The World Health Organization is warning of an "imminent public health catastrophe" in the Gaza Strip. The displacement of 1 million people, overcrowding in shelters and a lack of fuel needed to run sewage, waste and water desalination plants have created a perfect storm for the spread of disease.
"Hi guys, I'm still alive," is how Bisan Owda, 25, starts most of her Instagram reels. But after 16 days of Israeli bombing, the filmmaker told her 665,000 followers: "My biggest fear is not to die, my biggest fear is to live."
Owda and her parents are sleeping alongside some 50,000 other displaced people in and around Shifa Hospital, the largest hospital in the Gaza Strip. They are among the more than 1 million Gazans who have been displaced since Islamist militants from Hamas carried out a massacre in southern Israel on October 7, killing at least 1,400 Israelis and foreigners and kidnapping hundreds more. The attack prompted Israel to launch a bombing campaign against the enclave, warning Gazans living in the north to move southwards.
According to the health ministry in the Hamas-controlled Gaza Strip, at least 5,790 Gazans have so far been killed in Israeli air strikes.
The Owda family home in the village of Beit Hanoun in the north was bombed, as was Owda's office in the Rimal neighbourhood of Gaza City. She lost her possessions and all of her filming equipment.
'Diseases are spreading'
Conditions in the camp are extremely difficult, Owda says. All around Shifa Hospital, families have made camp in the streets, the carpark and inside the building's corridors.
"Winter is coming. It's getting colder, we don't have a proper place to sleep, we don't have any blankets," Owda says. "It rained on me while I was sleeping and it made my mother start crying. For some people winter reminds them of hot chocolate, but winter in Gaza is disastrous. Are we really that lucky to be alive?"
Living in close quarters without access to sanitation facilities and enough clean water means people are starting to get ill.
"People have fevers, they're coughing, children are in danger, we could get a new Covid," she says.
"Already, we've started to notice that some diseases are spreading, including smallpox," warns Adnan Abu-Hasna from the United Nations Relief and Works Agency (UNRWA), which supports relief and human development for Palestinian refugees.
In a situation report released on October 21, the World Health Organization warned of an "imminent public health catastrophe" propelled by mass displacement, overcrowding in shelters, and damage to water and sanitation networks.
Drinking water in short supply
After the bloody killings by Hamas on October 7, Israel introduced a total blockade of Gaza, cutting off clean water, electricity and fuel deliveries. Following a visit to Israel by US President Joe Biden, four humanitarian aid convoys have crossed into Gaza via the Rafah border with Egypt since October 21.
Israel has so far refused to allow fuel onto aid trucks on the grounds that Hamas could steal it from UN facilities and use it to launch attacks.
But fuel is badly needed for water purification and desalination plants to operate. Bottled water is scarce and unaffordable for most. UNRWA has been providing fuel but has warned it will run out by Wednesday night.
"We are heading towards a real catastrophe of not having any drinking water in the Gaza Strip," Abu-Hasna says.
In the camp at Shifa Hospital, Owda says the displaced get water from a nearby well that could be contaminated with sewage and saltwater.
"It's not meant for drinking, it needs to be cleaned," she explains. "We don't really know if it's safe but we're drinking it because there's no other option."
Sanitation network under pressure
Fuel is also needed to operate sewage and waste management systems.
"You can smell the sewage in the streets and it's horrible," says Abu-Hasna, who is also among the 1 million displaced Gazans. His home in the north of the enclave was partially destroyed by Israeli air strikes so he is staying with family further south.
Mass displacement is putting extra pressure on the sewage system. "You might have 5,000 people and only four toilets" in the shelters, Abu-Hasna says.
In the northern part of Gaza, waste management infrastructure is not functioning, he says. "In the south, rubbish collection and treatment centres are partially operating. But everywhere you see piles of waste in the streets."
Even in the south, Abu-Hasna says Israeli air strikes make it "very dangerous" for garbage truck drivers to move around "because they're very exposed when travelling through to the streets".
Israeli air strikes have destroyed entire neighbourhoods, leveling homes, schools and places of worship across Gaza.
"Why am I afraid to live? Because I'm not sure that we are lucky for surviving," Owda says. "We're hungry, we're thirsty, we're cold, we're without our homes, we have relatives who have been murdered. Because we've survived, it means we will have to face all this alone."
