"The UN agency for Palestinian refugees will run out of fuel on Wednesday night – forcing us to halt operations and delivery of humanitarian aid to people in need."

This was the stark warning by the UN agency in Gaza. They say nearly 600,000 internally displaced Gazans are sheltering in their 150 facilities with one third of hospitals and nearly two-thirds of primary healthcare clinics already shut down due to damage from the war and a lack of fuel.

It would seem worse is to come.

Eight aid lorries carrying medicine, food and water, crossed from Egypt into Gaza on Tuesday night. UN Secretary General Antonio Guterres described it as "a drop of aid in an ocean of need." But no fuel is arriving. 

Israel launched an assault on Gaza following the cross-border attack by Hamas militants on October 7 when over 1,400 people were killed and 222 hostages taken, according to Israeli authorities. They have refused to allow fuel shipments into Gaza, fearing Hamas will use it for weapons and have accused the militant group of stockpiling supplies in large tanks. 

As the war rages on, the death tolls mount and the calls for ceasefires and pauses in fighting grow louder, what are the consequences if fuel is not delivered to Gaza?

Water misery

Access to clean water has always been a massive challenge for those living in the Gaza Strip. The 365-square-kilometer territory with a population of 2.3 million is one of the most densely populated places in the world. 

Gazans are now living on less than 3 liters of water a day, according to the UN, far below the World Health Organization's (WHO) recommended 50 liters as the bare minimum required for drinking, cooking and hygiene.

Gaza received just 60,000 liters of water in Saturday's aid delivery. These arrivals have been described by the aid agencies as "just the initial drop in the ocean."

Gaza has three main sources of water: desalination plants, pipelines that carry in water purchased from Israel and groundwater wells. Reports say 97 percent of their water is undrinkable because it's salty and contaminated by untreated wastewater and pollution. Fuel affects all of this. 

Most of Gaza's water comes from these local sources, but the fuel required to pump and clean it is nowhere to be seen. Many of the water trucks Gazans rely on to fill water containers are unable to reach people's homes because they lack fuel, and because of the bombardment.

Making water drinkable relies on fuel. All five wastewater treatment plants and two of the three desalination plants have stopped working. The last remaining major desalination plant, which had been closed for a week, resumed operations at the weekend, but is at less than 7 percent of its usual capacity. No power means taps have run dry. Some of the luckier Gazans have wells but even then, pumps are needed. These are unoperational because there is no electricity.

A lack of water means dehydration. Even those finding water will probably bedrinking dirty, salty water. Concerns are mounting about disease as people resort to filling up containers and storing water. Local reports say sewage is accumulating in the streets and displaced Gazans are crowding into shelters that lack adequate sanitation. Experts fear the spread of waterborne diseases like cholera and dysentery, putting more pressure on a health system already on the edge of collapse.

Hospital crisis

According to the WHO, the fuel shortage is affecting the most critical functions of the still-operational hospitals in Gaza, including powering ambulances to transport the wounded and running dialysis machines that more than 1,000 patients depend on.

As well as the hospitals already closed due to damage and attacks, the WHO says six hospitals in Gaza have been forced to close due to a lack of fuel. They said: "Unless vital fuel and additional health supplies are urgently delivered into Gaza, thousands of vulnerable patients risk death."

Without fuel, vital medical supplies cannot be delivered. "We performed a number of surgeries on the wounded without anaesthetic," said an orthopedic surgeon working in the emergency room of Nasser hospital in Khan Yunis. "It's tough and painful, but with the lack of resources, what can we do?"

Patients are already being treated on the floors of hospitals overwhelmed with thousands wounded by bombing. Others wait for days for surgery because there are so many critical cases, according to the Hamas-run health ministry. Medical teams across the Gaza Strip have got used to using the glow from mobile phones to perform some procedures to save what energy their various hospitals have to run respirators and other machines keeping patients alive.

Doctors have also warned patients are showing signs of disease caused by overcrowding and poor sanitation. Some hospitals have so little water they are struggling to sterilize surgical equipment. Save the Children said earlier this week that over one million children are "trapped" in Gaza with no safe place to go and warned of the devastating impacts of not receiving medication and not having electricity to power vital health infrastructure in the enclave.

Aid groups are warning many more will die if medical equipment, water desalination plants and ambulances stop running in Gaza, where the only power plant went offline weeks ago. Hospitals are now relying on generators for their power, so crucial for keeping incubators, ventilators and dialysis machines running and to sterilize surgical equipment. Air conditioning units and refrigeration are also needed to save medicines, vaccines, blood and baby milk from perishing.

It is estimated there are around 100 newborn babies and 1,100 dialysis patients that need machines for survival in Gaza. The Red Cross has warned that hospitals, once the generators stop running, will "turn into morgues."

READ MORE

Gazans running out of places to shelter, says UN

Gaza healthcare system on 'verge of complete collapse' – UK surgeon

Israel delayed by logistics, politics and the 'Gaza Metro' – expert

Security issues

Another major problem of being without electricity, power and light is blackouts. In densely-populated urban areas, blackouts can lead to security problems such as looting. But in a city with badly damaged infrastructure and low resources the situation could become even more dangerous.

As Israeli forces continue to build around the borders of the Palestinian borders preparing for their long-awaited offensive, the immediate future looks bleak as aid agencies warn of a humanitarian catastrophe.

Israeli reservist major general Giora Eiland told media on Monday that Israel's actions in "creating a severe humanitarian crisis is a necessary means to achieve the goal. Gaza will become a place where no human being can exist."

There is some hope with aid trickling over from Egypt. But if fuel is not added to these supplies it would seem hundreds, maybe thousands, more Gazans could die.

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