1 of 5 | Families are surviving on flatbread cooked on a makeshift stovetop in the camp in Deir Al Balah. Photo by Ibrahim/UPI

Ibrahim and his family are among the 1.9 million people who have been displaced during the conflict that began over two months ago.

According to the Hamas-run Palestinian Health Ministry, some 20,000 people have been killed — almost 1% of the territory’s 2.2 million population — and more than 52,000 injured since the fighting began with a surprise attack by the militant group on October 7.

Those looking to survive aerial and ground assaults, a collapsing health system and a lack of food are trapped in what a top United Nations refugee official calls a “living hell.”

“The people of Gaza are running out of time and options, as they face bombardment, deprivation and disease in an ever-ever-shrinking space,” U.N. Relief and Works Agency head Philippe Lazzarini said in Geneva last week.

“They are facing the darkest chapter of their history since 1948,” he added.

Ibrahim agreed with the assessment.

“It’s a catastrophe — we’ve never seen anything like this,” he said from Deir Al Balah in Central Gaza, where he and his immediate family, including three young children, are sheltering amid conditions that grow more dire by the day.

Ibrahim’s 71-year-old mother was recently injured by rubble from an airstrike that hit a neighboring house and had to be transported to the hospital by the only available means: on the back of a donkey.

“She lost a lot of blood, but when we got there, they could not give her any,” he said. “The doctors said there was no safe blood that had been tested.”

The weather, meanwhile, has become increasingly dangerous as winter temperatures descend on Gaza. After heavy rains last week, all the tents collapsed in the UNRWA-run refugee camp where Ibrahim and his family were staying.

They moved to the grounds of the Al-Aqsa Hospital, where conditions are no better.

“The health system has collapsed,” Ibrahim said. “There is no electricity and people are freezing in their tents. Nowhere is safe.”

Humanitarian aid is almost nonexistent, with just a trickle of trucks able to cross Gaza’s heavily controlled southern border with Egypt each day.

Lazzarini said the UNRWA is often able to distribute only a bottle of water and a can of tuna a day to families of six or seven people.

“Those are the lucky ones,” Ibrahim said. “We haven’t received any aid in weeks and you can’t buy any food. Money is worth nothing.”

In his tent camp, families are trying to survive on a few bags of flour used to make flatbread on a makeshift stovetop.

UNICEF Executive Director Catherine Russell warned Wednesday that access to clean water is a crisis, especially for children, who she estimated are receiving only 10% of a normal daily amount.

“Children in Gaza have barely a drop to drink,” she said. “Without safe water, many more children will die from deprivation and disease in the coming days.”

As the war continues, most refugees have moved farther south toward the border with Egypt, where a humanitarian crisis is brewing with more than a million people pressed into the city of Rafah, usually home to around 280,000.

Samer, a man who escaped from the northern part of Gaza and is now in Rafah, said he fled as “airstrikes began hitting residential towers and houses filled with people without warning.”

“We have been looking for a safe place, but there is none,” Samer, who asked to be identified by only his first name, told UPI via voice and text messages.

“Many residents lack necessities such as food, bread, blankets, bedding and tents,” he said. “The Gaza Strip is not fit for life.”

Samer said he and many other Palestinians in Gaza are calling for a cease-fire and the release of hostages from both sides.

“We seek to live a decent life away from wars and the launching of rockets,” he said. “We hope to rebuild what was destroyed by the Israeli forces, return to our homes and live in peace.”

Hamas on Thursday seemed to dash any hope for an immediate cease-fire, saying there would be no hostages-for-prisoners swap until Israel agrees to end its military operation in Gaza.

Talks continued in Cairo on Thursday between leaders of Hamas and Egypt, however, in an effort to move forward with a second humanitarian pause in the fighting. Egypt has resisted accepting Palestinian refugees, but pressure is growing with the escalating crisis on its doorstep.

Many Palestinians do not want to leave their homeland, Ibrahim said, for fear that they will never return in a replay of “Nakba,” the forced removal of some 750,000 Palestinians during the founding of Israel in 1948.

Others, however — including Ibrahim himself — dream of being almost anywhere else.

“I spent seven years building my home, and it was destroyed in a minute,” he said. “I will not start over again here in Gaza. If you ask any youth, they will say the same thing.

“Here in Gaza, we have already lost everything,” Ibrahim said.