A ceasefire will only be the first step in remedying the humanitarian crisis for children in Gaza. Bombing has destroyed much of the infrastructure in Gaza. A public health catastrophe is already in place. It can no longer be averted; it can only be ameliorated.

While the official death toll according to Gaza’s health authorities has exceeded 23,000, an estimated 40% of them children, many buried under the rubble have not been counted. Further- more, Israel’s assault on health facilities, the killing and detention of health personnel, and the inability of people to present for medical attention has led to the collapse of medical and public health services, including the collection of morbidity and mortality statistics.

On Oct. 9, Israel’s Defense Minister Yoav Gallant said that Israel would impose a “complete siege” on Gaza: “No electricity, no food, no water, no gas — it’s all closed.” The bombing has destroyed the pipes carrying water. Desalination and wastewater facilities stopped functioning in Northern Gaza in mid-October from the lack of fuel and electricity.

The Integrated Food Security Phase Classification (IPC), a partnership of multiple organizations, including the World Health Organization and other United Nations agencies, released a report on acute food insecurity in Gaza on Dec. 21. It found that 4 of 5 households in the north and half of displaced households in the south are going entire days without food. Nearly 2 million of a population of 2.3 million have been displaced.

Clean drinking water is scarce, and people are forced to drink brackish and contaminated water. The minimal amount of drinking water that children need every day is 3 liters. According to UNICEF, in late December, displaced children in the Rafah district are receiving only 1.5 to 2 liters per day.

The WHO reports that the number of cases of diarrheal infections in children have increased 100-fold. Crowded conditions and the lack of sanitation has led to spikes in cases of scabies, lice, chicken pox, skin rashes and respiratory infections. While these are the cases that are officially recorded, many are unable to access health services because of bombardment and invasion.

Without the availability of clean water, life-saving oral rehydration cannot be delivered to children with diarrhea. If cholera were to appear, it would certainly increase mortality, but children can die of simple E. coli infections. If Gaza’s children do not die from dehydration or starvation, we can expect that malnutrition, stunted growth, poor immunity and lack of vaccination will lead to epidemics of diseases such as measles, often fatal for malnourished children.

The injured in Gaza have undergone operations without anesthesia, on the floors of hospitals, with cellphones for lighting. Vinegar has been used for antisepsis. Without water to clean wounds, without antibiotics to treat infections, without health workers to provide care, the wounds of the injured will fester and they will die of sepsis.

Wounded children with no surviving family are now so commonplace that they have been given the new acronym WCNSF. Even if they were to survive their physical injuries, they will grow up without their families to nurture them. Most no longer have a home to return to. Their home is now a wasteland that can hardly support life. They will carry the trauma of surviving assault throughout their lives. They will be lucky not to suffer the mental health consequences. They have suffered enough for the present. They need a ceasefire now, the release of detained health personnel, and a concerted multinational effort to stave off the worst effects of this public health catastrophe.

Seiji Yamada, a native of Hiroshima, is a family physician in Honolulu; Frederick M. Burkle Jr., a pediatrician and post-conflict specialist in humanitarian assistance and disaster response, is with the Woodrow Wilson International Center for Scholars in Washington, D.C.