A stream of dark and putrid sludge snakes through Gaza"s streets. It is a noxious mix of human and animal waste. The stench is overwhelming. The occasional passer-by vomits.
Over recent days this has been a more common sight than the sale of food on the streets of Gaza, choked by a relentless Israeli siege.
Hundreds of thousands of Gazans, almost all of its able male adults among a population of 1.5 million, crossed over into Egypt last week to buy essential provisions -- and a new lease of life. That has staved off starvation. But streets continue as sewers.
The rain has not helped. The sludge has spread, and the stench with it. Starved of timely income and essential supplies, municipal services have all but ceased.
"The smell," says Ayoub al-Saifi, 56, grimacing as he holds a handkerchief over his nose and mouth. "The stench of the sewage ... my wife has asthma, and she can"t breathe."
Saifi lives next to what has become a newly formed pool of waste. This used to be the street leading to home. "It"s getting worse day by day," says neighbor Said Ammar, an engineer, and father of four.
The sewage treatment plant in al-Zaytoun neighborhood in Gaza City requires 20,000 liters of fuel a day. Last week Israel ceased delivery of all fuel and supplies to Gaza. The consequences have been catastrophic.
Without fuel to pump it away, the waste backs up, flooding the streets and clogging the plumbing. The local ministry of health has declared this an environmental catastrophe.
Doctors have warned that a medical catastrophe could follow by way of spread of cholera and other diseases. That is at a time when not even life-saving medical services are on offer any more.
"We have to choose between cutting the electricity on babies in the maternity ward, cutting it to heart patients, or shutting down our operating rooms," says Dr. Mawia Hasaneen, director of emergency at al-Shifa Hospital, the largest in Gaza.
The World Health Organization released a statement 22 January warning of serious health difficulties arising in Gaza Strip, isolated by the Israeli siege, the Egyptian border and the Mediterranean Sea.
"Frequent electricity cuts and the limited power available to run hospital generators are of particular concern, as they disrupt the functioning of intensive care units, operating theaters, and emergency rooms," the WHO said. "In the central pharmacy, power shortages have interrupted refrigeration of perishable medical supplies, including vaccine."
Christine McNab, acting director in the communications department in Geneva, adds that "our current concerns are about the supply of electricity to health facilities, the ability to move medical supplies into the region, and the ability of people to seek care outside of Gaza."
McNab notes that even if the full blockade is lifted, additional measures would need to be taken by the international community against any further disruptions.
Israel has blocked off fuel and supplies to Gaza because it says it faces rocket attacks from the Palestinian area, which elected Hamas, the Palestinian party that does not recognize Israel.
Official Israeli sources say that about 150 homemade rockets have been fired from Gaza into Israel since Israel commenced this latest raid. Two Israelis have been slightly wounded and several others treated for shock.
Israel has retaliated with firing from tanks and attacks by F-16 aircraft firing Hellfire missiles into Gaza"s neighborhoods. At least 76 Palestinians have been killed, and another 293 injured since 1 January, officials here say.
Through the suffering, many Palestinians still do not blame Hamas.
"Hamas has never been the problem. The occupation has always been the big problem," says Ammar. He instead blames Palestinian Authority President Mahmoud Abbas, who administers the West Bank Palestinian area, and who has been in talks with Israel.
"Abbas doesn"t deserve one percent of the respect that [former Palestinian leader Yasser] Arafat earned. Israel will never find someone as good as Arafat. He gave them a historical chance at two states. Yet despite this, they [Israel] laid siege to him."
Rajaa Shalil, 38, and mother of four in Rafah at the Egyptian border, says "my respect for Hamas has increased more than ever. I love them for their empathy for the weak."
But not all of Gaza"s residents feel this way. "Both Israel and Hamas are the reason for this," says resident Abu Mohammed. "Before, we were all in better conditions, but since Hamas took over Gaza they have been unable to handle it."
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