Gaza City – The Abu Amr family have been displaced more than 17 times since Israel’s war on Gaza began. Each move has narrowed their options. Now, they are living in a tent pitched beside a sprawling rubbish dump in the Remal area of central Gaza City – one of the few remaining places where they could find space.

For the family, survival has become a daily struggle against pollution, illness and indignity.

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“We always say that we live in two wars in Gaza, one that kills with bombing, and one that is from rubbish,” said Saada Abu Amr, 64, who was displaced from Beit Lahiya and is now living in Gaza City. “I have an asthma attack, and the inhaler is always with me. I put it under the pillow at night. I use it several times at night as the smell of the waste blocks my breathing airway.”

Her daughter-in-law, Suryya Abu Amr, a 35-year-old mother of five, said basic hygiene has become nearly impossible.

“We use cleaning materials, but we can’t keep spending all we have on cleaning; things never become clean in a tent near a waste area, especially with the lack of water,” she told Al Jazeera. “We get infected with gastroenteritis several times a month.”

“I was almost dying once with gastroenteritis; they told me at the hospital it was because of poor sanitation,” she added, describing how she had been forced to use toilets shared between dozens of people.

It wasn’t always this way. Before the war, Suryya said, cleanliness was central to her daily life. “I used to clean my house several times a day. Before the war, I was someone who was obsessed with cleaning. I never imagined that I would live this nightmare.”

Desperation

Israel’s genocidal war on Gaza has had a horrific impact on the population – more than 70,000 have been killed. But it has also destroyed or damaged the majority of buildings in Gaza – in a campaign that many Palestinians say is a systematic attempt to make Gaza unliveable.

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It has left Palestinians in Gaza scraping to survive wherever they can, even if conditions are terrible.

For Surrya’s husband, Salem, 40, the decision to remain beside the dump was driven by desperation.

“My children suffer a lot in winter and summer, when the polluted smell comes with the wind, while we eat, we can’t eat, we feel like vomiting,” he said.

“We suffer from insects and mosquitoes. My two-week-old daughter Sabaa’s face is full of mosquito bites,” he added.

Salem described how sewage regularly seeps into the tent during storms. “When it is windy, the wastewater comes onto our tent, and sometimes it splashes on our clothes. We don’t have spare clean clothes; we fled without our clothes from the house in Beit Lahiya. I sometimes have to pray with dirty clothes on. I have no options; no money, no water, and it is winter, clothes take days to dry.”

Rodents, he said, have also become a serious health threat. “The rodents are all around us; we have all recently recovered from a very bad flu. My disabled father was about to die from it; the doctors said it might be because of contamination of rodents’ urine. It was almost similar to a coronavirus infection.”

The family’s children are also paying the price. “I am losing my hair because of the lack of sanitation here; I have got skin infections as well,” said Rahaf Abu Amr, 13.

Health crisis

Health professionals warn that the accumulation of waste, sewage and the lack of clean water are driving a surge in disease.

“The public health situation in Gaza is disastrous; we see viral and bacterial infections with severe complications that we haven’t seen or dealt with before the war,” said Dr Ahmed Alrabiei, consultant internist and pulmonologist and head of the pulmonology department at al-Shifa Medical Complex.

“There is an increase in Guillain-Barre syndrome, cases of meningitis, severe gastroenteritis, weakened immune systems, respiratory infections, Hepatitis A and asthma. There were suspected cases of cholera, but thankfully, no cases were recorded,” he told Al Jazeera.

“The groups most affected by these conditions are young children under two years, the elderly, and those with chronic diseases such as diabetes and high blood pressure, those with autoimmune diseases such as lupus, kidney disease, and cancer patients,” he said.

Hospitals, he added, are operating far beyond capacity. “The pressure on hospitals is too much; the beds’ capacity here is 150 percent overwhelmed. In the chest department, we have 20 beds with more than 40 cases. Patients are in the rooms and corridors, which will also increase the chances of spreading the infections among people.”

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“There is a lack of medications, antibiotics and medical equipment needed for diagnosis, which leads to late treatment for many cases,” Alrabiei said.

Gaza City is facing what municipal officials describe as one of its gravest humanitarian and environmental crises, following the near-total collapse of water and sanitation infrastructure caused by Israeli attacks.

“More than 150,000 metres of pipes and approximately 85 percent of the water wells inside Gaza City were destroyed, in addition to the complete destruction of the water desalination plant,” said Ahmed Driemly, head of public relations at Gaza Municipality.

Solid waste has also piled up across the city after Israeli forces blocked access to Gaza’s main landfill in the east.

“More than 700,000 tonnes of solid waste are piling up in the Gaza Strip, including more than 350,000 tonnes inside Gaza City alone,” said Husni Muhanna, spokesperson for Gaza Municipality.

“This has forced the municipality to establish a temporary landfill on the land of the historic Firas Market, turning the area into a health and environmental disaster, with the spread of insects and rodents and the leakage of wastewater into the groundwater tank, especially with the rainfall,” he added.

Municipal officials say they are operating under extreme constraints. “The Gaza municipality faces a complex set of obstacles that prevent it from fully resuming its services,” Muhanna said, citing the destruction of machinery, fuel shortages, restrictions on heavy equipment, security risks and the displacement of hundreds of thousands of people.

“The Gaza Municipality operates according to a limited emergency plan that falls short of a comprehensive plan,” he said. “Interventions are limited to opening storm drains using primitive means; the Gaza Municipality is no longer able to carry out periodic maintenance of water and sewage networks, rehabilitate roads, or manage waste in accordance with health standards.”

New reality

Despite the announcement of a second phase of a US-backed ceasefire, officials say Israeli authorities continue to obstruct reconstruction efforts – raising fears of the complete collapse of water and sanitation systems and the permanent uninhabitability of entire neighbourhoods.

It means that things won’t improve any time soon for the Palestinians forced to live in unsanitary conditions.

Rojan Jarad, 38, is a mother of four, one of whom is disabled. Her family were displaced from northern Gaza and now shelter in a classroom in Gaza City.

Rojan explained that the lack of access to toilets has reshaped the family’s daily life.

“We used to walk for a very long distance to use the toilet; on some days, we don’t eat or drink a good amount of water, so we don’t have the urge to use the toilet,” she told Al Jazeera.

“My daughters and I line up in a very long row, awaiting to use the public toilets in the school, which is dirty in a way I can’t even describe,” she added.

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“In a different displacement shelter, I found it really difficult to use the public toilets. We got infections back then, so I decided to have our own one in the tent using a bucket. It’s humiliating.”