Since the terrorist attacks by Hamas on October 7, Israel has been responding with retaliatory strikes in the Gaza Strip. Hamas is a political organization with a militant wing that the EU, as well as the US, the UK, and several other nations have designated as a terrorist group. Some analysts have said Israel's siege of Gaza amounts to collective punishment, a war crime under international humanitarian law.

Living conditions for civilians in Gaza have worsened dramatically. Philippe Lazzarini, general-secretary of the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA), has described the situation as an "unprecedented catastrophe."

Medicine, food, water and fuel are running out, while hundreds of thousands of desperate civilians have been seeking out UNRWA shelters and facilities. According to UNRWA's latest situation report on November 3, more than 695,000 internally displaced people are sheltering in 149 UNRWA installations.

Christof Johnen, head of international cooperation at the German Red Cross, told DW that fresh aid staff were unable to enter Gaza: "Many Palestinians working on the ground are volunteers. They are providing the lion's share of aid, and are doing this under grave danger and at great personal risk," he said.

DW takes a closer look at the most pressing questions on the humanitarian situation in Gaza.

How do aid deliveries reach Gaza?

International aid deliveries from various countries are first shipped to Egypt. At the Rafah border crossing, in Egypt's northeastern Sinai region, the deliveries are brought into Gaza and transported throughout the besieged region.

Once they arrive at their destination, they are received by UN organizations as well as other aid agencies such as the International Red Cross, who distribute them to hospitals and UN facilities.

But deliveries have been severely hampered by the fact that many streets in Gaza have been destroyed in shellfire, or are obstructed with rubble from collapsed buildings. Extensive destruction in northern Gaza has made aid deliveries impossible for the German Red Cross and the Palestinian Red Crescent, said Johnen.

In addition, Israel has placed restrictions on aid deliveries in the hope that relief supplies do not reach Hamas. Reports suggest the state is particularly concerned that Hamas could use fuel supplies for military objectives. According to the Palestinian Red Crescent, Israel has permitted some 370 aid trucks to enter Gaza in the past two weeks. None of the deliveries appear to have contained fuel.

UNICEF spokesperson Toby Fricker told DW that at least 100 truckloads would have to be shipped to the Gaza Strip each day to provide for the over 2 million people living there.

How do people communicate?

Last week, the Palestinian telecommunication company Paltel reported a "complete disruption" of internet and phone services in Gaza caused by "intense bombing" by the Israel Defense Forces (IDF). DW was unable to independently verify this information.

Internet blackouts have encumbered the work of aid groups, who are only able to communicate with their teams provisionally through radio links, said Johnen. In addition, inhabitants are no longer able to contact emergency services to receive on-scene care.

Aid staff have therefore resorted to positioning ambulances at various spots across Gaza. People nearby can then try to alert the medical staff to the whereabouts of injured persons. 

"But of course, these are extremely difficult circumstances that are particularly dangerous for those trying to help, because there is no guarantee for their safety," Johnen added.

How can people access clean drinking water?

"The water supply is indeed very scarce and precarious," said Johnen. The UK-based charity organization Save the Children confirmed this: "Many people are forced to rely on contaminated water sources, which could lead to the outbreak of waterborne diseases." 

The UN Office for the Coordination of Humanitarian Affairs (OCHA) has said there are three water supply lines from Israel into Gaza. After the attack by Hamas, Israel announced it would not open these water lines until the hostages kidnapped in the attack were released and returned home.

On November 3, OCHA reported that two of the three water pipelines from Israel were "functioning." An earlier report by UNRWA, however, stated that none of the water lines from Israel to Gaza were in operation.

Residents in Gaza depend on desalination plants, wells and water reservoirs. But the water supply from these sources is unreliable. Water from wells still needs to be purified before it can be safely consumed. "The water is actually dirty and often very, very salty," said Fricker. 

OCHA estimates that people in Gaza currently only have access to three liters of water per day. Fricker said each person requires 15 liters per day to cover their basic needs, including drinking, cooking and hygiene.

What are the consequences of the fuel shortage?

In early October, the Palestinian Energy Authority announced that the only power plant in the Gaza Strip had shut down due to a lack of fuel.

Meanwhile, the IDF has accused Hamas of "stockpiling" between 500,000 and 1 million liters of fuel. Again, these claims could not be independently verified.

Fuel is essential for people living in Gaza, among other things, to maintain a power supply. The UNRWA has made repeated calls for more fuel deliveries. Hospitals require fuel, for example, to power standby generators that keep vital machines operational.

Upon enquiry, UNRWA told DW that no new fuel had entered Gaza for about a month. Over the weekend, several news agencies reported that the IDF had indicated a willingness to permit fuel deliveries to hospitals.

What are conditions like in hospitals?

Christian Katzer, managing director of the German branch of Doctors Without Borders, or MSF, wrote on the organization's website: "Our surgeons have told us that they sometimes have to operate without general anesthetics. Proper pain medication is not available for patients. It is unimaginable under what conditions health care is being provided. It is unacceptable."

The MSF page also features an account by Mohammed Obeid, MSF surgeon at al-Shifa Hospital in Gaza City, of an operation he conducted on the hospital floor: "We amputate the foot of a 9-year-old boy, with hardly any anesthetics. Our anesthetist holds his mouth open, so he doesn't choke. That's all we can do."

Hospitals are running low on medicine, pain medication and fuel, while people who are not injured seek shelter from the ongoing shelling in hospitals.

On Wednesday, the Rafah border crossing was opened for injured Palestinians to enter Egypt for the first time since Hamas' attack on Israel four weeks ago. Dozens were brought to be treated in various Egyptian hospitals.

What about transportation in Gaza?

Since there is no gas available for cars, people in Gaza have had to find alternative modes of transport. Johnen said many have traveled on foot, or used horses, mules or donkey carts.

Following Israel's evacuation orders, many people attempted to get from northern Gaza to southern Gaza. But not everybody was able to make the move, Johnen explained. Hospitals, for example, are hard to evacuate. According to the German Red Cross, emergency and medical workers reported that they were unable and unwilling to leave those injured behind.

This article was originally written in German.

Correction, November 6, 2023: An earlier version of this article incorrectly referred to the Gaza Strip as being occupied. DW apologizes for the error.