Students in this refugee camp study in stifling hot metal shipping containers, and there's no space in the crammed U.N. classrooms for thousands of incoming first graders because Israel's blockade of Gaza has kept out supplies for building schools.
At Gaza's largest hospital, dialysis patients live in fear of frequent power cuts, and the CT scanner is used only for the most urgent cases because there are no spare parts to fix its failing cooling system.
Since the violent 2007 takeover of Gaza by Hamas — an Islamic militant group responsible for firing thousands of rockets at Israeli border communities — Israel has let in only limited humanitarian supplies, including basic foods and medicine.
Construction materials, which Israel maintains Hamas could use to make weapons and build bunkers, were barred; the vast majority of Gaza's 1.5 million people could not travel, and a ban on trade has wiped out tens of thousands of manufacturing jobs.
Now that Israel is promising, under international pressure, to ease the restrictions, aid officials say urgent action is needed. Israel must move "within days, not months," Gaza's top U.N. aid official, John Ging, said Monday.
During the three-year blockade, the U.N. has been forced to put nearly $110 million worth of construction projects on hold, including six schools, five clinics and 2,300 apartments for Gaza's poorest and those made homeless by past Israeli military operations.
Signaling a change of course, Israel's Cabinet said Sunday it would allow all goods into Gaza, except for weapons and items deemed to have a military use. Israel insists on maintaining its sea blockade and inspecting overland cargo to keep weapons and missiles out of the hands of Gaza militants.
Israel remained vague Monday about how and when it expected to deliver more goods to Gaza. Officials outlined procedures that suggested a slow pace, despite a White House call for quick changes in the blockade policy.
In coming days, Israel will review building projects with representatives of international organizations, including the U.N., said Maj. Guy Inbar, a Defense Ministry official. If there are no security concerns, talks will begin on how much material is needed, he said.
Such a procedure was in place during the blockade, but only one U.N. construction project was ever approved and then only after the direct intervention by U.N. Secretary General Ban Ki-moon. Cement and other building materials were delivered only last month.
Now the pace is expected to pick up, Inbar said.
Israeli TV stations showed footage Monday of trucks entering Gaza with building materials, and government spokesman Mark Regev pledged quick movement of goods.
But many questions remain unanswered, including whether Israel will allow full trade, seen as key to reviving industry and creating jobs. Israel currently operates only one land crossing, but the government said it will open others if needed and if security concerns are addressed.
Even before the blockade, most of Gaza's 119 U.N. schools were overcrowded, running morning and afternoon shifts with as many as 50 students crammed into a classroom.
With no new schools being built and a third shift deemed unacceptable, even by Gaza's harsh standards, alternatives were hard to find. One principal rented space outside his school to store supplies so he could turn a storage room into another classroom.
In the Nusseirat refugee camp, the U.N. turned 17 shipping containers into a school for nearly 900 middle school boys at the start of the 2009-2010 school year.
Principal Hamdan al-Hor said parents initially did not want to send their children there, but conditions became more tolerable when he mounted fans to circulate the stifling hot air.
Welders cut openings for doors and windows and whitewashed the metal walls, transforming the containers into classrooms, as well as a small science lab, a library and a computer rooms. A sandy lot serves as a playground.
U.N. schools tend to be bare-bones, and Al-Hor said his students scored the best test results in central Gaza despite the no-frills setup.
He said he keeps telling his students: "You don't have land, you don't have money, you are poor, and all you have is education."
Still, even the container model couldn't be copied elsewhere because Israel stalled on U.N. requests to allow in dozens more containers, with the first batch only arriving toward the end of the school year, U.N. officials said.
One of the planned new schools for 1,000 students is a five-minute walk from the Nusseirat container school, but will take six months to build. In the meantime, Ging says he doesn't know where to put about 7,000 first graders set to join U.N. schools across Gaza in September.
Gaza City's Shifa Hospital, which is run by the Hamas government, is also barely hanging on.
Construction of a new surgical wing has been on hold for three years, though ostensibly building could have continued with supplies smuggled through hundreds of smuggling tunnels under the Gaza-Egypt border. The U.N. is barred from using smuggled goods, but Hamas-run facilities face no such restrictions.
Spare parts for medical equipment, while permitted by Israel, are slow to come in. Shifa's CT scanner, one of only five in Gaza, has been operating at one-fourth of capacity because of missing parts requested five months ago, said technician Adel Abu Sultan.
He allows only urgent patients with head trauma or stroke to book appointments, and everyone else is turned away.
In the dialysis department, some 200 patients have had to cut back from three to two sessions a week to ease the load on 30 machines hit by frequent power cuts, said Dr. Mohammed Shitat, head of the department.
Patients live in fear of the outages, because it can take a few minutes for generators to spring into action. In the meantime, precious blood running through the machines' tubes often clots and has to be thrown away, he said.
Dialysis patient Jafar al-Beik, sitting in a lounge chair while undergoing dialysis, said he went through a power cut a week ago. Asked if he was now more hopeful, with the promised easing of the closure, the 58-year-old shrugged. He's only counting on Allah, he said.
Associated Press Writer Mohammed Daraghmeh in Ramallah, West Bank, contributed to this report.