“I Don’t Want to Die”: Bearing Witness to Palestinians Under Siege in Gaza
The people of Gaza are no strangers to humanitarian crises and war. The territory has been under siege for 16 years. Recurring conflicts between Hamas and Israel have spun out into episodes of mass violence. Last year, even before this latest round of conflict, four of every five people in Gaza were dependent on humanitarian aid. Years of dwindling global funding for the UN’s agency for Palestinian refugees (UNRWA) have forced aid workers to do more with less.
But no one in Gaza—civilians, doctors, journalists, humanitarians—has experienced anything like the crisis that has engulfed the territory since October 7, 2023.
Hamas’s historically violent attack on Israel killed some 1,200 people and injured thousands. An estimated 240 people were taken hostage. The resulting Israeli offensive has thrust 2.2 million people in Gaza into one of the century’s worst and fastest-growing humanitarian and displacement crises.
Yet international media coverage since October 7 has only rarely given voice to people inside Gaza to share in their own words what they are experiencing. Independent access for the press inside Gaza has been almost entirely closed.
Palestinians are teetering on the brink of survival. A staggering 28,000 people have been killed, and more than 67,000 injured. Of those, an estimated 70 percent are women and children—making Gaza the most dangerous place on earth to be a child. More than half of Gaza’s buildings are damaged or destroyed. An estimated 1.7 million people have been forcibly displaced, virtually overnight. Meanwhile, Israel has blocked the entry of food, water, fuel, and other basic goods necessary for survival. A floundering humanitarian response is struggling to save lives in these near-impossible conditions. Israel will not guarantee the safety of humanitarians delivering food to starving people—nor people seeking care. Credible projections now show famine setting in, with 90 percent of people experiencing crisis-level hunger.
In roughly four months, Gaza has become a hell on earth. The following brief shares testimonials from Palestinians in Gaza—in their own words—about their experiences during the war, based on interviews Refugees International conducted by phone and in person in early January 2024 with Palestinians inside Gaza and with people who had recently fled the conflict. Together, these testimonials paint a portrait of life under siege—and a humanitarian response under attack.
Refugees International reiterates our long-standing call for an immediate ceasefire, the release of all hostages, and the lifting of the siege.
Living Through Hell: Palestinians Under Siege
Forced Displacement: Nowhere to Go
Most people inside Gaza—approximately 1.7 million of Gaza’s population of 2.2 million—have been forced from their homes amid the Israeli offensive. The nature of these displacements have been chaotic, disorganized, and perilous. Many people have been displaced multiple times, only to experience more danger where they fled.
On October 13, 2023, Israel ordered 1.1 million people to leave areas in the north of Gaza within 24 hours. Nearly half of Gaza’s population was displaced overnight. Many had no choice but to walk south. One Palestinian woman who worked as a photographer before the war and was forced to flee Gaza City during the evacuation told Refugees International:
“We could see rockets glowing in the sky. We sought refuge behind a mosque’s walls on the ground, not expecting to survive. The area was packed with elderly people and children, and the distance between us and the bombing was just a few meters. No matter how much I try to describe it, I can’t fully convey the intensity of the situation. I couldn’t bring my cameras or even my clothes, just my slippers. It was October, we had no winter clothes or anything. The experience was incredibly challenging and unpredictable.”
The vast majority of displaced people were systematically uprooted from north and central Gaza, and are now seeking refuge in the southern border town of Rafah—currently under intensifying bombardment—and in certain designated “safe areas.” Refugees International heard repeatedly that there is no safe place inside of Gaza as these areas continue to see intense bombings. A nurse in Gaza shared with the team:
“I received a case of a woman who lost all of her family due to the bombing after they were displaced to the south of Rafah thinking it might be safe for them there. They have no involvement in political dealings. Their sin is simply being a family from Gaza.”
Despite Israel’s claims that it notifies people for evacuations ahead of an attack, many Palestinians described these warnings to Refugees International as inadequate or wholly absent. This is corroborated in a February investigation on unlawful Israeli strikes in Gaza by Amnesty International. Palestinians in Gaza shared situations in which they followed evacuation orders, only to experience bombing in the place where they were told to shelter. One Palestinian woman told Refugees International:
“Some of [the warnings] are live calls between the IDF officer and the building owner, and they tell them to evacuate. But it’s rare to happen in this war. Before we used to receive what is called a ‘warning missile’ that they send, and then the people can know they have to evacuate. This time, they target the areas directly and without warning. Rarely do they send something like texts to the citizens telling them that they will target the whole area… And they always tell the people to evacuate to a certain area, then they target that same area they told them to go to. Today, I heard testimony from a man who was told to evacuate from Gaza to the south to Rafah on Friday. By Sunday, they bombed them in Rafah, and he lost all his family.”
Another shared similar testimony:
“We really don’t feel safe anywhere, not in the south nor in the central area. Nowhere is safe at all. They [Israeli forces] ask families from Gaza and the north to leave to certain places like camps or schools used as shelters or even hospitals, then they are bombed directly.”
Yet another Palestinian woman in Gaza shared the same:
“Certainly, the IDF tries to present a cleaned-up image by advising people to evacuate before bombing, but the reality is they bomb anyway. We were told not to move until the morning, but when morning came, the bombing persisted.”
An estimated 1 million people are living in or near emergency shelters, makeshift accommodations, and hospitals in central and southern Gaza. Informal camps continue to expand as thousands of newly displaced Palestinians arrive daily to the south, especially in areas near Rafah. The area is massively overcrowded. Rafah’s pre-war population of 280,000 has ballooned to 1.5 million. Conditions are ripe for the spread of disease. Shelters are far over capacity, and resources are scarce. Palestinians displaced in Gaza described to Refugees International that the severity of their conditions are wholly undignified. A Palestinian mother told Refugees International:
“Many children are suffering from fever, diarrhea, or skin diseases, and I witnessed that in the camp. Many children have that kind of disease. My children got a fever in the first few days when we got to the camp; they got diarrhea as well. So things are tough living in the camp.”
Many displaced people are living in makeshift tents or in the open. Israel’s blockade on the territory and tight control and ban on the entry of relief items it considers “dual use”—including essential items such as tent poles—make relieving the situation nearly impossible. One NGO representative told Refugees International that in lieu of sending tents to Gaza, they have resorted to sending plastic tarp and duct tape with an expectation that Palestinians would find materials to use as tent poles in the rubble.
A Palestinian woman working as a nurse in Gaza told Refugees International explained how hard it is to find shelter:
“I went to Rafah looking for a tent, but I couldn’t find any. So I had no option but to buy the necessary materials to make one from the market. I had trouble finding wood and nylon. It’s either unavailable or very high in price and extremely low in quality. The smallest tent you can find to take refuge in costs you at least U.S. $500.”
Indiscriminate Attacks
Israel’s military campaign has destroyed critical civilian infrastructure, including hospitals, housing, shelters, sanitation, sewage, water and energy infrastructure, bakeries, agricultural land, schools, and more. Not even religious or cultural institutions have been spared. Palestinians in Gaza repeatedly told Refugees International that, from the ground, there is no apparent distinction in Israel’s attacks.
“Moving on the ground is risky; everything and everyone is a target—journalists, medical staff, animals, humans, everything.”
In Gaza City, one Palestinian told Refugees International:
“All buildings are targeted—religious, social, cultural, economic, hospitals, and even journalistic buildings. Everything on the ground is a target now, including roads and stones, something unprecedented in history.”
Several others in Gaza pointed out that these tactics are different than in previous Gaza wars:
“Bombing entire buildings with everyone inside, especially women and children, is happening for the first time. In past wars, targeted buildings usually had someone inside who was a specific target, but now, entire buildings are bombed with numerous victims. It’s heartbreaking, and you wonder why so much killing, just for the sake of killing, nothing else.”
Another Palestinian woman in Gaza working as a journalist shared how immense the carnage has become:
“There is nothing more horrific than bombing a house with people sleeping inside, civilians who have no business with the resistance or anything. One minute they’re sleeping peacefully and the next they’re in the hospital as body parts and limbs. I remember an instance when I was in Al Shohdaa Square filming, a man told me to come to [look under] a blanket and film. He raised the blanket, and under it are body parts of different people mingled together. A man’s torso, a little girl’s scalp, a lady’s stomach, a man’s hand, a child’s hand. Nothing is more horrific than being asleep in your house and arriving in the hospital later as unidentified body parts.”
In December, a U.S. intelligence assessment found at the time that nearly half of all bombs used in the war in Gaza were unguided, “dumb bombs” that can have catastrophic impact in highly populated areas.
Attacks on Healthcare and Limited Access to Care
Hospitals in Gaza—which are protected sites under international humanitarian law—have been besieged and struck by Israeli bombardment, threatening patients, staff, and people sheltering for safety alike. At the end of January, only 14 out of 36 hospitals in Gaza were partially functioning, and two were minimally functioning and unable to accept patients or supplies.
A medical professional in Gaza told Refugees International:
“Just imagine a hospital with no electricity or water, in the midst of relentless bombing and an ever existent smell of death and blood. This is what I saw and experienced under the siege of Al-Shifa Hospital. I survived miraculously after the hospital was bombed, and I really hope this doesn’t happen to us again here.”
Al-Shifa Hospital is just one example where military operations in a hospital compound resulted in the widespread displacement of its patients and people sheltering inside. While there remains debate over Israel’s claims that the hospital was being actively used as a militant base, the net effect is that Israel’s military operations forcibly displaced thousands of civilians, staff, and patients southward. As many as 10,000 civilians still remain in Al-Shifa Hospital, many of whom were unwilling or physically unable to move due to the security risks.
But this experience is not unique to Al-Shifa. A Palestinian hospital staffer working in a major hospital in southern Gaza told Refugees International that these evacuations occur in desperate conditions, increasing risks for the sick and injured:
“When the Indonesian Hospital was under siege in the north, they sent the injured people here in a bus, a public transport bus, not an ambulance [most ambulances were destroyed]. A whole lot of injured people were transported in a bus, mostly severe cases with severe injuries, and they were all piled up on top of each other in extremely difficult circumstances. Even before they brought the injured people down, the sound of their screams and their pain was louder than the bus itself. It was a difficult sight that gave me the chills. Transporting these people like this and for a long distance while being harassed on the way of course by the occupying Israeli forces. That was a very difficult situation, and most of them were children, and these children, their injuries, mostly required amputation of limbs.”
The southward displacement of Palestinians to the remaining operational hospitals in central and southern Gaza have stretched them far beyond capacity. A Palestinian doctor at the European Hospital in Gaza told Refugees International in January that their hospital was treating 900 patients—more than twice its capacity of 300 to 400 patients under normal conditions—and sheltering 20,000 people. The ability to sustain care for these patients is increasingly difficult due to the risks of sickness and disease spreading among those sheltering. As one Palestinian doctor described to Refugees International:
“The crowded conditions make it easy for simple ailments, like lung infections or stomach issues, to spread among the displaced.”
Safety for those inside hospitals is not guaranteed. One Palestinian man working as a journalist in Gaza recounted to Refugees International:
“Let me tell you a story about a kid named Dunnya. I went to film her family’s house, which was bombed in Khan Younis. I was reporting about the injured people, so I met her. Her foot was amputated, and she lost all of her family. She was 12 years old in Nasser Hospital. About a week and a half ago, they bombed the maternity section in the hospital with artillery. Dunya was in that section, and tragically, she lost her life. First, she lost her family, and now her life is gone. What makes it even harder is that just a day after she died, her name appeared on the lists for those who were supposed to leave for medical care in Turkey to get a limb transplant.”
Because of the risks to hospitals—and the lack of security guarantees in transit to hospitals—and because of the lack of capacity, many with chronic conditions in Gaza are not getting the treatment they need. As one Palestinian in Gaza shared with Refugees International:
“I have a cousin, Wael, who had a kidney transplant. He called me crying because he needed medication to maintain his kidney transplant. I managed to arrange for a 15-day supply through Khan Younis Hospital, even though it’s risky to go there. But he risked his life and went there although it’s very dangerous. It’s a tough situation for everyone with chronic conditions.”
Another shared similar testimony:
“Before the war, the elderly and people with chronic diseases used to depend on a routine way of receiving treatment and medication. Especially those suffering from diabetes or unstable blood pressure. The health centers caring for them have stopped working because the medication is no longer available, and their health has deteriorated severely. Some of these people are worried that if their medication runs out, they’ll simply die.”
Others are delaying urgent care. A Palestinian doctor in Gaza told Refugees International:
“The patients that arrive at the hospital now from any disease are in a bad condition because it’s difficult to arrive at the hospital… There was a young boy and his family who traveled from Gaza City, aiming for a supposed safe passage. Unfortunately, his father was taken by the Israelis during the journey. Upon arriving in Rafah, the child, unwell with stomach pain, stayed with his mother for three or four days. In an attempt to alleviate his discomfort, his mother used various herbs. Three days later, the boy was brought to the hospital in a critical state. The appendix had burst, leaving him in a state of shock—unresponsive, dehydrated, and unable to eat or drink.”
He also shared that limited medical supplies are straining the response:
“The scarcity of antibiotics poses a significant problem, particularly for children dealing with conditions like pneumonia. Without timely treatment, their cases may worsen, eventually requiring hospitalization for vascular treatment. However, even these medical resources are extremely limited. This shortage leads to complications of course. And also it’s tough for people to move between places due to the lack of fuel for transportation.”
Another Palestinian in Gaza described the difficulty finding basic medicine:
“A lot of medication is missing on the market; we cannot find it. For example, my mom is suffering from a heart condition and she uses specific pills, but she can’t find it at all because it’s not available now. If you are looking for medicine, you need to go all over Gaza in many places because a lot of the pharmacies were destroyed, and the clinics are not functioning all the time. So you need to look among people or post online asking if anything is available in this area or that, so it’s a struggle.”
Attacks on Humanitarians and Limited Access to Aid
The indiscriminate nature of attacks have directly killed more than 150 UN staff and numerous Palestinian NGO and humanitarian staff, making the conflict the deadliest ever for aid workers in UN history. Critical humanitarian infrastructure across Gaza has been damaged or destroyed. This has made the job of humanitarians—who are themselves living through hell in Gaza—nearly impossible.
As one Palestinian originally from Gaza City told Refugees International:
“During the war, apart from the death and destruction, a lot of the people have been piled up in certain areas where they’re displaced because of the war. And the food that enters into Gaza is very scarce. The aid trucks that you see on the news are extremely few in number, and there is not enough for these people’s needs… Drinkable water is very scarce, and it takes a lot of time to find it. You can wait in line for eight hours to get a bottle of no more than 2 liters.”
UN agencies and humanitarians have tried to work with the Israeli military on “deconfliction,” or no-strike guarantees for humanitarian sites and convoys. But these requests are not guaranteed, and critical humanitarian infrastructure and convoys have been repeatedly hit, including a deadly attack on a UN training site sheltering displaced people in late January. Following, the UN OCHA Deputy Humanitarian Coordinator for Palestine called for such attacks to stop, condemning the “consistent failure to uphold the fundamental principles of international humanitarian law: distinction, proportionality and precautions in carrying out attacks.”
This has limited the movements humanitarians can make to deliver aid, endangering aid providers and recipients alike. These conditions have made it too dangerous to facilitate mobile aid distributions, so sometimes distributions are made at points of entry. Those who cannot access distribution points themselves thus suffer the most.
A Palestinian woman who has now fled Gaza explained that her family in central Gaza cannot access aid deliveries.
“Even nowadays with humanitarian assistance, people are suffering because it’s condensed in the south, in Rafah and Khan Yunis. And my family is too—they are really struggling to find anything… My brother, every day he tries to go to Rafah to find anything… And I always try to call him, please do not take the risk to go. But he told me, ‘And how can we survive? I have to take the risk.’”
Attacks on Bakeries and Limited Access to Food
Gaza’s critical food infrastructure, including bakeries that make bread—a staple food for Palestinians—have been destroyed in airstrikes or closed due to shortages of fuel and other essential supplies like wheat. As of mid-January, only 15 bakeries in Gaza were functioning—a fraction of the 130 bakeries in the territory before the war. Eleven have been completely destroyed in Israeli strikes. No bakeries are open in the north.
In one case, a bakery in the Nuseirat camp was bombed twice in two days. A Palestinian who witnessed both attacks told Refugees International the first strike destroyed part of the bakery, but it remained partially operational to provide food for the local residents. The second strike came two days later, and destroyed not only the bakery, but the entire block, including housing units. He recounted the incident to the Refugees International team:
“The Al Nuseirat bakery had already been bombed two days before… people were still using it, then they [the IDF] finished it off with F-16s. There was a line in front of the bakery. A very small part [of the bakery] was working just to help people in Nusairat… They [the IDF] bombed the whole block and destroyed it. One of those affected [in the attack] is a colleague of mine. He was sleeping with us in the tent in the hospital [nearby]. His kids were in a house in a flat in that area [near the bakery]. He received the news that his house was bombed in the morning. All his kids arrived at the hospital dead. Only one of his kids survived.”
He went on to share what he described as a pattern of attacks on Gaza’s food system:
“There was a bakery called Al Ahaly in Gaza owned by a Christian person. They [the IDF] targeted it with a drone and then called him and told him to shut it down immediately… They shot it with a drone as a warning, shooting the electric generator as warning and then they called him personally telling him to shut your bakery down.”
In another case, IDF soldiers threatened the owner of Gaza’s largest mill, Al Salam Wheat Mill. Despite attempts by the Red Crescent to secure protection guarantees for the mill, it was severely damaged by Israeli strikes in November, ceasing its operations.
“They [the IDF] told one of their owners specifically that if you put out one sack of flour we’ll bomb you directly… He [the owner] said they [IDF] told him that if he worked, they will destroy the whole place. We tried through the Red Crescent to get the approval for him to work and get guarantees that he wouldn’t be hit, but they couldn’t do that.”
Others described to Refugees International how hard it is to find food. As one Palestinian woman shared:
“You eat only one meal, and it’s not a complete meal. It’s like maybe a piece of bread with something, and you’re lucky if you have it. It will at least help you survive. You don’t eat it to enjoy it; we don’t eat it for that purpose.”
The combined effects of Israel’s blockade of Gaza, along with severe restrictions on the movement of humanitarian workers and the widespread devastation of essential infrastructure, services, and food production, have led to a profound hunger crisis that teeters on the brink of famine. Approximately 1.3 million people in Gaza are experiencing catastrophic or emergency level hunger. The situation inside Gaza is exacerbated by rising inflation and a market that is largely depleted due to Israel’s closure of borders, unpredictable border management, and limits on the number of trucks allowed entry each day.
“Some children are suffering from a lack of food, resulting in deaths due to insufficient sustenance as well as the unavailability of medication. Additionally, displacement has left some without their money. People left their houses with nothing, and high prices make it challenging for them to meet their most basic needs. In essence, if people don’t die from the war, they face the threat of dying from hunger.”
Mental Toll
The psychological repercussions of the Gaza conflict will profoundly affect millions of Palestinians for generations. Families, spanning from the youngest children to the eldest grandparents, have been wiped out in singular, devastating attacks. Witnessing such horrors firsthand—children seeing their parents fatally shot, parents desperately unearthing rubble in search of their offspring, and grandparents watching the annihilation of their entire lineage—has inflicted deep, lasting psychological wounds that will be felt for years to come.
A doctor in Gaza shared with Refugees International:
“I saw an 80-year-old man who lost all five of his young sons. Lost them all at once. He was walking around the hospital injured looking for his sons he lost, and he couldn’t bear the situation.”
A Palestinian woman told the team:
“It’s hard when you lose your family members, and everyone is left to survive on their own. I lost my aunt and her family, lost more than 30 cousins with an airstrike without any warning. Some of them were left in the street for days before they were buried. It’s difficult because sometimes you feel that it’s beyond your ability to continue or provide for the community, and do your job so the world can see what’s going on.”
Another Palestinian in Gaza described how, in some cases, the psychological toll of loss has caused some to give up.
“My sister was working at an UNRWA clinic. She told me a heartbreaking story of a girl displaced from Beit Hanoun. This girl’s siblings were killed. From the start of the war until now, she couldn’t eat due to grief over her loss. Her mental state was desperate. Despite efforts to help her, she passed away three days ago. One of her brothers had died a few days before her passing, and it seems she was deeply attached to him.”
For those living through the daily bombardment, the psychological trauma is severe:
“In addition to the direct casualties of war, there are also fatalities due to heart failure and strokes triggered by anxiety and fear. The mere sound of bombing and artillery strikes can instill indescribable fear, leading to strokes and deaths.”
A Palestinian mother from Gaza shared the effects the war is having on her children:
“It’s very hard because my children are scared most of the time. They’re afraid of any sound. Sometimes I get nervous and feel like collapsing. It’s beyond my capacity to endure.”
Even for those who were able to escape Gaza, the mental toll lingers with them. One Palestinian who fled Gaza told Refugees International,
“It’s not easy for me as a journalist to be away from Gaza, especially if you feel their suffering and their pain, and you lived what they lived and their suffering, the same pain they lived. When they are talking that there is no water, you remember you were searching for water for days and couldn’t find one bottle. When they say there is no food, you remember you couldn’t find food for your family. When they say they can’t charge their mobile phones, you understand there is no electricity, and you had to find someone with a solar battery to charge your phone and equipment. I understand it because I lived it.”
Dr. Omar’s Story
For days, Dr. Omar was warning his brother Mohamed to leave his home in Khan Younis with his family. December’s short ceasefire had come to an abrupt halt in Gaza, and Israeli forces were moving in by land into the city. Dr. Omar recently moved his own wife and children into Gaza’s European Hospital, where he works as a pediatric surgeon.
Moamen and his dad before his dad was killed.But Mohamed could not be convinced to leave. His five-year-old son Moamen has cerebral palsy. Moamen always felt most comfortable at home with family. And the boy would often yell at night. Mohamed was afraid people might not be tolerant of his son in crowded shelters.
On December 15, Israeli forces surrounded and stormed Mohamed’s home. Eleven of Dr. Omar’s family members were inside.
An IDF soldier shot Mohamed dead. Then another threw a grenade into the home. It exploded, the shrapnel injuring young Moamen and his mother. Then they shot her dead as well, in front of her children.
“I tried communicating with the Red Crescent, and telling them there are civilians in this house,” Dr. Omar recounted. “I told them these people in that house have nothing to do with the resistance, and there are women and children there. They’re all civilians! The Red Crescent informed the IDF in their own way about the civilians in this place, but still they broke into it and killed these people.”
Dr. Omar didn’t see his family until some of them arrived at the hospital the next morning. His nephew was carrying young Moamen, who was bleeding from his head.
Dr. Omar x-rayed Moamen and was relieved to see that the shrapnel had not entered his skull. But the boy’s eye was destroyed and needed to be removed.
Moamen recovering after his eye surgeryHis family recounted to him what happened. After killing Mohamed and his wife, the IDF soldiers interrogated the surviving family members for several hours, beat them, and took all of their belongings.
“They gave them white flags and told them to [walk], except for my brother Mahmoud,” Dr. Omar said. “They kept walking till it was night, and they slept in some sort of kindergarten that was abandoned, of course. All the places were abandoned. They stayed there till dawn, and they kept walking until they reached me in the Gaza European Hospital at 7:00 a.m.”
Meanwhile, his brother Mahmoud was arrested, interrogated, and beaten.
“They tied his legs and his hands. And he has injuries in his torso and legs and hands. There was no medical care, of course, or water. So by the time he reached us he was exhausted. Now he reached the house of his wife’s family in Deir al Balah. I haven’t seen him since they released him.”
Despite this massive loss and horror, Dr. Omar perseveres and continues to provide medical care under the most difficult of circumstances. Moamen is recovering—though he, like so many children in Gaza, is not yet safe.
Conclusion
The war in Gaza will only spell more starvation and death as it continues. Already, 100,000 people in Gaza are dead, injured, or missing. Without a ceasefire, many more will join that fate.
One Palestinian mother from Gaza simply told the team, “I don’t want to die. I don’t want to die.”
As a ground invasion of Rafah seems imminent, it is past time to make every effort possible to save civilian lives.
Jesse Marks is the senior advocate for the Middle East and Sarah Sheffer is the vice president for strategic outreach at Refugees International.
Refugees International would like to thank the people inside Gaza—and those who recently fled—who shared their perspectives and experiences with our team. For more from Refugees International on the crisis in Gaza, including our latest policy analysis, see here.
Featured Image: 14-year-old Palestinian Mohammed El-Yazici, who lost his mother and has not heard from his father due to Israeli attacks on Gaza, kisses his 6-month-old baby brother in front of the makeshift tent they take shelter in in Rafah, Gaza on January 28, 2024. (Photo by Abed Zagout/Anadolu via Getty Images)