LONDON: When a ceasefire was declared in Gaza on Oct. 10, even this narrow window of calm was enough to revive hopes of peace after two years of war. Aid convoys began moving once again, and families allowed themselves to dream of recovery.

That optimism faded quickly, however. After a fleeting lull in the fighting, Israeli airstrikes resumed across the Palestinian enclave, replacing fragile hope with renewed fears for civilians and aid workers.

Joseph Belliveau, executive director of the US-based medical charity MedGlobal, was among those who felt that shift firsthand.

In the Al-Mawasi area of southwestern Gaza on a rare frontline assessment mission, Belliveau was awakened on Nov. 21 at 5:20 a.m. by explosions that shook the building where he was staying.

“I lost count of how many bombs we were hearing throughout the day,” he told Arab News over the phone from Al-Mawasi. “Even though we’re now calling this a ceasefire, it is still a very violent period.”

The strikes he heard that morning were not the first nor the only ones since the US-brokered truce took effect.

UN experts say Israel violated the ceasefire 393 times between Oct. 11 and Nov. 24, killing 339 Palestinians, including at least 70 children, and injuring more than 871 others.

They said airstrikes on Oct. 28 “marked the deadliest single night since the ceasefire began, with at least 104 Palestinians killed.”

Israel’s military said it struck “dozens of terror targets and terrorists” after accusing Hamas of breaching the ceasefire terms with the killing of an Israeli soldier, the BBC reported in late October.

Hamas denied involvement, saying it had “no connection” to the attack that killed the Israeli soldier, and that Israel was looking for excuses to undermine the ceasefire.

While the parties trade blame for the resumption of violence, Gaza’s humanitarian crisis has only deepened.

Shortages of food, clean water, shelter, and essential medical supplies persist. Nearly all of Gaza’s two million residents have been displaced multiple times with most now living in tents or amid the rubble.

Winter conditions have deepened the suffering, with heavy rain flooding shelters and affecting more than 13,000 households, according to UN figures. Health workers report rising cases of illness tied to hunger, displacement, exposure to harsh weather, and poor sanitation.

“Almost everyone is living in a tent now,” Belliveau said. “There are still some standing buildings and apartments, but most dwellings have been destroyed by the bombing, leaving the vast majority of people, including nearly all of our staff, living in tents.

“Now, with the cold season approaching, conditions are getting harder.”

Through the window of his office in Al-Mawasi, Belliveau said he could see “tents in every direction and children playing around them, barefoot. It has started to rain, and temperatures are dropping.”

Israel’s offensive in Gaza, which came in retaliation for the Oct. 7, 2023, Hamas-led attack, has devastated critical infrastructure and damaged or destroyed 90 percent of the enclave’s homes, leaving some 1.9 million Palestinians without a safe or permanent shelter, according to the UN.

“Only about a third of Gaza’s hospitals that were operating before Oct. 2023 are still functional,” said Belliveau.

The World Health Organization said 94 percent of hospitals have been damaged or destroyed, leaving the remainder partially operational and overwhelmed. Stephane Dujarric, spokesperson for the UN secretary-general, said on Nov. 26 “not a single hospital in Gaza is fully functional.”

Medical staff are also reporting a surge in respiratory and waterborne disease.

“As it gets colder and wetter, we’re seeing a growing number of bronchial infections and upper respiratory tract infections,” Belliveau said. “People don’t have reliable access to clean water or proper drainage, so diarrheal infections are also widespread.”

Similarly, the WHO’s Health Cluster said acute respiratory infections accounted for 68 percent of all reported medical cases in 2025.

Many of Gaza’s displaced families have taken to social media to share videos of rain-soaked tents flooded with muddy water.

Shivering children huddle for warmth under thin plastic sheets and tattered bin liners, while adults slog through knee-deep mud, watching their few possessions drift away in the downpour.

For the hundreds of thousands of displaced children in Gaza, the cold season is a threat multiplier, warned Ricardo Pires, communication manager and deputy spokesperson at the UN children’s fund, UNICEF.

“Our colleagues in Gaza describe what they see every day from children sleeping in the open and living with amputations to children orphaned and trembling in fear while living in flooded, makeshift shelters, stripped of their dignity,” he said in a statement on Nov. 21.

Israel has reportedly allowed hundreds of aid trucks into Gaza each day since the ceasefire began, but shortages of medicines and equipment persist.

“There are severe shortages of essential medical supplies, most notably antibiotics, antiseptics, and gauze,” Belliveau said.

Other NGOs, including the UK-based Medical Aid for Palestinians, report similar shortfalls at three major hospitals — Al-Shifa, Nasser, and the Patient’s Friends Benevolent Society — where staff say IV fluids and anesthesia are in short supply.

“We see the transport trucks are coming in — I counted one convoy of 68 transport trucks full of flour and foodstuffs and tents,” Belliveau said. “While those items are coming in, medical supplies and medicines are not coming in.

“MedGlobal still has two full transport trucks of medicines and medical supplies that have been ready since a few days before the Oct. 10 ceasefire, but still blocked, not able to get those medicines in here.”

Medical Aid for Palestinians said on Nov. 27 that less than 5 percent of the aid offloaded from trucks in Gaza has included medical supplies, despite hospitals facing overwhelming demand.

In August, a group of UN experts accused Israel of deliberately targeting Gaza’s health system, calling it “medicide.” They also said Israel was attacking and starving healthcare workers.

Israel has repeatedly rejected such accusations, saying it is conducting operations against Hamas and other armed groups that it claims are using hospitals and medical facilities for military purposes.

Despite diplomatic pressure, UN experts said on Nov. 24 that Israeli attacks have continued across all five of Gaza governorates.

On Nov. 17, the UN Security Council adopted Resolution 2803, endorsing the US-backed “Comprehensive Plan to End the Gaza Conflict,” a framework also known as President Donald Trump’s 20-point plan.

The resolution welcomes the creation of a Board of Peace and authorizes the establishment of a temporary international stabilization force in Gaza.

However, Belliveau said there is a gulf between diplomacy and reality.

“Lately, there are some potentially hopeful developments — the recent UN Security Council resolution, ceasefire agreements, movement toward peace, aid beginning to flow — those semi-hopeful developments,” he said.

“But when you’re here, speaking directly to people, visiting tents, or going to clinics where patients are arriving every day, you can feel how fragile it all is, and how distant that international dialogue is from their lived reality.”

His team saw this firsthand. On Nov. 19, MedGlobal surgeons stationed at Nasser Hospital treated victims from what Belliveau described as “a series of mass casualty events around the yellow line, (and) across the yellow line,” which demarcates the Israeli military’s area of control.

Casualties arrived with blast trauma, shrapnel wounds and gunshot injuries. Three people, including two children, died.

“One of those children died in the arms of our surgeon due to trauma to the head,” Belliveau said. “A bit of the skull had lodged into her brain, and her brain haemorrhaged and swelled, and she lost her life.”

Another patient, he added, was a woman with “a piece of shrapnel lodged into her spinal cord.” She is “now permanently paralyzed from the waist down, and also had a head injury and has most likely permanent brain damage as well.”

Local health authorities said at least 25 Palestinians were killed in strikes across Gaza that same day.

The yellow line is a new internal boundary in Gaza created under the US-brokered ceasefire. It marks the line to which Israeli forces withdrew in the first phase, while still retaining control over more than half the Gaza Strip.

Despite the ongoing violence, Belliveau points to incremental, but insufficient, signs of progress.

Since the ceasefire began, food shipments have modestly improved supply and driven prices down from their peak, though food availability remains far below pre-conflict norms. 

On Aug. 21, MedGlobal released a report citing evidence that Gaza had reached the famine threshold. It said more malnutrition-related deaths were recorded in July than in the previous six months combined.

The next day, an analysis by the Integrated Food Security Phase Classification found more than 500,000 people in Gaza were experiencing famine.

Today, “we don’t see those numbers the way we did,” Belliveau said. “That’s really wonderful progress.” But improvement does not mean an end to the crisis.

“We still do see a lot of malnutrition, and particularly among pregnant and lactating women. That’s where we still see a really alarming number of malnourished.”

Kiosks now carry fresh produce, said Belliveau, albeit at costs still out of reach for most families, despite being dramatically cheaper than before Oct. 10.

“That price tag is out of reach for many, many families right now,” he added, noting that many families across the enclave still cannot afford bread, as many have no income.

The World Food Programme confirmed a slight rise in food consumption by mid-October. In the first three and a half weeks since Oct. 10, WFP delivered 20,000 metric tons of food — about half its monthly target.

While food inflows have driven prices down, WFP said liquidity constraints persist, with cash withdrawal fees still between 20 and 24 percent.

“I’m not sure that those following the news from outside fully grasp how precarious things are in Gaza right now,” Belliveau said.

He noted that MedGlobal’s own staff “are scared and worried — they don’t know when the next violent event is going to come, or how it’s going to come.

“Security Council resolutions, peace processes, debates about Palestinian statehood — it all feels very removed from daily life here.

“For most people, day-to-day survival is the priority: finding enough food, avoiding disease, and trying to stay safe from both violence and outbreaks.”