In Rafah, in the south of the Gaza Strip, over a million people brace for a military onslaught which could arrive any day now.

Once a city of 300,000, its numbers have been swelled by those fleeing the death and destruction in the north of the besieged enclave - decimation which, if Israeli Prime Minister Benjamin Netanyahu has his way, will follow them south.

"Rafah is Gaza’s last hope," says UNICEF's James Elder, speaking from the ground in Gaza.

"Rafah was about 250-300,000 people and there are now 600,000 boys and girls. A military offensive there, given their exhaustion, given 90% of children under five have had some sort of infectious disease, given Rafah is home to many of Gaza’s last remaining hospitals, shelters, markets, water systems… offensive is the right word.

"All these things I’ve seen in Gaza City and Khan Younis, apparently people are converging to contemplate doing all that again.

“It would be absolute madness, the people of Rafah are on the edge of this unfolding horror and it would be catastrophic.

“The problem is when you use the word ‘catastrophic’ so many times – because there have been so many catastrophes. This goes further. It goes to a level of darkness we haven’t seen, that the world keeps promising itself it won’t get to.

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“This is a strange moment, because we’re looking ahead, we’re not looking back at something the world regrets. We have eyes wide open.

"Just think about it: 600,000 utterly exhausted children are in Rafah, the health system is broken, 13,000 children have died and there are genuine discussions about a military offensive.”

Mr Elder was in Gaza during the temporary ceasefire in November, returning this month at a far later stage of the war.

More than 30,000 have been killed, more than half of them children, with the United Nations warning of disease and famine for those who remain.

Mere words and statistics, though, cannot convey the situation.

Mr Elder says: "Incredibly it gets worse every day, it’s much worse than when I was here three months ago.

“I’ve followed it every day so I know the nutrition numbers, I know the lack of aid getting in, I know the crazy, brutal number of children being killed.

The Herald: People inspect the damage to their homes following Israeli air strikes in Rafah, Gaza

“But to be here and see people sleeping on the streets, in any available space – it’s so overcrowded you can barely walk – people are hungry. And that’s here in the south where we’ve got more aid in, the malnourishment rate among children is three times worse in the north.

“Next door in Khan Younis, a city I went to a lot previously, it’s just utter devastation. In 20 years with the United Nations I haven’t seen annihilation that could compare to that – nothing like it.

“It’s street after street, building after building, home after home: rubble.

"Every time you turn around you encounter some moment of human darkness.

“As I waited to go to Nasser hospital I was waiting for a security brief and talking to a new colleague. They told me that two weeks ago they’d come back late from work and in that time almost his entire family had been killed in his three-storey apartment block: mother, father, brothers, sisters, aunts, uncles.

“That should be a story you never hear in your life, but here it’s not that uncommon – I’ve heard that double digit times.

"People have lost loved ones, a job, the ability to feed their family, their home – most people are holding on to one thing, which is hope.

“Here in Rafah that’s tenuous because they know full well that discussions are going on around a possible military offensive.

"The population has grown 400-500% and it’s basically now a city of children, there’s absolute exhaustion among people and they spend most of the day wondering how they might get a little bit of food and water.

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“At the same time the basic sanitation and sewage is becoming overwhelmed because there are just too many people and the system has broken down."

Gaza is, as defined by the British Government and others, an occupied territory.

While UNICEF and others stand ready to deliver aid, the air, land and sea is blockaded by Israel and trucks may only enter at either its discretion or, in the case of the southern border, Egypt.

This week the UK foreign secretary, David Cameron, said aid not reaching Gaza was down to "arbitrary denials by the government of Israel and lengthy clearance procedures, including multiple screenings and narrow opening windows in daylight hours".

Attempts have been made to deliver food and medical supplies by air and sea, but Mr Elder makes clear that the phalanx of trucks waiting at the border are the best way to save lives.

He says: "The only way we are going to prevent famine and more utterly unnecessary death of children is by flooding the Gaza Strip with aid – and that can only happen with roads.

“Luckily the roads are there, there are multiple entry points where they could come in. However, when I came in a few days ago there were miles and miles of trucks backed up.

“People are in such pain and hunger and all the food and medicine they need is five or 10 miles away.

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"UNICEF and the United Nations has repeatedly attempted to deliver aid, repeatedly called for access, but the situation is just getting worse by the day.

"Israel has to fulfil its legal obligations to facilitate aid operations.

“The delays and restrictions are incredible at times: anaesthetic, ventilators and things like that.

"Bringing in ships is fine but the first ship that came in had the equivalent of 12-13 trucks on it – I passed hundreds of trucks a few days ago.

"You use air drops in areas that are utterly remote and inaccessible, because they’re expensive and they deliver a small amount of aid.

“Here you have multiple routes, you’ve got trucks back-to-back-to-back – there’s no reason we should be in this situation.

The Herald: James Elder of UnicefJames Elder of Unicef (Image: Supplied)

"Those things are happening because of decisions that are being made, we have to be very clear about that. Children are suffering and dying because of decisions that are being made."

With the death toll rising and the prospect of a military offensive into Rafah, the numbers suggest the wider world wants to see a ceasefire.

A recent YouGov poll put support for a cessation of hostilities at 66%, with similar numbers in the United States.

Despite that the US has repeatedly vetoed UN security council motions calling for a ceasefire - with the UK abstaining - while Mr Netanyahu remains determined to move into Rafah on the basis, he says, that not doing so would allow Hamas to regroup.

Even among allies there is unease though, and Mr Elder believes that putting pressure on officials is not as hopeless as it may appear.

He says: "When people raise their voice, in whatever way, people notice that.

“Compared to when I was here a couple of months ago, people feel that they are being heard. They understand that it’s not being heard in the corridors of power, but they feel it and that’s very important for people who otherwise have felt absolutely forgotten.

“To have a desperate lack of aid, and to be bombed, AND to feel like no-one cares is a terrible combination.

“People raising their voices, in whatever capacity they choose to do so, will hopefully make a difference to people in power but it certainly makes a difference to people here in Gaza.

“If people have the fiscal ability then organisations like UNICEF and other agencies on the ground know what need to be done and you can easily equate each pound to therapies and food for a malnourished child.”