.

Esayas Welda, a 24-year-old kidney patient, described the harsh reality of managing dialysis sessions amid spiralling costs. Recommended three times a week, financial pressures have stretched his treatments to every 10 or 12 days, leading to severe toxin buildup and emergency fluid removal procedures from his lungs.

"The worst part is that after the procedure, the toxins return in increased quantity," Esayas confided, frustrated.

For Wongel Tena (MD), a surgical physician at Jimma University, the catastrophic health impacts of intermittent dialysis or medication gaps post-transplant potentially lead to organ rejection or permanent dialysis dependence. She advised preventative care, urging annual kidney assessments for patients with diabetes and hypertension.

Nationally, only 1,132 patients underwent dialysis in 2022, far fewer than international averages, partly due to cost barriers. Privately, dialysis sessions cost about 2,300 Br each, with annual expenses reaching approximately 8,000 dollars, an insurmountable burden given Ethiopia’s per capita income of about 1,272 dollars in 2023, according to the World Bank.

The country's nephrologist-to-population ratio is alarmingly low at 0.26 a million, with 80pc concentrated in Addis Abeba, leaving rural populations deeply underserved.