At the foot of a sand dune in a coastal sliver of the Gaza Strip west of Khan Younis, 58-year-old Nahed Barbakh tightens the ropes holding the nylon sheets that cover two small, makeshift shelters where he has been living with 13 family members for the past month.

“Our life as displaced people resembles the dead,” Barbakh says. “We are breathing, but this here is torment, and we are forced to endure it because there is no other alternative.”

About one kilometre wide and 14 kilometres long, al-Mawasi is one of the shrinking areas of Gaza that Israel has designated a so-called “safe zone” during its punishing military campaign in the enclave, which has now entered its fourth month.

Consisting mostly of farmland and sand dunes, the area is largely barren and lacks basic utilities and infrastructure, including roads, water and sewage systems, and health facilities. It is also difficult for aid groups to access. There is no official count of how many people have taken refuge there, but according to estimates by relief workers, hundreds of thousands are now crowded into the inhospitable territory, struggling to survive.

An Israeli airstrike that killed 14 people – the majority of them young children – in al-Mawasi on January 4 was a grim reminder that nowhere in Gaza, including Israeli-designated safe zones, is actually safe, according to Save the Children.

Israel began bombarding Gaza after Hamas, the Palestinian political and militant group that governs the enclave, launched an attack into southern Israel on October 7, killing around 1,140 people, mainly civilians, according to Israel authorities and taking around 240 hostages.

Since then, around 1.9 million Palestinians in Gaza – about 85 per cent of the population – have been displaced from their homes, many more than once, with Israel’s military campaign laying waste to much of northern Gaza and pushing into the south.

More than 23,300 Palestinians – around 70 per cent of them women and children – have been killed, according to health authorities in Gaza, and Israel has imposed a near-total siege on the enclave, cutting off electricity and water, and blocking the entry of food, medicine and other essential supplies.

Israel is allowing small amounts of humanitarian aid to enter Gaza through the Rafah border crossing with Egypt and – since mid-December – the Kerem Shalom border crossing with Israel. But it is far from enough, and ongoing hostilities, fuel shortages, communication blackouts, and a lack of Israeli security guarantees have made it nearly impossible to deliver even limited assistance to people throughout Gaza, according to UN officials.

International experts are warning of the looming risk of famine, and the World Health Organization has raised the alarm about the near-collapse of Gaza’s health system and the rapid spread of infectious diseases.

In a landmark case at the International Court of Justice, the UN’s top court, that began on January 11, South Africa has accused Israel of committing genocide in Gaza – a charge Israel denies but which is based on the scale of death and destruction in the enclave as well as rhetoric from Israeli politicians.

“How will I be able to find the appropriate food for this child,” Hazem Abu Obeid, 37, said as he held his two-year-old son. “Where will I be able to provide winter clothing for this freezing cold?”

Abu Obeid and his wife, three children and elderly parents had been displaced twice already before moving again, in early December, to al-Mawasi, where they now live in a shack covered with a light nylon sheet.

“Our life carries only its name. It is closer to death, torture, and hell than it is to life. We escaped death by shelling only to die alive here in al-Mawasi,” he said.

When Barbakh first fled his home in the centre of Khan Younis in mid-November along with his family members, they only carried a few kitchen items and some bed covers and sheets with them, thinking they would be able to return home in a few days. Two months later, after relocating several times in an elusive search for safety, the family is struggling to meet their most basic needs.

The makeshift shelters they have built are lodged between a greenhouse on one side and a sand dune on the other – in the hope that they will provide some protection from the bitter wind and Israeli shelling. Other displaced people have built dozens of similar shelters nearby.

International, Arab, and local humanitarian organisations have provided tents to some of the displaced people in al-Mawasi. But most live in cobbled-together shelters like Barbakh’s that are spread haphazardly among the fields and in camps set up by the Qatari Red Crescent.

As he moved barefoot between his family’s two shelters, Barbakh, who suffers from five slipped discs, pressed his hands against his back to ease the chronic pain, which had been worsened by the piercing cold. He instructed his children to remove their sodden mattresses and blankets – rainwater had flooded their improvised shelters – and place them on the bushes to dry.

“I often collapse from the pain because I have no painkillers and it is difficult to seek medical check-ups or undergo surgery in these circumstances,” he told The New Humanitarian.

Close by, Barbakh’s wife was busy kneading dough in a bowl she had borrowed from her neighbours. Once done, she took the dough to other neighbours, 500 metres away, to bake it in their makeshift clay oven. Her son Mohammed, tried to light a fire with some sticks so he could prepare some tea and fava beans for breakfast. They often have the same for lunch, if there is enough for a second meal.

“We barely receive any food items or aid from UNRWA (the UN Agency for Palestinian Refugees) or others. We are forced to divide two loaves of pita bread among us to sustain us for the day. Sometimes we go without bread for days,” Barbakh said.

• The New Humanitarian report