Palestinians in Gaza marked another grim milestone as Israel’s genocide entered its 10th month, with no end in sight, and as public health experts warned of a massive wave of secondary mortality even in the event of an immediate ceasefire.

On Tuesday, Israeli airstrikes hit people sheltering outside a school in eastern Khan Younis in the southern Gaza Strip, killing at least 29.

Israel claimed to have targeted a Hamas fighter with a “precise munition” in the deadly strike but video broadcast by Al Jazeera shows the area filled with civilians enjoying a game of football at the time of the attack:

Israeli tanks pushed into an already battered Gaza City on Tuesday following renewed intense attacks. The Palestine Red Crescent said that it had received dozens of distress calls but the intensity of the bombing made it impossible for them to help.

The armed wings of the Palestinian resistance groups Hamas and Islamic Jihad said they were battling “​​Israeli forces with machine guns, mortar fire and anti-tank missiles and killed and wounded Israeli soldiers” on Gaza City’s front lines, Reuters reported.

The fresh Israeli attacks in Gaza City caused a new wave of mass forced displacement and Hamas said it may derail protracted negotiations towards a ceasefire and prisoner swap.

Hamas had in recent days reportedly attenuated its position that Israel end the war as a precondition to any agreement but was seeking guarantees that negotiations would lead to a permanent ceasefire.

Israel once again indicated that it would reject any deal that would leave Hamas as the de facto governing authority in Gaza. On Sunday, Prime Minister Benjamin Netanyahu reiterated his position that he would only accept an agreement that would “allow Israel to return and fight until all the goals of the war are achieved.”

That position appears guaranteed, if not explicitly intended, to ensure that no deal is possible.

Meanwhile, Israel’s Channel 12 news reported on a recent military assessment finding that “much of Hamas’ tunnel network is still in a ‘good functional state’ in many parts of Gaza.”

The resistance group is still able to launch raids near boundary with Israel “and possibly even cross it,” according to the assessment, as reported by The Times of Israel. The military chiefs reportedly recommended in their assessment that Israel reach a negotiated deal with Hamas, even if it ends the war, in order “to get back the hostages.”

In his first video appearance in weeks, Abu Obeida, the pseudonymous spokesperson for the armed wing of Hamas, said on Sunday that all 24 of the Qassam Brigades battalions were intact and had recruited thousands of new fighters.

No relief as journalists killed

With ceasefire talks seemingly fated to reach another impasse, there is little sign of relief for Palestinians in Gaza who have endured relentless attacks, trauma and grief, and now increasing hunger and disease.

Between 4 and 6 July, six Palestinian journalists, one of them a woman, were killed in three incidents in Gaza City and Deir al-Balah, bringing to 158 the number of journalists killed since 7 October, according to the government media office in the territory.

On 6 July, an Israeli airstrike killed six Palestinian police officers in Rafah, southern Gaza.

The following day, the bodies of three Palestinians who were apparently executed with their hands cuffed were recovered from the area of Kerem Shalom crossing in southern Gaza.

“Abdel-Hadi Ghabaeen, an uncle of one of the deceased, said they had been working to secure the delivery of humanitarian aid and commercial shipments through the crossing,” the AP news agency reported.

“He said he saw soldiers detain them on Saturday, and that the bodies bore signs of beatings, with one having a broken leg.”

The government media office in Gaza announced that Ihab Ribhi al-Ghussein, an engineer and deputy labor minister, was killed in an Israeli airstrike on a school in Gaza City on Saturday.

The media office said that al-Ghussain’s wife and daughter were killed previously in an Israeli strike on a house they were sheltering in after being displaced from their home in Gaza City.

Also on Saturday, Israel carried out an airstrike targeting a United Nations-run school in central Gaza’s Nuseirat refugee camp, claiming that it was being used as a command center by Hamas operatives.

It is unclear why Israel thinks this would be a credible excuse when even its military admits that Hamas operates out of an extensive underground infrastructure that remains functional, largely intact and beyond reach.

The government media office in Gaza said that at least 16 Palestinians were killed and more than 75 were injured in the attack on the Nuseirat school, which the UN said was being used as a shelter for nearly 2,000 displaced people.

UNRWA, the UN agency for Palestine refugees, said that 190 of its facilities in Gaza “have been hit, some multiple times, some directly” since 7 October, killing 520 people and injuring 1,600.

The Euro-Med Human Rights Monitor said that by targeting UN schools used as shelters, Israel was demonstrating “a deliberate policy intended to prevent security across the entire Gaza Strip and deny displaced Palestinians stability or shelter, even if that shelter is only temporary.”

Gaza City evacuation orders

The Israeli military ordered tens of thousands of Palestinians in central and western Gaza City to immediately evacuate on Sunday and Monday.

On Sunday, Israel ordered residents of five blocs in Gaza City to evacuate to the western part of the city, only for that area to be ordered evacuated the following day, with Israel instructing people to move to Deir al-Balah in central Gaza.

The areas affected by the new evacuation orders “encompass 13 health facilities that were recently functional, including two hospitals, two primary healthcare centers and nine medical points,” according to the UN Office for the Coordination of Humanitarian Affairs.

“In addition, four hospitals are located in close proximity to the evacuation zones,” the UN office added.

Two health facilities – the al-Ahli Baptist hospital and the Patients Friends Association Hospital – evacuated “in fear of intensified military activities that would render them inaccessible or non-functional,” according to the UN.

The lack of fuel has forced the suspension of kidney dialysis services at Kamal Adwan Hospital, the director of the facility announced on Sunday, and has placed “the lives of newborns in the neonatal department and critical patients in the intensive care unit at risk,” OCHA said.

Following the hasty evacuation of the European Gaza Hospital in Khan Younis on 2 July, three hospitals have become non-functional since the beginning of the month, “leaving only 13 out of 36 hospitals in the Gaza Strip partially functional at present,” according to OCHA.

The medical charity said that the facility is the “main site for field hospitals to sterilize their equipment.” Should Nasser Medical Complex lose electricity, “sterilization becomes difficult, and the care provided at several field hospitals will come to a stop.”

Doctors Without Borders added that Israel denied entry of trucks carrying the organization’s medical supplies on 3 July. The charity said it hasn’t been able “to bring any medical supplies into Gaza since the end of April.”

Meanwhile, the Euro-Med Human Rights Monitor warned that the ongoing closure of Gaza’s crossings amounts to a death sentence for more than 26,000 sick and wounded people needing life-saving care outside the territory.

Only 21 sick and wounded patients have been evacuated out of Gaza since Israel closed Rafah crossing on 7 May.

Efforts to increase aid “wiped out”

A senior UN official said last week that a recent Israeli evacuation order affecting one-third of Gaza’s territory in southern Rafah and Khan Younis had “wiped out” efforts towards improving the humanitarian situation in the Strip.

Meanwhile, within Gaza, “insecurity, damaged roads [and] the breakdown of law and order” have also hampered the delivery of fuel and aid needed to sustain humanitarian operations, according to UN OCHA. This has caused food and other supplies to spoil during extremely high temperatures.

The lack of fuel has forced bakeries to close once again, including the largest bakery in Gaza, located in Gaza City. Only seven out of the 18 bakeries supported by its humanitarian partners, all of them located in Deir al-Balah, remain operational, according to the UN office.

Community kitchens are also struggling to stay open amid a lack of fuel and food supplies, “resulting in a reduced number of cooked meals prepared throughout Gaza,” OCHA added.

No commercial trucks have entered northern Gaza for months, according to the UN, resulting “​​in a near total lack of protein sources (e.g. meat and poultry) on the local market and only a few types of locally produced vegetables available at unaffordable prices.”

Meanwhile, ongoing military operations have caused people to leave their agricultural land untended and the destruction of greenhouses have harmed the ability of Palestinians in Gaza to produce their own food.

Assessments undertaken by OCHA and other groups at 10 sites hosting new waves of internally displaced people “show critical levels of need across all sectors,” the UN office said, noting a particular “dire need for safe drinking water” and access to emergency services.

On Friday, the Euro-Med Human Rights Monitor accused Israel of using water as a weapon of war through the “persistent, systematic and widespread targeting of the Gaza Strip’s water sources and desalination plants.”

The group said that “as a result of the genocide, the per capita share of water in the Strip has decreased to between three and 15 liters per day, while in 2022 it was approximately 84.6 liters per day.”

The World Health Organization says that “between 50 and 100 liters of water per person per day are needed to ensure that most basic needs are met and few health concerns arise.”

UN OCHA said that “many were found sleeping amid solid waste and rubble, with no mattresses or enough clothing, and some had sought shelter in partially destroyed UN facilities and residential buildings.”

“What’s happening in Gaza since last night is a return to the first month of genocide,” Dr. Mustafa Elmasri, a psychotherapist in Gaza, wrote on X (formerly Twitter), on Monday.

“Under relentless bombing, people are forced to wander aimlessly, driven south to be slaughtered there. These are the darkest and most dangerous days of the war,” Elmasri added.

She added that the areas unilaterally declared by Israel as safe zones are in fact “the polar opposite, leaving families with the horrific choice between staying in an active combat zone or moving somewhere that is already desperately overcrowded, dangerous and unfit for human existence.”

Gaza deaths vastly undercounted

The Lancet, an independent medical journal based in London, published an article by three public health experts stating that Gaza fatalities are vastly undercounted.

“Collecting data is becoming increasingly difficult for the Gaza health ministry due to the destruction of much of the infrastructure,” according to the Lancet article, which observes that the ministry “is the only organization counting the dead.”

“The ministry has had to augment its usual reporting, based on people dying in its hospitals or brought in dead, with information from reliable media sources and first responders. This change has inevitably degraded the detailed data recorded previously,” the authors added.

Not all identifiable victims of airstrikes and other forms of direct violence are are included in the health ministry’s list of fatalities. The some 10,000 people missing under the rubble of destroyed buildings amid the widespread destruction in Gaza are also not reflected in the official fatality figure of nearly 37,500 as of 19 June.

On Sunday, the Euro-Med Human Rights Monitor called for international pressure on Israel to “bring in trucks, special equipment and sufficient fuel, given the urgent need to clear the debris, locate bodies, and recover them with special procedures to identify and bury them in marked graves.”

The group said that the presence of decaying bodies “poses a threat to public safety” amid a spread of epidemics, jeopardizing the coastal enclave’s “long-term environmental health … to the point of ecocide, rendering the Gaza Strip unfit for human habitation.”

Even higher than the number of victims of direct violence are those who lose their lives “from causes such as reproductive, communicable and non-communicable diseases” resulting from the conflict, according to the authors of the Lancet article.

These deaths are a result of destroyed health and sanitation infrastructure, malnutrition and lack of access to clean water, repeated displacement and the loss of funding to UNRWA, the organization with the largest humanitarian footprint in Gaza.

“There will continue to be many indirect deaths in the coming months and years,” according to the authors of the Lancet article, who conservatively estimate “that up to 186,000 or even more deaths could be attributable to the current conflict in Gaza.”

That represents approximately 8 percent of Gaza’s population of around 2.3 million Palestinians.

Journalist Hossam Shabat, based in northern Gaza, said that he knows from personal experience that “deaths are way higher” than what is being reported.

UN experts declare widespread famine

On Tuesday, a group of independent UN human rights experts warned that “the recent deaths of more Palestinian children due to hunger and malnutrition leaves no doubt that famine has spread across the entire Gaza Strip.”

At least three children in central Gaza, where medical treatment is available, have died in recent weeks, leaving “no doubt that famine has spread from northern Gaza into central and southern Gaza,” the experts said.

They added that “Israel’s intentional and targeted starvation campaign against the Palestinian people is a form of genocidal violence and has resulted in famine across all of Gaza.”

The experts called for the prioritization of delivery of humanitarian aid through land crossings “by any means necessary” and called for an end to Israel’s siege and for a ceasefire.

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• The Lancet

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