The fighting in Gaza is over. The humanitarian crisis isn’t.

With the ceasefire came relief. The shelling had stopped. People were visiting each other, feeling happy, Salwa Tibi, a Gaza program representative for CARE International, said.

Earlier this week, Tibi hadn’t been sure if she would see the next morning, or the morning after that, so heavy was the bombardment from Israeli airstrikes. This week, Tibi’s daughter, pregnant for the first time, gave birth in the hospital, Tibi’s granddaughter, Naya, entering the world to the sound of shelling for hours and hours.

The Egypt-brokered ceasefire between Israel and Hamas, the Islamic militant group that controls Gaza, ended the immediate violence, the most pressing need for a territory that had been besieged by Israeli airstrikes for 11 days.

Humanitarian aid groups in Gaza had been struggling to respond to a ballooning emergency. Fuel, food, water, and medicine are all scarce in Gaza. Israeli airstrikes have blown up roads and other critical infrastructure. And the violence had prevented humanitarian groups and workers from being able to reach the people most in need.

Gaza is no longer an active war zone, but the emergency hasn’t fully abated. Israeli airstrikes have toppled high-rise buildings and turned homes and apartments to rubble. Israel said it was targeting Hamas and its networks, including rocket launchers and tunnels, but those targets are often intertwined with schools, clinics, and residential buildings.

According to Gaza’s Ministry of Public Works and Housing, before the ceasefire, about 230 buildings containing more than 991 housing and commercial units were destroyed, with hundreds more severely damaged. More than 72,000 people were displaced in the past week, and about 56,000 — about half of whom were children — sought shelter in schools run by the United Nations Refugee and Works Agency (UNRWA).

Some of those people are expected to start returning to their homes now that the fighting has halted. But clean drinking water remains scarce because of damage to some of Gaza’s water and sanitation facilities, and because of a lack of fuel to run these systems. About 800,000 people don’t have ready access to safe piped water, according to the United Nations Office for the Coordination for Humanitarian Affairs (OCHA).

Electricity is also in short supply; during the bombardment, electricity would come on for just a few hours a day. Those shortages also affected hospitals, which have been relying on generators for incubators, surgeries, and treatment of injured patients. Medical supplies and equipment are stretched.

That is taxing a health care system already strained by the pandemic, which must now treat the coronavirus and the traumas of war. There are also increasing fears of another coronavirus spike, because the violence forced some to crowded shelters and halted the territory’s vaccination campaign.

International aid organizations and humanitarian groups are rushing to meet this need — and to prepare for the rebuilding process.

The reality of the past two weeks is also settling in. Though Israeli officials repeatedly said they sought to minimize civilian casualties, the death toll is stark: more than 240 Palestinians killed, including more than 60 children, according to the Hamas-affiliated Gaza Health Ministry. More than 6,700 have been wounded, according to the World Health Organization.

“The bombs aren’t dropping, and everyone’s relieved to get on with their lives,” Jack Byrne, Palestine country director for Anera, an organization that works with Palestinian and other refugees in the region, said.

“But the reality of what happened, of the people who died, is hitting people now after the relief of this stopping,” he added.

Gaza has been pushed to the brink

About 2 million Palestinians live in the Gaza Strip, a tiny strip of land just 140 square miles that’s wedged between Israel and the Mediterranean Sea. It’s one of the most tightly populated places on the planet.

Since the Islamist militant group Hamas seized control of Gaza in 2007, Israel has imposed a blockade of the flow of commercial goods into the territory that has decimated the economy and denied Palestinians basic necessities. For this reason, Gaza is often described as an “open air prison.”

The periodic outbreak of war between Hamas and Israel has exacerbated the crisis. Israel has launched several military operations in Gaza, including an air campaign and ground invasion in late 2008 and early 2009, a major bombing campaign in 2012, and another air/ground assault in the summer of 2014.

Gaza, then, has been stuck in a state of crisis, which this latest round of fighting made more acute. Many international, regional, and local NGOs and UN-funded agencies, like UNICEF and UNRWA, a longstanding agency that works with Palestinians refugees in Gaza and the region, maintain a permanent presence, providing economic development; agriculture; and women, youth, and mental health programs, among many others.

Now, for most, the mission has shifted to trying to meet the most urgent needs of the people in Gaza.

The truce between Israel and Hamas has started to allow for the increased flow of goods, which had slowed during the fighting because of border closures.

The conflict had also complicated the ability to deliver aid at all, or fully assess what was happening on the ground. Hozayfa Yazji, area manager in Gaza for the Norwegian Refugee Council (NRC), who spoke to me before the ceasefire, said the insecurity had left “no way to assess the situation, to find a secure road for our humanitarian workers so they can do the work.”

The ceasefire has removed the biggest obstacle to delivering aid. Food, first-aid kits, medicines, and fuel are now arriving mostly unimpeded. But now groups are rushing to deliver aid as soon as possible, and to make sure they can find the families who are the most in need.

Gaza’s health care system is also being tested. It was already overstretched before the outbreak of fighting, because of the wear and tear of the 14-year blockade and because the territory had just experienced a Covid-19 surge.

Aid workers said medical facilities lacked basic supplies and equipment, like blood bags. Two prominent doctors — the head of internal medicine at Al-Shifa Hospital, who trained other doctors, and a neurologist — were killed in airstrikes last week.

According to the World Health Organization, 19 health facilities have been damaged in the Gaza Strip. A primary health care clinic in northern Gaza was destroyed, and an Israeli airstrike damaged a Doctors Without Borders (MSF) trauma and burns care clinic last weekend. Nobody at the clinic was hurt, but according to MSF, the bomb tore down the room where the clinic sterilizes its medical equipment. The clinic, which normally serves about 1,500 patients a year, had to close.

Natalie Thurtle, MSF medical coordinator in the Palestinian territories, said the closure meant that less serious injuries would have to be offloaded to hospitals, which also had to deal with more critical injuries, including people wounded by airstrikes.

Concerns about a resurgence of coronavirus are also increasing. A blast destroyed Gaza’s only lab to process an already limited number of Covid-19 tests. With tens of thousands displaced, many sought safety in crowded schools or shelters, or moved in with other family members, making social distancing impossible.

The violence also interrupted Gaza’s small Covid-19 vaccination campaign. The World Health Organization is sending about 10,000 doses of China’s Sinopharm vaccine. But even with that incoming aid, many humanitarian workers fear the chaos and confusion and the still precarious position Gaza is in may give Covid-19 a chance to resurge.

A ceasefire will help critical aid get through. But the damage is already done.

An end to the fighting is the first step, but it won’t fully stem the crisis already underway. The humanitarian crisis persists.

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“The population of Gaza is not going to be able to recover easily from this,” MSF’s Thurtle told me.

Tens of thousands of Palestinians have lost their homes; critical infrastructure, already fragile, has to be rebuilt. These are also just the visible signs of a trauma Gaza recently went through, and has before, multiple times.

And humanitarian groups said another generation in Gaza will now be traumatized by war. More than 40 schools were damaged during the bombardment, according to OCHA. The NRC was already providing psychosocial support to about 75,000 kids between ages 5 and 15.

Of the dozens of children killed in Gaza, at least 11 were already involved in their programs, some of them siblings. Ivan Karakashian, Palestine advocacy chief for the Norwegian Refugee Council, told me the NRC will now provide emergency education and mental health support to kids who are currently in shelters or staying with host families.

“Children have been suffering terribly after 12 years of closures and four armed conflicts,” Damian Rance, from UNICEF’s Palestine office, said. “And really, what we need to do is allow a reprieve and some respite, so we can at least pick up the pieces and try and rebuild.”

There is desperate need, but there is also a sense of déjà vu: Gaza has been here before. The truce is just a temporary fix. Without resolving the underlying crisis, every time there’s a cycle of hostilities, Karakashian said, “we just seem to be building and rebuilding and rebuilding again.”

The economic situation, always precarious, will crack even more. The moment they make progress, Yazji told me, something happens, and you have to go back and reconstruct all that work, everything again from scratch.

“We will start doing our work again and to start to rebuild again, to support the kids the children and their teachers, their parents — and then something new happens,” Yazji said.