In a sprawling tent camp in Gaza, Israeli bombs fall close enough to hear and feel. But daily life is also a fight against hunger, cold and a growing health crisis.

The lack of sufficient toilets and drinking water, as well as open sewage, are problems that displaced Palestinians have struggled with since the early days of Israel’s attack on Gaza.

For two months after Salwa al-Masri, 75, and her family fled to the city of Rafah, on the southern edge of Gaza, to escape Israel’s military offensive, she said she would walk 200 meters to reach the nearest bathroom. If she was lucky, the younger women in line behind her would let her get ahead. Other times, she can wait up to an hour to use a dirty bathroom that she shares with thousands of people.

“It’s horrible,” Ms. al-Masri said recently via WhatsApp from her family’s ramshackle tent, which they made from wood and plastic sheets. “I wouldn’t drink water. I would stay thirsty so I wouldn’t have to go to the bathroom. I stopped drinking coffee and tea.”

Many other Gazans, already facing hunger and thirst as a result of Israel’s more than four-month siege of the territory, say they too have tried to further reduce their food and drink consumption to avoid an uncomfortable and dangerous visit. unsanitary to the bathroom. .

Recently, Ms. al-Masri’s son and other relatives bought a cement toilet and dug a hole behind their store, where sewage accumulates. It is a closer bathroom that you share with fewer people.

But the challenges of getting water for washing and accumulating sewage threaten their health, and the stench of sewage fills their makeshift camp.

Last month, the World Health Organization reported that cases of hepatitis A had been confirmed in Gaza. He also said that there are several thousand people with jaundice, caused among other diseases by hepatitis A. Cases of diarrhea among children have also skyrocketed. All of this is linked to poor sanitation, according to UNICEF.

“Inhumane living conditions – hardly any drinking water, clean toilets and the ability to keep surroundings clean – will allow hepatitis A to spread further,” said Tedros Adhanom Ghebreyesus, WHO director-general. wrote on social media at that time, “and highlight how explosively dangerous the environment is for the spread of disease.”

Leading epidemiologists have estimated that an escalation of the war in Gaza could cause up to 85,000 Palestinian deaths in the next six months from injuries, illnesses and lack of medical care, on top of the nearly 30,000 that local authorities have already reported since early October. Their estimate represents “excess deaths” that would not have been expected without the war.

Schools, hospitals, mosques and churches have become overcrowded shelters for Palestinians seeking safety from Israeli airstrikes. The few bathrooms available have to be shared among hundreds or thousands of people who sometimes queue for hours to use them.

The Israeli bombardment of Gaza and the accompanying ground offensive have increasingly pushed Palestinians south into the overcrowded corner of Gaza around Rafah and forced them to pitch makeshift tents. As a result, access to bathrooms and sanitation services has only worsened.

About 1.5 million displaced Palestinians are now in Rafah – more than half of Gaza’s total population of about 2.2 million – even as Israel threatens to invade the area.

Following the Hamas-led attacks on Israel on October 7, Israel’s near-complete siege of Gaza has prevented most things from entering the territory, creating severe shortages of food, water and medicine. Additionally, representatives of both UNICEF and the Palestinian Red Crescent Society said their organizations had attempted to bring in portable toilets and materials to build sanitation facilities, but were prevented from doing so by Israeli authorities.

“It’s a public health problem,” said Abrassac Kamara, UNICEF director for Palestine’s WASH programme, which helps deliver clean water and sanitation services. “But the second thing is simply dignity. “It’s something we take for granted, but that’s how we’re really taking away people’s dignity.”

Israel’s civil administration, the bureaucratic arm of its military in the occupied West Bank and Gaza, said restrictions on the entry of certain goods into Gaza prevented the entry of items that could also be used for military purposes.

Hamas “exploits civilian resources to strengthen itself militarily at the expense of caring for the civilian population,” the civil administration said, without explaining how portable toilets could meet military needs.

UNICEF officials said they have had to resort to building toilets with wood, concrete and plastic sheeting – materials already available in Gaza – often at high cost. The agency plans to build 500 such toilets in Rafah to help reduce congestion.

“At the moment, anything that is considered construction material (mainly metal, but also sandwich panels, nails and rebar) is prohibited,” Kamara said. “We’re getting by.”

UNICEF had planned to build another 500 toilets in the southern Gaza town of Khan Younis, but had to abandon those efforts when Israel’s ground offensive recently advanced into the area.

“They literally put up any kind of privacy screen (plastic in the back of the tent) and just dig and bury when they need to do their business,” Kamara said. “We’re back to basic sanitation of digging a hole and covering it.”

In a video posted on Instagram last month, Bisan Owda, a journalist and documentary filmmaker from Gaza, recounted the daily struggle to find a latrine. As she passed tents on the street, carrying a large jug of water, she recounted her challenges.

“This is my daily routine,” he said, “walking for almost 20 to 25 minutes to reach the bathroom; actually struggling to get to the bathroom.”

Other women have lamented the desperate lack of sanitary pads in the territory, with at least one telling the New York Times that she had started taking birth control pills to stop her period altogether.

Sana Kabariti, 33, a pharmacist from the northern Gaza City, said she fled with her family to the central Gaza city of Nuseirat as Israeli bombs fell on her neighborhood in the early days of the war. She and about 40 members of her extended family, including 10 children, were locked in a small room and shared a bathroom, she said. But there was no water or toilet paper.

So, despite the dangers, they returned to their homes.

“As for the bathroom, there was no water,” he said. “And this is what led the families who were with us to return to Gaza City, and into danger, because they couldn’t bear the lack of water and toilet paper.”

Eventually, the bombing in Gaza City became so intense that she and her family had to flee again. They headed south, first to the city of Deir al Balah and finally to Rafah.

They are in a better situation than many in Rafah because they take refuge in a room in a house shared by many. But the bathroom is small and they have to walk every day to get water to wash and try to keep the bathroom clean. Showering is a luxury they can rarely afford.

They don’t use toilet paper. Even if they can find it in the markets, the price is exorbitant: Israel’s siege has raised the cost of the few goods still available in Gaza.

Instead, the family cuts pieces of cloth to use, Kabariti said.

“There are many people who are not willing to go to the bathroom more than once a day,” he said.

In her neighborhood, she said she met an older woman who refused to use the bathroom at the center where she was taking refuge because it was very dirty and unhygienic. Instead, the neighbors allowed him to use the bathroom.

But since he does not want to impose himself, he uses it only once a day, just after dawn, when he has said his morning prayers. Then he puts it away until the next morning.

“I don’t know how long a person’s body can continue like this after almost four months,” Ms. Kabariti said.

Abu Bakr Bashir contributed reports.

By Sam