What does more than 120 days of relentless war look like? Forced displacement; destruction of sewage networks, many hospitals and most other infrastructure; paralysis of all municipal functions. The result is a near-total collapse of the health care system, and that means the tent camps have become dangerous hotspots for the spread of infectious diseases.

I live in one of these refugee camps in Rafah and I see this firsthand. There are just 30 outhouses for about 10,000 people and emptying them is left to each user. The water isn’t suitable for human use.

With the steady increase in the number of people displaced from the north, the tent camps have become as densely populated as chicken farms. There doesn’t seem to be free space for anything, not even to stand in the sun and take a breath of fresh air.

When I walk around the camp, I see only tents erected haphazardly on land that wasn’t prepared for habitation. Where does all the sewage go? Right now, it flows freely in the streets and among the tents, sometimes seeping into the tents, spreading diseases such as hepatitis A and both viral and bacterial infections. I am aware of this because I live in a camp and I am also a nurse.

Viruses and bacteria are rampant

On average, seven children come to the camp’s medical station every day with symptoms of viral hepatitis A, and dozens of others have with gastrointestinal or viral infections, all due to sewage water.

As for waste, there is no removal system. Waste is dumped in specific areas in the camp and accumulates day after day, forming a mountain of garbage and a fertile environment for insects, and bacteria, emitting a foul odor. The many children and elderly people who suffer from respiratory disorders such as asthma cough and gag. Also aggravating their condition is the toxic smoke from rocket explosions.

Meanwhile, there is a shortage of water for drinking and even bathing. There is only one desalination station, in the far west of Rafah, and not everyone can reach it. Instead, they’re forced to drink water used for bathing and washing dishes, or to irrigate farming land. But this water contains parasites and bacteria that cause acute gastrointestinal infections, especially in children. The result can be severe dehydration.

I recall one mother and her 7-year-old daughter, who was suffering from dehydration. The mother had come to my makeshift clinic a few days prior for the same symptoms. When I asked her about the environment in their tent encampment and whether they had access to clean water, the mother told me their tent is located next to one of the nearby schools, since there was no space inside. Nearby, there is a pool of sewage water infested with mosquitoes. Because there’s no drainage in the streets, the sewage and other water remains stagnant until it finally evaporates on its own. I saw the result in this mother and child.

But we can’t treat them

The tragic fact is that we don’t have treatments for all these diseases. Many people need inhalation therapy such as Ventolin nebulization, but there is no electricity. We try as much as possible to provide medication close to what is needed or “home remedies” such as herbal concoctions. But it’s not enough, and camp residents can’t even follow basic preventive steps like drinking clean water or maintaining personal hygiene. Over and over, I must tell a patient that I cannot help.

The abject poverty in which people now live is forcing children and youth to scavenge through the garbage dumps to find food or things that can be sold!

A 70-year-old man I saw comes to mind. When I examined him, his right foot was swollen with fluid due to heart disease, as well as inflamed with a type of fungus common in the camp. His diabetes made it hard for such wounds and infections to heal. His foot required daily attention, but he told me that the last time he had received medical care was five days previously, when he was forced to leave the hospital in Khan Younis and move to Rafah. Now, his fungal infection was spreading to his left foot. I promised to visit his tent daily to treat his feet, since he couldn’t walk properly.

If this situation continues, I am sure we will witness an increase in cancers, miscarriages, birth defects and other long-term health consequences in the years and decades to come, due to malnourishment, exposure to toxic pollution, and even the extreme fear and tension.

Most of us have witnessed loved ones and neighbors killed in often gruesome conditions and have been exposed to the repeated and intense sound of bombings that make the ears ring. They may not show symptoms of shock immediately because they are preoccupied with trying to stay alive. However, after the end of the war, post-traumatic stress disorder (PTSD) and other mental illnesses are sure to manifest.

Already, as I man the camp’s medical station, I have observed changes in people’s personality and behavior, ranging from forgetfulness and depression to extreme mania. Some children are withdrawing, with no interest in playing or running, as is usual for kids. Those who still play do so in dangerous places such as trash dumpsters and patches with munitions that have fallen without exploding.

Psychological support is often not possible, since UNRWA clinics are located where scarce transportation is needed. And with the widespread despair, mental health care is regarded as somewhat of a fantasy. Survival is all we can handle.