Fuel for emergency generators that keep Gaza's hospitals and sanitation services operating will run out within 10 days, the United Nations said on Tuesday in an appeal for immediate donor support.
The shortage stems from a dispute between Gaza's dominant Hamas Islamist group and the West Bank-based Palestinian Authority (PA). Both signed a unity deal in October but have failed to finalise the details of political power-sharing.
So far generators have stopped at three of Gaza's 13 hospitals and 14 of its 54 medical centres, said Ashraf Al-Qidra, the Hamas-appointed spokesman for the impoverished territory's Health Ministry. Officials at the affected facilities said they were directing seriously ill patients to other health facilities and operating at limited capacity.
With Gaza's electrical grid supplying only about four to six hours of power a day to Gaza's two million people - a complicated crisis also largely rooted in the Hamas-PA rivalry - back-up generators are a lifeline for health care and sanitation facilities.
At Durra Hospital for Children in Gaza City, which normally treats up to 180 patients a day, many of its 90 beds were empty on Tuesday. Doctors said fuel ran out a week ago and services were operating at minimum levels.
"We are working in life-saving mode," the hospital's director, Majed Hamada, told Reuters. He said doctors were providing primary health care and, in emergency cases, transferring patients to other hospitals after stabilising them.
In a statement, the United Nations Office for the Coordination of Humanitarian Affairs (OCHA) in the Palestinian territories said emergency fuel for critical facilities in Gaza "will become exhausted within the next ten days".
It said emergency and diagnostic services, intensive care units and operating theatres were at risk, as well as the running of 55 sewage pools, 48 desalination plants and solid waste collection facilities.
Hamas, which seized the enclave in 2007 from Fatah forces loyal to the PA's leader, President Mahmoud Abbas, said the Authority was withholding payment for the fuel, which is supplied via Israel.
The PA said Hamas had failed to transfer money collected from the sale of medicine to patients in Gaza, funds the Authority uses to buy the fuel.
OCHA said $6.5 million is required to provide 7.7 million litres of emergency fuel in 2018 - "the bare minimum to stave off a collapse of services".
"Without funding, more service providers will be forced to suspend operations over the coming weeks, and the situation will deteriorate dramatically, with potential impacts on the entire population," the OCHA statement quoted Roberto Valent, the acting Humanitarian Coordinator for the Palestinian territories, as saying. "We cannot allow this to happen."
In Durra hospital, mothers sat beside their sick children and complained that politics were endangering lives.
"We blame all parties. Why should these children be at risk of dying because Hamas and Fatah failed to reconcile?" said one mother, whose three-year-old daughter has been waiting a week for an X-ray.
A US decision to cut aid to the United Nations Relief and Welfare Agency (UNRWA), which provides aid to Palestinian refugees, also threatens to deepen hardship in Gaza.