Winter is fast coming to Gaza. Rain storms and powerful winds have already swept through the coastal strip, scattering tents and soaking those with little shelter in a crisis in which about 1.8 million Palestinians have been displaced by Israel’s offensive. And with the advent of winter, an already catastrophic situation in which almost all of Gaza’s healthcare has collapsed is quickly worsening. Women are giving birth in tents in unsterile conditions. Smoke from the wood fires is exacerbating respiratory ailments. Those in need of medicine have been forced to go sometimes to up to 10 pharmacies in an often fruitless search. “It’s so cold, and the tent is so small. All I have is the clothes I wear, I still don’t know what the next step will be,” said Mahmud Abu Rayan, displaced from the northern town of Beit Lahia to Rafah. “We didn’t see anything good here at all. We are living here in a tough cold. There are no bathrooms. We are sleeping on the sand,” added Soad Qarmoot, a Palestinian woman who was also forced to leave Beit Lahia. “I am a cancer patient,” Qarmoot said as children circled a wood fire for warmth. “There is no mattress for me to sleep on. I am sleeping on the sand. It’s freezing.” Displaced Palestinians who spoke in Rafah in recent days, tell a similar story: a perfect storm of colder weather, hugely overcrowded and insanitary conditions and a lack of food and proper shelter. Communicable diseases are increasing alarmingly, according to surveillance data shared by the World Health Organization. There is bloody diarrhoea, respiratory infections, jaundice, hepatitis A and meningitis. A shortage of antibiotics is driving deaths from post-operative infections among the wounded. The chronically ill, unable to access care and medication are dying often unrecorded as victims of the war. The mother of Ramzy S, aged 54 years, who had been evacuated from northern Gaza to Rafah, was one of those cases. “My mother died last week,” Ramzy told the Guardian. “She had high blood pressure and diabetes. We’re living in bad conditions in a Rafah UNRWA shelter. We’re in tents, lacking the most basic things we need, and everything is hard to get. “Older people can’t tolerate these conditions. In cases like this, hospitals are unable to deal with what we call normal diseases, they are full with hundreds of injured people and still receive daily. Even injured people are in the yards of hospitals as all bed are full. “We never expected to bury our relatives out of our area or town.” “The conditions are extremely dire,” said Léo Cans of Médecins Sans Frontières. “People are overcrowded, then there is a lack of quality water and what water is available is bad. Because people are conserving what water they have, they are washing less. “It is a perfect recipe for communicable diseases. And what healthcare is available has been most focused on life-saving care in the hospitals.” Amid the focus on the injuries from the conflict, a mounting concern is disease outbreaks. Margaret Harris of the World Health Organization told NPR last week: “We’re already seeing very, very worrying outbreaks, such as outbreaks of jaundice, which we are presuming is hepatitis A because the conditions for hepatitis A are everywhere. “That’s dirty water, lack of sewage services, overcrowding. But we can’t actually test to know whether it’s hepatitis A because the laboratory we would normally use is in al-Shifa hospital and is currently not functioning. “You’re constantly exposed to everybody else’s bacteria and viruses. And we’re seeing huge numbers of diarrhoea on what we would normally see in populations in Gaza at this time.” Hanin Wishah, a project manager with Action Aid at the now besieged al-Awda hospital in northern Gaza, was displaced to Rafah early in the war. She describes the situation in Gaza as a disastrous return to the pre-antibiotic period, as stock has dwindled to almost nothing. “Hepatitis is spreading among the internally displaced because the shelters were not designed to receive the thousands of people. There are thousands more sleeping on streets with no shelter. It’s absolutely crazy.” With Israel having said it plans to prosecute its campaign until the end of January, it is the arrival of full winter that is alarming many in an already desperate situation. “Oh my God, winter,” said Hanin. “If people are not dying in the bombardment, people will be dying in streets. We are all praying for winter to be miraculously postponed. It’s horrible without the rain and storms. When it rains people are going to die.” Voice messages from Action Aid staff to colleagues outside Gaza, shared with the Guardian, portray the increasingly desperate situation. “We were drenched in the rain yesterday,” said Abu who is living in a tent at a UN warehouse. “The tents that were supported by nylon sheets and wood were all scattered. They are supported in a very simple way that cannot shelter anyone. “[So] they couldn’t hold against the wind and rain, [and were] all scattered by the wind. “The other problem is the spreading of diseases now, specifically diarrhoea. Sadly, I caught it. But thankfully I got better in a few days. It’s somewhat better for people living in prefabricated housing. They were warm and sheltered from the wind and rain. “People are trying to get medicine for their children but there’s no medicine in pharmacies. It’s an absolute disaster, beyond anyone’s imagination.” And complicating the issue is that many who fled south in the early weeks of Israel’s offensive escaped with only their summer clothes in the midst of an unseasonably warm autumn. Lacking winter clothes, blankets and even mattresses to sleep on, they are doubly vulnerable. In a second voice message, shared with the Guardian, Rana who is living in a tent with her children, described a recent storm. “For [those of] us who live in tents, the situation we have is a period of [bad] weather that we are facing now. “My children were [so scared] because of the storm that occurred. The tent was about to fly away, and we were freezing. The children were shivering so much. “I can’t find a blanket to cover them. They gave us a blanket for each person, but the blanket was very thin. It doesn’t [keep us] warm. It’s useless. “Sweaters and winter clothes are not available. We don’t know what to do. There is no mattress to sleep on. We sleep on the ground, and the ground beneath us is [covered with] thorns. “All my kids are [young]. My husband isn’t here and I am alone.”