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Having volunteered in war zones such as Yemen and Syria, paediatrician Dr John Kahler lists three elements that make the conflict in Gaza stand out from others.
The first is the "scale and scope" of the war, meaning all of Gaza's two million-plus people are in the firing line, said Dr Kahler, who co-founded an aid group called MedGlobal, which has a team of medics on the front line.
It means there is "not a single safe area" in Gaza, including for Dr Kahler's team of volunteers, he told The National.
The second is what he called the "paradox between aid availability and accessibility". After an 11-week blockade by Israel, supplies began trickling back into Gaza last week – but although hundreds of lorries are lined up at the border, Palestinians remain desperate for food.
Tom Fletcher, the UN's under-secretary general for humanitarian affairs and emergency relief co-ordinator, has described the volume of aid as "a drop in the ocean of what is urgently needed".
"There's a big step between getting it in, and getting it cooked, and getting it to the people who need it," Dr Kahler said of the aid and food being delivered. "And even if you get it in, it has to be distributed in a war zone under active fire. Now, you see it ramped up to a level of just barbaric, mass denial of aid, as well as food."
The third issue, Dr Kahler emphasised, is the inability to exit or escape the enclave. "There's tens of thousands of children injured and adults injured and cancer patients that need to get out and get treated, or they're going to die," he said.
Babies in grave danger
Israel's attacks have showed no signs of slowing down, despite countries and international organisations cranking up the pressure for an immediate ceasefire in Gaza.
The 19 months of conflict are long enough for children to have been born in the war zone, twice over, to mothers who have not had adequate nutrition and have been psychologically stressed throughout their pregnancies.
Dr Kahler described the war as an unnatural experiment on mothers and their babies. "It's apocalyptic. It isn't post-apocalyptic, it's ongoing," he said.
"Even when the bombing stops, and the gates are open, and the world turns [to] some place else, those effects are gonna be felt for years and they won't ever be attributed back to this war, but they'll be as much on this war as the kids who are amputees."
More than 80,000 people are in danger of being left disabled in Gaza as a result of the war, as reported by the UN Health Cluster. However, psychological and physiological damage inflicted by the war and the mass starvation could also be long-lasting issues.
For the development of a child, the "real key is in utero, when they are being carried", Dr Kahler said. Starvation at that time affects the growth of a foetus and the development of its brain, he added.
There has been a severe shortage of basic necessities and even when some flour is available, consuming bread only is "dead calories" that can satiate hunger momentarily, but provide no nutritional value for the mothers or their babies, he said.
With a lack of iron-rich foods during pregnancy, mothers often develop anaemia – their blood count drops, causing them to feel lethargic and have trouble taking in oxygen. In that case, iron pills would typically be prescribed but with Gaza's humanitarian crisis, mothers are left to fend for themselves and their hungry children.
"Little babies don't complain, they cry," Dr Kahler said. "And so, now you got a baby crying because she's not getting fed. You got two other little kids, one is two and one is four, that are crying because they want that food – all of that adds on the psychology of the mother, which then adds to the inability to actually nurture."
Gaza on the verge of famine - in pictures
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Palestinians struggle to get donated food at a community kitchen in Jabalia, northern Gaza Strip. AP -
Displaced Palestinians reach out with pans to collect cooked food from a community food kitchen in Jabalia. Bloomberg -
International pressure has mounted on Israel to restart aid. Bloomberg -
Supplies of donated food are running short. AP -
An aid truck at the Kerem Shalom crossing after the Israeli cabinet approved the entry of nine aid trucks into Gaza. EPA -
Aid loaded on one of three World Food Programme aid trucks crossing into Gaza at Kerem Shalom. EPA -
Trucks loaded with aid continue to wait in the Egyptian city of Al Arish, 45 kilometres west of the Gaza border. Reuters -
A Palestinian staff member inspects the medicine warehouse in Nasser Hospital after an Israeli strike in Khan Younis. Reuters
'Gaza is a toxic dump'
With bombs and air strikes raining over the cities, no rubbish collected for almost two years and water infrastructure destroyed, Gaza's health crisis worsens by the day.
"Gaza is a toxic dump," Dr Kahler said. "I don't care whether the Israelis or Palestinians live there. It's a toxic dump, meaning there's been all of these bombs that have been dropped, all these buildings that you see blown up, all of the toxic chemicals are pulverised and then just settle into the ground.
"The chemicals are carcinogenic, there's no question about that," he added. This could lead to an outbreak of thyroid disease and cancer among children and adults, creating a need for thyroid testing.
"Every baby needs to have developmental testing, and you have to have a registry of all those kids that have been born since October 7," he said, referring to the Hamas attack on Israel in 2023 that triggered the war. "When the mother is stressed, the baby feels the stress," he added.
While children over five years old, along with adolescents and adults, may well recover when they receive adequate nutrition, there is a real danger for babies and toddlers. "It's a generational catastrophe," he said.
As for Gazan men, they are being "either jailed or killed", Dr Kahler added. "This is what ethnic cleansing is. It isn't the violence against people, it's what it does to the community, to the population at large."
