Hundreds of people are forced to share toilets and showers as overcrowding in the southern Gaza Strip increases.
Some are sleeping on playgrounds or in tents made of bedding as the region faces the arrival of thousands of civilians fleeing Israel’s offensive against Hamas.
Aid workers fear overcrowding could lead to outbreaks of infectious and water-borne diseases such as cholera.
An aid worker said more than 150 people use one toilet, and schools that have been converted into shelters have up to 80 students per class.
Israel has urged civilians to move south while continuing ground offensives in the northern Gaza Strip. Thousands of people have hit the road in recent weeks.
The Gaza Strip has been under constant airstrikes since early October as Israel tries to root out Hamas, the British-banned terrorist organization that controls the strip, after killing 1,400 Israeli civilians.
A temporary ceasefire between Israel and Hamas will take effect at 7 a.m. Friday. The release of 13 hostages abducted by Hamas on October 7 is expected, followed by another group each day.
Families sleep in tents and classrooms.
As the weather gets colder, there are fears that even more citizens will try to hunker down in closed shelters, exacerbating the capacity crisis and health risks.
“Most shelters are for women and children, and the men sleep outside. They want to be as close to UN shelters as possible, so they sleep on playgrounds or near buildings,” said Hiba Tibi, CARE’s director in the Gaza Strip.
“Some people built tents from sheets, but they were flooded or could not withstand the wind.
“Some places now have 80 people in a class,” she said. “Overcrowding is only going to get worse as winter approaches.”
Islamic Relief, a humanitarian organization working on the ground in the Gaza Strip, said the situation in Gaza was “desperate” and that overcrowding in the south was a “serious problem.”
She fears diseases will spread in overcrowded shelters.
“People live in overcrowded schools and shelters, where on average there is one shower for every 700 people, and hundreds of people share toilets,” the spokesman said.
“It is estimated that more than 1.7 million people have been displaced. Conditions in these shelters are conducive to the rapid spread of disease, and we are seeing an increase in childhood diarrheal diseases and acute respiratory illnesses. Fears of possible cholera outbreaks are growing.”
“We are deeply concerned about the risk of increased malnutrition and even hunger if people do not have better access to food.
“People wait in line for two flatbreads on average four to six hours. Vegetables such as tomatoes and potatoes are rare. Farmers across the Gaza Strip have reportedly begun slaughtering their livestock for food and because they cannot feed them – which, while providing them with immediate food, is likely to worsen the food and poverty crisis in the long term.”
People stand in line for hours to go to the toilet.
Fikr Shallut, director of the Palestinian Medical Assistance Authority in the Gaza Strip, said more than 900,000 people in the southern Gaza Strip were living in some 154 temporary shelters – nearly 6,000 each.
“People live in very difficult conditions. Emergency shelters are full. In each room, 150 people share the same toilet, meaning they have to queue for hours to use the toilet. Many people do not have access to a shower. People suffered from various infections such as skin diseases such as scabies, which could be due to poor hygiene. They don’t have access to basic healthcare and medicine,” she said.
“Access to food, water and sanitation materials is very limited. People spend most of their day searching for food and water. It’s hard for them to find anything in the local market because the stores don’t have everything.”
“Aid currently provided in Gaza is very limited. The total number of trucks is about 13,000 trucks; Previously, this number would reach Gaza within a few days.
“People are afraid that land-based activities will expand. There are already explosions in the south, killing many people and destroying houses.”
Two aid workers said some people in the southern town of Khan Younis were also ordered to evacuate, forcing them to move further south towards Rafah.
Rafah is the point through which humanitarian aid enters Gaza and some wounded and dual citizens are evacuated from Gaza.
Food and water supplies have improved since several trucks carrying humanitarian aid were allowed into the Gaza Strip. Canned food is available but is “very expensive” and a bottle of water costs between one shekel (20p) and six (£1.30), Ms Tibi said.
“My family sent me a photo of the food they received for five participants. There were cookies, tea bags and half a liter of water. This should have fed the family for two days,” she said. “Not enough, but at least there is access to food.”