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Hundreds of thousands in Gaza face shortages of clean water and medicine.

Crucial infrastructure has been destroyed or taken offline in the latest eruption of deadly violence, which shows no sign of abating.

Palestinian families taking shelter in a United Nations school in Rafah, southern Gaza, on Monday.Credit...Said Khatib/Agence France-Presse — Getty Images

Marc SantoraIyad Abuheweila and

Until Monday evening, the Al-Rimal health clinic in central Gaza City was a key cog in the Palestinian health system. Its eight doctors and 200 nurses administered hundreds of vaccinations, prescriptions, and screenings a day. And Al-Rimal housed the only laboratory in Gaza that could process coronavirus tests.

But then, on Monday night, an Israeli airstrike hit the street outside, sending shrapnel into the clinic, shattering windows, shredding doors, furniture and computers — and wrecking Gaza’s only coronavirus test laboratory.

“During times of war people need more treatment than usual,” Mohammed Abu Samaan, a senior administrator at the clinic, said Tuesday. “Now we can’t give people medicine.”

The wreckage at Al-Rimal is one of the most striking examples of devastation wrought by the nine-day-old battle between Hamas militants and the Israeli military — creating a humanitarian catastrophe that is touching nearly every civilian living in Gaza, a coastal territory of about two million people.

Sewage systems have been destroyed, sending fetid wastewater into the streets of Gaza City. A critical desalination plant that helped provide fresh water to 250,000 people is offline, and water pipes serving at least 800,000 people have been damaged. Landfills are closed, with trash piling up. And dozens of schools have been either damaged or ordered to close, forcing some 600,000 students to miss classes on Monday.

Even before the loss of the coronavirus testing center, vaccine supplies headed to Gaza had been indefinitely delayed by the fighting, and only a tiny fraction of Gazans had been vaccinated.

“All of this is happening in a situation where we know in Gaza, the humanitarian situation even before this latest round of fighting was not good, to say the least,” Stéphane Dujarric, a spokesman for the United Nations, told reporters on Tuesday at U.N. headquarters in New York. “Access to vaccines was very challenging. So, this only makes things worse.”An operation to move some emergency relief supplies into Gaza on Tuesday was suspended by what Israeli officials and senior aid workers said was Palestinian mortar fire near Israel’s Kerem Shalom crossing into the territory. Only five fuel trucks from a 24-truck convoy of the United Nations Relief and Works Agency, which aids Palestinian refugees, made it through before traffic was halted because of mortar explosions.

“I recognize the efforts undertaken today to open Kerem Shalom crossing, allowing UNRWA fuel trucks to enter Gaza,” Mark Lowcock, the top United Nations humanitarian aid official, said in a statement. “Regrettably, other essential humanitarian cargo was unable to cross.”

He called upon “all parties to allow and facilitate rapid and unimpeded passage of humanitarian relief for civilians in need.”

The level of destruction and loss of human life have underlined the challenge in the Gaza Strip, already overpacked with people and suffering under the weight of an indefinite blockade by Israel and Egypt even before the latest conflict.

President Biden added his voice to the growing chorus of international leaders calling for a cease-fire on Monday night, but there was little indication that an end to the hostilities was near on Tuesday.

Militants in Gaza aimed a barrage of around 100 rockets at southern Israel overnight, adding to the more than 3,300 fired in just over a week. And the Israeli bombardment showed no signs of letting up, with the sound of explosions once again rocking Gaza before dawn.

General Hidai Zilberman, a military spokesman, who spoke to the Israeli network Army Radio, said there was no plan to suspend operations.

“We have a bank of targets that is full, and we want to continue and to create pressure on Hamas,” he said. “This morning, the chief of staff gave us the plans for the next 24 hours, the targets. We will hit anyone who belongs to Hamas, from the first to the last.”

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A building in Ashdod, southern Israel, on Monday, after a strike by a rocket from Gaza.Credit...Dan Balilty for The New York Times

Hamas said it would not stop its assault, accusing “the criminal Zionist enemy” of “bombing of homes and residential apartments.”

“We warn the enemy that if it did not stop that immediately, we would resume rocketing Tel Aviv,” the militant group’s spokesman Abu Ubaida said, according to Reuters.

While Hamas fighters move through an extensive series of tunnels under Gaza, and as Israeli warplanes drop bombs aimed at destroying that network, it is the people caught between who suffer the most calamitous losses.

Schools in southern Israel within range of the rocket fire have been closed and many families have left the border areas. The constant wailing of sirens warning of incoming rocket fire punctuate daily life, particularly in the south, sending Israelis repeatedly running to shelters.

At least 10 people in Israel have been killed in rocket attacks, the Israeli authorities said.

The death toll in Gaza itself has surpassed 200, including at least 61 children, according to the health authorities in the territory.

And the sprawling humanitarian crisis in Gaza — documented by both United Nations agencies and the local authorities — is growing by the day, adding to pressure on political leaders to pause the hostilities so that relief can reach those in desperate need.

Palestinian activists across Israel took part in a general strike on Tuesday to protest Israel’s air campaign in Gaza and other measures targeting Palestinians.

Even before the current conflict, Gaza was facing an economic crisis and political crisis.

Hamas won elections in the territory in 2006 and took full control in 2007, after which Israel put a blockade on the region, citing the need to curb weapons smuggling. Egypt, which shares a border with Gaza, also put in restrictions that tightly control the movement of people and goods in and out of the territory.

Since 2007, Hamas has engaged in three major conflicts with Israel and several smaller skirmishes. After each eruption of violence, Gaza’s infrastructure was left in shambles.

The result, according to a report last year by the United Nations, is that Gaza has “the world’s highest unemployment rate, and more than half of its population lives below the poverty line.”

The latest round of fighting has crippled that fragile infrastructure.

Six hospitals and eight clinics have suffered bomb damage, according to the United Nations’ humanitarian affairs office, limiting medical treatment available for many people living in the region.

By Monday, Israeli bombs had destroyed 132 residential buildings and damaged 316 housing units so badly that they were uninhabitable, according to Gaza’s housing ministry.

More than 40,000 people have been forced into shelters and thousands more have sought refuge with friends or relatives, according to the U.N. humanitarian affairs office.

“Until a cease-fire is reached, all parties must agree to a ‘humanitarian pause,’” the office said in a statement. “These measures would allow humanitarian agencies to carry out relief operations, and people to purchase food and water and seek medical care.”

Marc Santora is the International News Editor based in London, focusing on breaking news events. He was previously the Bureau Chief for East and Central Europe based in Warsaw. He has also reported extensively from Iraq and Africa.

  More about Marc Santora

Patrick Kingsley is the Jerusalem bureau chief, covering Israel and the occupied territories. He has reported from more than 40 countries, written two books and previously covered migration and the Middle East for The Guardian. More about Patrick Kingsley

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