In the last week alone, Israel has attacked the United Nations-run Abu Oreiban school in the Nuseirat refugee camp — killing at least 17 people and injuring about 80. Most of the victims were women and children.

This followed a deadly strike on tents near the entrance to Khan Younis’ Al-Awda school on July 9, killing at least 29 people. Two days before that, another strike on the Church-run Holy Family school in Gaza City killed four people.

On Saturday, July 13, Israel struck the al-Mawasi area — designated as a safe zone — killing at least 90 people and injuring 300 others.

The images of slaughtered, maimed, and bloodied children are just too heartbreaking to bear.

The level of violence inflicted on Gaza since October 7, 2023, is beyond words

Over nine months into this brutal war, almost 40,000 civilians are dead — 72% women and children. 90,000 people are seriously injured. Some 90% of the population have been displaced, many multiple times. Over 30 are dead from man-made malnutrition, more than 24,000 children are orphans. This cannot be normalised.

A recent study published in The Lancet suggests the accumulative effects of Israel’s war on Gaza could mean the true death toll could reach more than 186,000. This is a devastating loss of life.

Also devastating was the killing of 1,200 Israelis by Hamas on October 7 and the taking of 250 hostages into Gaza. However, the inhuman and callous Israeli response can never be justified.

The Lancet study pointed out that the death toll is higher because the official toll does not take into account thousands of dead buried under rubble or indirect deaths due to destruction of health facilities, food distribution systems, and other public infrastructure.

It said that conflicts have indirect health implications beyond the direct harm from violence.

Even if the Gaza war ends immediately, it will continue to cause many indirect deaths in the coming months and years through things like diseases.

While the daily bombing has been the biggest risk to the population, starvation has fully taken hold and people are starting to die of hunger.

According to a group of UN experts, famine is spreading across Gaza. In total, 34 Palestinians have died from malnutrition according to Gaza’s health authorities — most of them children. These UN experts were clear that this starvation of Palestinians by Israel is deliberate and intentional.

Behind these numbers are the mums and dads who cannot feed their children, cannot get any fruit or vegetables, and who watch their children’s lives fade before them.

Despite Israeli claims that they are facilitating the entry of aid, non-governmental organisations like ActionAid are experiencing first-hand Israel’s systematic obstruction of aid and its ongoing attacks on aid operations — including facilities, personnel, and distribution points. This is all preventing the effective delivery to people in need.

None of the land crossings into Gaza — the most effective, viable way to deliver assistance — have been fully functional since October 2023, while the north of the strip remains effectively cut off from the south by the Israeli army. The area between this crossing and the so-called “humanitarian zone”, where most Palestinians in Gaza reside, is an active combat zone and has become extremely unsafe since the onset of the Israeli offensive on Rafah.

The security situation has further deteriorated due to Israeli attacks on Gaza’s civilian police force, which have hindered their ability to work due to life safety concerns.

Israel is prioritising commercial goods over humanitarian supplies gaining access, despite the sky-high prices in the markets

Regardless, counting trucks is a false metric for evaluating humanitarian access in the Gaza Strip. Humanitarian access should be gauged by the reduction in human suffering and the availability of sufficient supplies to provide assistance to the population. This is not the situation in Gaza, with critical shortages of urgently needed items.

Palestinian humanitarian workers have continued operating against the odds, making a vital difference.

Our partner, Al-Awda hospital, is supporting pregnant women — many losing their babies because they are so malnourished and desperate mothers are struggling to find anything to feed their starving children. Others distribute food, hygiene kits, psychological support.

Our presence in Gaza is solely due to the unwavering commitment of our colleagues on the ground. The risks our colleagues are exposed to each moment are unacceptable.

As the war passes its nine-month mark, what is happening must not become the “new normal” and fall down the list of news bulletins and drop on politicians’ priorities.

There is nothing normal about innocent people — and children — having no safe haven and being indiscriminately killed on a daily basis.

There is nothing normal about denying an entire population food, water, and access to health services as a weapon of war.

There is nothing normal about children becoming orphaned and suffering horrendous and life-changing injuries.

What is happening is a stain on humanity’s conscience and is an entirely preventable, human-made crisis.

More life-saving aid must be allowed into Gaza immediately, and we call on all states to use every diplomatic lever available to them to bring about a permanent ceasefire. A permanent ceasefire is needed now, because the people of Gaza do not have the time to wait.

• Karol Balfe is the CEO of ActionAid Ireland. ActionAid has been working in the occupied Palestinian territory for many years supporting Palestinian people living without access to basic services. For further information about their Gaza appeal see www.actionaid.ie.