Miserable Conditions

"Nearly all sewage and water pumps are now out of operation due to lack of electricity and diminished fuel supplies to operate backup power generators," the World Bank said in a statement on the 13th day of fighting in the enclave.

The bank has been a key player in trying to rehabilitate Gaza's decrepit sewage system, which suffers from years of decay.

Sewage in the streets

Estimates say about 1 million people remained without electricity and nearly that number lacked running water, which is pumped using power. Sewage was reported to be spilling into the streets in certain areas as those pumps have also failed.

Aid groups have blamed Israel's sanctions on Gaza, which include restrictions on fuel imports. The military said it would let in heavy diesel for Gaza's sole power plant on Thursday.

"I go out every day to look for water," said Abu Shaaban, a resident, in a testimony to the human rights organization Gisha. He said he went seven days without any running water.

Shortages in hospitals

Meanwhile, the United Nations' World Health Organization (WHO) has warned that Gaza's hospitals are running on backup generators for the fifth consecutive day. Some medical centers had so little fuel they had to shut down vital services.

Primary health care centers in Gaza have seen activity decreased by over 90 percent since Operation Cast Lead, as patients and staff have seen their movement severely restricted.

The WHO said six medical workers have been killed and three ambulances were damaged in fighting. Medical and psychiatric centers have also been hit and incurred damage.

'The morgue is full'

Doctors have said they are overworked, undersupplied and without space for the dead and wounded.

"The morgue is full," said Khamis El-Essi, a doctor at Gaza's main Shifa hospital. The death toll had exceeded 710 people, he said, and in the last five days "80 per cent of the dead and wounded are women and children."

"It is a very complex and very sad situation," the doctor said, adding that the hospital needed medical supplies, drugs and more surgeons from outside the enclave to help assist the local staff. Ten percent of the over 3,000 wounded were said to be in critical condition.

"Our surgeons are working for days on end, with no sleep. If they rest, patients die," he said.

Short cessation

Israel has said Hamas has been confiscating humanitarian aid, based on unnamed "Palestinian sources."

An aid worker for CARE International, who worked in its food distribution programme, was also killed, the charity said in a statement.

The Israeli military had initiated a three-hour lull in fighting Wednesday, during which residents were able to restock basic supplies. The cessation had again started early Thursday afternoon.

Residents said they were mostly living on canned and packaged foods and bread lines remained long. Fresh goods such as vegetables were hard to find due to restrictions on lorry movement while farmers feared entering their fields due to the fighting, witnesses said.

"We are living on canned foods, beans and things like that," said Mustafa, a resident of Gaza City. "I have not had electricity since the second day of the fighting."

"There is no milk, no flour and no eggs," said Khaled, a father of four in Khan Younis, two days ago.

Earlier, the International Committee of the Red Cross said that it had utilized the lull to operate joint search teams with the Palestinian Red Crescent.

Lull is 'a drop in the ocean'

It slammed Israel for violating international law by not allowing medical staff to access wounded people for four days. The teams found severely weak and wounded children stuck in rubble along with their dead mothers.

An Israeli defense official said the military could not always be concerned about the welfare of civilians and that its soldiers remained its priority.

A UN official said a three hour lull, while welcomed, was a "drop in the ocean," and said a permanent ceasefire was needed.