Rania Sakallah is holding onto happy memories. Shortly before the war started, she and her family enjoyed a day out together at Sheikh Ijlin beach in the south of Gaza City.

They stopped at the Tropical Restaurant to eat chicken pizza. Her twin son and daughter were about to embark on their final year of studies at Al-Azhar University. There was a lot to look forward to.

Now they face the bleakest of starts to 2024. Huddled in a freezing room in the southern border town of Rafah with other family members – 11 people in total – the future resembles a gaping void and the Gaza City home Rania and her husband Hazem had built together possibly reduced to rubble.

“I don’t sleep all night,” says Rania. “I lie awake all night thinking: What are we going to do? Where are we going to go?”

Rania and Hazem, an accountant with the Palestinian Authority, decided to flee Gaza City on October 13, leaving behind their four-bedroom home. “Because we were so scared, we didn’t take much,” says Rania. Carrying a few bags with clothes and tinned food, they walked the 33km (20 miles) to Khan Younis, taking turns to push Rania’s 75-year-old mother, who had recently suffered a stroke, in her wheelchair.

For about 50 days, they stayed in Khan Younis, sleeping on the floor of Rania’s brother’s shop as Israel launched some of the most intense air attacks of the entire war on the Israeli-declared “safe zone” in early December.

Chased by bombs, they hit the road again, joined by the families of Rania’s brother and sister, scrambling for accommodation in Rafah, just as the heavy winter rains began.

Rania and her family are far from alone. According to the United Nations, half of Gaza’s population of 2.2 million is now crammed into schools, public buildings and makeshift camps in Rafah and nearby al-Mawasi. The most desperate are in the streets.

Although southern Gaza is supposed to be the enclave’s last refuge, Israel continues to pound the area. With aid trucks only able to bring in scant supplies, disease and extreme deprivation are rife, says Rania.

Talking on the phone to Al Jazeera, Rania described the battle for survival in Rafah. “Life has tired us out. It has become impossible,” she says. “It’s not just me. It’s like a million Palestinians just like me. And some of them are in an even worse situation.”

Food, water and fuel

More than half a million people in Gaza have run out of food and are now at immediate risk of starvation, UN agencies said last week. Deliveries of food, water and medicine were stopped at the start of the war, with November’s pause in fighting allowing more aid to enter via Rafah – still, only 10 percent of food needs are being met right now.

In Rafah, life revolves around getting enough food and water to survive another day. “When we want to make bread, the first challenge is finding the flour,” says Rania. Even that basic ingredient has become scarce, with family members queueing for hours at a school run by UNRWA (United Nations Relief and Works Agency), which is sheltering thousands and distributing some food aid. Sometimes people leave empty-handed.

It is still possible to buy food, she says. But with supplies running low, prices of basics like fava beans, chickpeas and cheese have skyrocketed, rendering them inaccessible for most people. Once food has been secured, members of the family have to search for firewood outside, as fuel and gas are now impossible to get hold of. Rania uses an old oil drum as a stove to cook.

Water only comes on tap once a week, on Fridays, but is sometimes too dirty even to shower, let alone drink. The mixture of poor nutrition and dirty water is making people ill, sparking outbreaks of diarrhoea, gastroenteritis and skin infections.

Healthcare

Rania does not leave the house without a face mask. As the weather gets colder, catching flu or respiratory infections can mean death. Many of those sheltering at the UNRWA school where she queues for food are ill, she says.

There is a room in the school offering medical assistance but it is unable to provide any treatment beyond paracetamol. “You’re not going to get help if you go there,” she says.

But going to the hospital is not an option either. Right now, Rafah’s Abu Yousef al-Najjar Hospital and the Kuwaiti Hospital are operating beyond capacity on barely any medical supplies. Fuel supplies needed for generators, cut off at the beginning of the war, are still heavily restricted.

Overcrowding and poor sanitary conditions have spawned a whole new set of health hazards. On average, 160 people sheltering in UNRWA schools share a single toilet and there is one shower unit for every 700 people, according to UN figures.

Doctors report that many are infected with parasites. Infectious dysentery, causing vomiting and diarrhoea, is now widespread. Cases of contagious illnesses like chickenpox, measles and viral meningitis are also rising fast.

“I’m trying for there not to be illness in my family,” says Rania. “We’re thinking we could be losing one of our loved ones at any moment and we are scared.”

Communications

With no electricity, Rania’s phone call with Al Jazeera required careful preparation, involving a one-hour walk to the nearest UNRWA school to charge her phone. Once a connection was established, it repeatedly threatened to drop.

This is nothing unusual these days – sometimes it takes Rania dozens of attempts to reach her ailing mother and father, who joined the family in Deir el-Balah when she left for Rafah, Rania tells Al Jazeera.

Right now, the internet is usually only available for 10 minutes at a time. Rania’s children, Rana and Mohammed, both 22 years old, feel like their dreams have been shattered, their world now reduced to a single room in a war zone, with no means of communicating properly with the outside world.

Rana was about to qualify as a dentist, while Mohammed was studying software engineering.

“I tell them to find other places where they can finish outside Gaza but they ask how they can do this. There’s not even any internet for them to look for universities,” Rania says. In any case, she wonders if they would be accepted anywhere without a certificate.

Gaza has endured repeated phone and internet blackouts due to strikes on telecommunications infrastructure, deliberate shutdowns and power cuts since the war started on October 7.

Under blockade for the past 16 years, the enclave has often been compared with an open-air prison, even before the war.

On the cusp of the New Year, Rania, Hazem and the twins are praying for peace. Right now, the only certainty Rania has is that she will not leave Gaza — at a time many Israeli politicians have suggested that the people of Gaza move into Egypt’s Sinai desert. Egypt has rejected the proposal.

Rania’s sister, Aya, also sharing the room in Rafah, stuck it out for as long as she could in Gaza City, eventually forced to leave with her husband and their son, all holding white flags and their identity papers aloft so they would not be shot as they walked south. One uncle who stayed behind was killed by the bombs.

Rania does not even know if the family home, with her beloved garden full of lemon, mango and guava trees, is still standing. But, she says, she is prepared to live in a tent amid the rubble of the destroyed city. “Every day my kids ask me when we are going to go back to Gaza City,” she says. “Why would we go to Sinai? Sinai is a desert.”

“If Gaza too is a desert, I’d rather return there and rebuild it.”