The Gaza Strip has only “24 hours of water, electricity and fuel left”, the regional head of the United Nations’ World Health Organisation said on Monday, as Israeli forces kept up their bombardment of the Palestinian enclave.

If aid is not allowed into the besieged territory, doctors will have to “prepare death certificates for their patients,” WHO regional director for the eastern Mediterranean, Ahmed al-Mandhari, said in an interview with AFP.

Israel stopped piping water to Gazans as part of a siege imposed to stop food and fuel from reaching the enclave of 2.3 million people, many poor and dependent on aid in response to a surprise Hamas offensive on October 7 that left 1,300 Israelis dead, according to officials.

After it suffered the deadliest attack in its history, Israel unleashed a relentless bombing campaign on the Gaza Strip. The health ministry in Gaza said around 2,750 people have been killed and 9,700 wounded while, according to the UN, one million have been displaced.

Key developments:

• Convoys of international aid are waiting just across the border with Egypt
• WHO says 111 medical facilities targeted, 12 healthcare workers killed and 60 ambulances bombed
• Pakistan to immediately dispatch humanitarian assistance to Gaza
• Putin speaks to Netanyahu, Middle East players; US president says any move by Israel to occupy Gaza would be a ‘big mistake’

Power outages threaten to cripple life-support systems, from seawater desalination plants to food refrigeration and hospital incubators.

Even everyday functions — from going to the toilet, showering and washing clothes — are almost impossible, locals say.

With emergency responders overwhelmed, doctors working around the clock and a dire lack of space, “bodies cannot be properly taken care of”, Mandhari said.

Overcrowding has paralysed hospitals, where “intensive care units, operating rooms, emergency services and other wings” are all on the brink of collapse, he said.

Israeli Energy Minister Israel Katz on Sunday said water supplies to southern Gaza had been switched back on, a week after Israel announced a “complete siege” cutting water, power and fuel supplies to the territory where it wants to crush Hamas.

Depriving civilians of goods essential for survival is banned under international law, the UN human rights chief has said.

‘Left to die’

During the air and artillery bombardment, the WHO has recorded 111 medical facilities targeted, 12 health care workers killed and 60 ambulances bombed — in violation of both “international law and the principles of humanity”, Mandhari said.

A total of 22 hospitals in northern Gaza are treating more than 2,000 patients, including “some on ventilators, some who need regular dialysis, in addition to children, infants and women”.

The enclave’s hospitals have run out of clean water, while “fuel shortages threaten electricity supply,” he said.

As medical resources dry up, Mandhari said doctors — who know they cannot save everyone — are having to make impossible choices.

“They have to triage the patients who are coming in. They have no other choice. There are too many people, so some are left to die slow deaths.”

Aid must be allowed to enter the Gaza Strip within one day before the situation becomes completely unmanageable, Mandhari said.

Convoys of international aid are waiting just across the border with Egypt, but they have been allowed no closer than the Egyptian town of El Arish, 50 kilometres (31 miles) away from the Rafah border crossing — the only passage in and out of Gaza not controlled by Israel.

Cairo has refused to allow foreign nationals to exit without humanitarian aid coming in.

Egyptian Foreign Minister Sameh Shoukry accused Israel of blocking the aid, despite “repeated requests” from Cairo.

Under a joint Israeli-Egyptian blockade in place since Hamas took control of Gaza in 2007, Israel has a say in the passage of all goods and people coming in and out of the territory.

United States Secretary of State Antony Blinken returned to Israel on Monday after shuttling between Arab states, hoping to coordinate efforts against Hamas while finding ways to alleviate Gaza’s humanitarian crisis.

He announced in Cairo on Sunday that the US had appointed veteran former diplomat David Satterfield to work on aid to Gaza.

The UN’s humanitarian chief Martin Griffiths said he would be heading to the Middle East on Tuesday “to try to help in the negotiations” for aid access.

“We are in deep discussions with the Israelis, with the Egyptians and with others,” Griffiths said.

Heavy bombing

In Gaza’s north, where Israel says Hamas fighters are hiding in a tunnel network, people said Israeli aircraft bombed areas around the Al-Quds hospital early on Monday. Houses were damaged, forcing hundreds of people to take shelter in the Red Crescent-run hospital.

Israeli planes also bombed three offices of the Civil Emergency and Ambulance Service in Gaza City, killing five people and paralysing the rescue services, health officials said.

Israel has told Gazans to evacuate south, which hundreds of thousands have already done in the enclave, home to about 2.3 million people. Hamas has told people to ignore Israel’s message.

In southern Gaza, five members of a family were killed in Khan Younis refugee camp.

With hundreds of people trapped in collapsed buildings, rescuers and residents were frantically tearing away rubble, sometimes pulling out barely breathing children.

“We were inside the house when we found bodies scattering, flying in the air - bodies of children who have nothing to do with the war,” said resident Abed Rabayaa, whose neighbour’s house in Khan Younis was hit overnight.

Reserves of fuel to power generators at all hospitals across the Gaza Strip are expected to last only around 24 more hours, putting thousands of patients at risk, the United Nations Humanitarian Office (OCHA) said early on Monday.

More than one million people – almost half the population of Gaza — have been displaced within the enclave, the United Nations said, and it is struggling to cope with their needs.

For the fifth consecutive day, Gaza has had no electricity, pushing vital services, including health, water and sanitation to the brink of collapse. People are consuming brackish water from agricultural wells, raising concerns over the spread of disease.

US officials have warned that the war between Israel and Hamas could escalate after cross-border clashes between Israel and militants from Lebanon’s Iranian-backed Hezbollah.

As US Secretary of State Antony Blinken arrived in Israel for talks on Monday, Iran said the United States should be held to account for its role in the conflict.

Israel, Hamas deny border ceasefire

The Israeli military said earlier on Monday it would refrain from striking two roads in the Gaza Strip marked for residents to move south and out of the way of a possible ground offensive.

“The IDF (Israeli Defense Forces) will refrain from targeting the designated axis from 8am until 12pm,” military spokesman Avichay Adraee said on X, formerly Twitter.

“For your safety take advantage of this short period of time to move south from the north of the strip and Gaza City.”

Military spokesman Jonathan Conricus pledged in a separate statement that the two designated roads “would be safe to use” for that duration.

Putin speaks to Netanyahu

Russian President Vladimir Putin called Israeli President Benjamin Netanyahu for the first time since the Hamas attack, and briefed him on several talks with leaders from the region and Palestinian Authority.

“The Israeli side was in particular informed of the essential points of telephone correspondences that took place today with the leaders of Palestine, Egypt, Iran and Syria,” the Kremlin said in a statement.

According to Moscow, the discussion focused on “the crisis situation resulting from the brutal escalation of the Israeli-Palestinian conflict”.

Putin expressed “his sincere condolences to the families and friends of the deceased Israelis,” the Kremlin said.

He also told the Israeli president of the steps Russia has taken to “promote the normalisation of the situation, prevent a further escalation of violence and prevent a humanitarian catastrophe in the Gaza Strip.”

Putin spoke in telephone calls with the Egyptian President Abdel Fattah al-Sisi, Iranian President Ebrahim Raisi, Syrian President Bashar al-Assad and Palestinian leader Mahmud Abbas.

The Russian leader also told Netanyahu that Russia had a “fundamental desire to continue its targeted action aimed at ending” the conflict and finding “a peaceful settlement through political and diplomatic means,” according to the government’s statement.

“We believe that the main thing right now in this situation is to immediately cease the fire and begin the process of a political settlement,” Kremlin foreign policy adviser Yuri Ushakov was quoted by state news outlets as saying.

“The Middle East conflict is old of character but now it is necessary to take active, sharp steps in order to stop this escalation which is unprecedented,” Ushakov said.

The results of the calls were unclear. TASS said Putin and Assad want humanitarian aid delivered to Gaza.

Putin will meet Xi Jinping in China this week in a bid to deepen a partnership forged between the United States’ two biggest strategic competitors.

Putin, who says the West is seeking to cleave Russia apart by supporting Ukraine, says the current violence in the Middle East shows just how far US policy in the region has failed.

But Russia has also repeatedly warned that the situation could swiftly escalate into a regional war.

Russia and China, both permanent members of the United Nations Security Council, have said that the fundamental issue at the heart of the conflict is the lack of justice for the Palestinians.

China’s foreign minister on Monday called for a ceasefire to halt the bloodshed in Israel, suggesting at a meeting with his Russian counterpart that major world powers should work to avoid a humanitarian disaster.

Russian Foreign Minister Sergei Lavrov discussed the conflict between Israel and Hamas with Chinese Foreign Minister Wang Yi in Beijing ahead of a visit by President Vladimir Putin to China.

“The United Nations Security Council must take action, and the major powers should play an active role,” Wang told Lavrov, according to a Chinese transcript of the meeting.

“It is imperative that a ceasefire be put in place, that the two sides be brought back to the negotiating table, and that an emergency humanitarian channel be established to prevent a further humanitarian disaster.”

Pakistan to immediately dispatch humanitarian assistance to Gaza

As the humanitarian crisis in Gaza depends, Pakistan has decided to immediately dispatch humanitarian assistance to the Palestinian enclave.

“In the wake of indiscriminate Israeli aggression and siege of the Gaza Strip, the already oppressed people of densely-populated Gaza are in urgent need of humanitarian assistance,” a press release issued by the Foreign Office said.

It stated that the government was coordinating with the Palestinian Red Crescent Society, relevant UN agencies, Egypt and Pakistan Missions abroad to finalise modalities of the delivery.

Earlier today, Interim Prime Minister Anwaarul Haq Kakar said that Israel’s “deliberate, indiscriminate and disproportionate” targeting of civilians in Gaza was against “all norms of civility and in manifest violation of international law”.

In a statement on social media platform X (formerly Twitter), Kakar said, “Pakistan is deeply concerned on the ongoing violence and loss of life in Gaza. We stand in solidarity with the oppressed people of Palestine and call for an immediate ceasefire and lifting of the blockade in Gaza.”

He said that the violence needed to be viewed in “the context of years of forced and illegal occupation of Palestinian territory and repressive policies against its people”.

“The UN and international community must immediately act to open safe and unrestricted humanitarian corridors for transportation of urgently needed relief supplies to the besieged Gaza,” he said.

The prime minister added that Pakistan was closely coordinating with the Organisation of Islamic Cooperation (OIC) and its member states on the “fast deteriorating situation” in Gaza.

He said that the foreign minister would also be attending an emergency meeting of the OIC’s executive committee on October 18 and “call for urgent action to alleviate the suffering of people of Gaza”.

Meanwhile, caretaker Foreign Minister Jalil Abbas Jilani on Monday said he spoke to his Iranian counterpart Hossein Amir Abdollahian and discussed the crisis unfolding in Gaza including the killing of civilians and large-scale displacement of Palestinians.

“We agreed that urgent steps were needed to prevent conflict from escalating and provision of humanitarian assistance,” he said in a post on X (formerly Twitter).

‘Gaza is being strangled’

“Gaza is being strangled and it seems that the world right now has lost its humanity,” said United Nations Relief and Works Agency (UNRWA) Commissioner-General Philippe Lazzarini, in an urgent appeal for critical aid to be allowed in.

“We all know water is life — Gaza is running out of water, and Gaza is running out of life,” he said.

Lazzarini feared that soon there would be no food or medicine in the Palestinian enclave. “There is not one drop of water, not one grain of wheat, not a litre of fuel that has been allowed into the Gaza Strip for the last eight days.

“The number of people seeking shelter in our schools and other UNRWA facilities in the south is absolutely overwhelming, and we do not have any more the capacity to deal with them,” he added.

“An unprecedented humanitarian catastrophe is unfolding under our eyes,” the UN official stated, highlighting that UNRWA has lost 14 of its members in the war so far and Gaza had even run out of body bags.

“All parties must facilitate a humanitarian corridor so we can reach all those in need of support,” Lazzarini added.

One million Gazans flee as Israel readies for ground attack

More than one million people have fled their homes in Gaza in scenes of chaos and despair as Israel bombarded the Hamas-ruled territory and continued massing troops on Monday in preparation for a full-blown ground invasion.

Following an Israeli order to move to the south of the Gaza Strip, people have fled their homes in the north of the enclave to seek shelter wherever they can, including on the streets and in UN-run schools.

Palestinians carrying whatever belongings they can, in bags and suitcases, or packed onto three-wheeled motorbikes, battered cars, vans and even donkey carts have become a common sight.

“No electricity, no water, no internet. I feel like I’m losing my humanity,” said Mona Abdel Hamid, 55, who fled Gaza City to Rafah in the south of the enclave, and is having to stay with strangers.

US President Joe Biden said in an interview with the CBS news programme ‘60 Minutes’ that while invading and “taking out the extremists” was needed, any move by Israel to occupy Gaza would be a “big mistake”.

Biden said he believed Hamas must be eliminated but there should be a path to a Palestinian state.

‘Verge of abyss’

A bereaved and infuriated Israel has massed forces outside the long-blockaded enclave of 2.4m in preparation for what the army has said would be a land, air and sea attack involving a “significant ground operation”.

“We are at the beginning of intense or enhanced military operations in Gaza City,” spokesman for the Israeli Defense Forces (IDF) Jonathan Conricus said. “It would be unsafe for civilians to stay there,” he added.

Iran and Lebanon’s Hezbollah have warned that an invasion of Gaza would be met with a response.

“No one can guarantee the control of the situation and the non-expansion of the conflicts” if Israel sends its soldiers into Gaza, said Iran’s Foreign Minister Hossein Amir-Abdollahian.

Fire along the Israeli-Lebanese border has intensified in the last week, prompting Israel to shutter the area to civilians.

On Sunday, a rocket hit the UN peacekeeping base in southern Lebanon, while Hezbollah attacks killed one person in Israel, the Israeli military said. At least 11 people have been killed in Lebanon and at least two in Israel in the past week.

Among those killed in Lebanon was a Reuters journalist, Issam Abdallah.

Blinken was due to hold talks in Israel on Monday after a crisis tour of Middle Eastern countries in a frantic attempt to avert a wider crisis in the volatile region.

But as Israel seeks to avenge the brutal attack that also saw Hamas fighters take scores of hostages, the Arab League and African Union have warned an invasion could lead to “a genocide”.

UN chief Antonio Guterres has warned that the entire region was “on the verge of the abyss”.

Escalation risk

Israel’s Defence Minister Yoav Gallant said his country had “no interest in a war in the north, we don’t want to escalate the situation”.

The United States, which has given unequivocal backing to Israel, has sent two aircraft carriers to the eastern Mediterranean as a deterrent.

The White House has voiced fears at the prospect of Iran becoming “directly engaged”, after Tehran praised the Hamas attack but insisted it was not involved.

Biden, asked in the ‘60 Minutes’ interview whether US troops might join the war, said “I don’t think that’s necessary”.

“Israel has one of the finest fighting forces … I guarantee we’re gonna provide them everything they need,” he said.

The United States has also appealed to China to use its influence in the region to ease tensions.

On Sunday, Foreign Minister Wang Yi said Israel’s response had “gone beyond the scope of self-defence”, and demanded that it “cease its collective punishment of the people of Gaza”.

Aid agencies’ alarm

Massing thousands of troops and heavy weaponry in the desert south of the country, the Israeli military has said it is awaiting the “political” green light to go into northern Gaza.

The army has told 1.1 million Palestinians in the north of the Gaza Strip to head to the south of the enclave.

But Israeli air strikes were continuing in the south of Gaza, including in Khan Yunis and Rafah, where one resident said a doctor’s house was targeted. “All the family was wiped out,” said Khamis Abu Hilal.

The UN said on Monday that 47 entire families, amounting to around 500 people, have been killed in Israel’s bombing campaign.

Foreign governments and aid agencies, including the UN and Red Cross, have repeatedly criticised Israel’s evacuation order.

The UN agency supporting Palestinian refugees said on Sunday that some one million Palestinians had already been displaced in the first week of the conflict — but the number was likely to be higher.

Lynn Hastings, the UN humanitarian coordinator for the Palestinian territories, decried that Israel was connecting humanitarian aid into Gaza with the release of scores of hostages kidnapped during the Hamas attack.

“Neither should be conditional,” she insisted in a video posted by the UN. “They have said they want to destroy Hamas, but their current trajectory is going to destroy Gaza.”