Epidemic risk rising as Rafah invasion compounds lethal cocktail of over-crowding, sewage and hunger

Oxfam's Middle East Director, Sally Abi Khalil, said: "The situation is desperate, with so many people in Gaza living in fear and being forced to endure inhumane and unsanitary conditions caused by sustained Israeli bombardment. One colleague told me there was so much human waste in the streets, it literally smelt like disease.

"Israel's military assault on Rafah could be devastating, not only because of the risk of mass civilian casualties, but also the repercussions of vast numbers of people being forced to move. With the infrastructure already beyond breaking point, little or no healthcare available, and widespread malnutrition this could quickly escalate into a major epidemic."

One of Oxfam's partners in Gaza, Juzoor for Health and Social Development - which is operating in more than 50 shelters and numerous health points across North Gaza and serving hundreds of thousands of people - said they've seen a worrying rise in disease outbreaks.

Celine Maayeh, Advocacy and Research Officer for Juzoor, said: "Unfortunately, all of our shelters lack proper sanitation and sewage systems, and just a few days ago we started hearing reports of areas in Gaza being infested with bugs and flies. Our health teams have been dealing with skin infections and cases of watery diarrhoea for months now; and we've recently detected thousands of cases of hepatitis A and other gastrointestinal and respiratory diseases. While we've managed to treat them, the rising temperatures and accumulating waste and sewage are creating the perfect recipe for a health catastrophe that our health teams alone cannot tackle."

UNICEF analysis of satellite images found that in Gaza Governate 87 per cent of critical water and sanitation facilities have been destroyed or severely damaged. Across Gaza, at least five of Oxfam's projects - three wells, a desalination plant and a sewage pumping station have been destroyed or severely damaged that served over 180,700 people a day. A further seven Oxfam water or sanitation projects are also believed to have sustained some degree of damage.

Israeli airstrikes also destroyed the warehouse of one of Oxfam's local suppliers with the loss of an estimated $60,000 worth of Oxfam latrine blocks - purpose-built toilet and shower facilities, which were due to help improve sanitary conditions for thousands of people.

Attacks which target civilian infrastructure are illegal under the Geneva Conventions. The extensive damage to water and sanitation infrastructure is one example of Israel's relentless assault on Gaza, which according to UN experts, may amount to breaches of International Humanitarian Law.