Children in sandals trudge through water contaminated with sewage and scale growing mounds of garbage in Gaza’s crowded tent camps for displaced families. People relieve themselves in burlap-covered pits, with nowhere nearby to wash their hands.

In the stifling summer heat, Palestinians say the odor and filth surrounding them is just another inescapable reality of war — like pangs of hunger or sounds of bombing, reports AP.

The territory’s ability to dispose of garbage, treat sewage and deliver clean water has been virtually decimated by eight brutal months of war between Israel and Hamas. This has made grim living conditions worse and raised health risks for hundreds of thousands of people deprived of adequate shelter, food and medicine, aid groups say.

Hepatitis A cases are on the rise, and doctors fear that as warmer weather arrives, an outbreak of cholera is increasingly likely without dramatic changes to living conditions. The UN, aid groups and local officials are scrambling to build latrines, repair water lines and bring desalination plants back online. COGAT, the Israeli military body coordinating humanitarian aid efforts, said it's engaging in efforts to improve the “hygiene situation.” But relief can't come soon enough.

“Flies are in our food,” said Adel Dalloul, a 21-year-old whose family settled in a beach tent camp near the central Gaza city of Nuseirat. They wound up there after fleeing the southern city of Rafah, where they landed after leaving their northern Gaza home. "If you try to sleep, flies, insects and cockroaches are all over you.”

Over a million Palestinians had been living in hastily assembled tent camps in Rafah before Israel invaded in May. Since fleeing Rafah, many have taken shelter in even more crowded and unsanitary areas across southern and central Gaza that doctors describe as breeding grounds for disease — especially as temperatures regularly reach 90 degrees Fahrenheit (32 degrees Celsius).

“The stench in Gaza is enough to make you kind of immediately nauseous," said Sam Rose, a director at the U.N. agency for Palestinian refugees. Conditions are exacting an emotional toll, too.

Anwar al-Hurkali, who lives with his family in a tent camp in the central Gazan city of Deir al-Balah, said he can't sleep for fear of scorpions and rodents. He doesn’t let his children leave their tent, he said, worrying they’ll get sick from pollution and mosquitoes.