Fistfights break out in bread lines. Residents wait hours for a gallon of brackish water that makes them sick. Scabies, diarrhea and respiratory infections rip through overcrowded shelters. And some families have to choose who eats.

"My kids are crying because they are hungry and tired and can't use the bathroom," said Suzan Wahidi, an aid worker and mother of five at a U.N. shelter in the central town of Deir al-Balah, where hundreds of people share a single toilet. "I have nothing for them."

With the Israel-Hamas war in its second month and more than 10,000 people killed in Gaza, trapped civilians are struggling to survive without electricity or running water. Palestinians who managed to flee Israel's ground invasion in northern Gaza now encounter scarcity of food and medicine in the south, and there is no end in sight to the war sparked by Hamas' deadly Oct. 7 attack.

Thousands who were sheltering at Gaza City’s hospitals flee as Israel-Hamas war closes in

Over half a million displaced people have crammed into hospitals and U.N. schools-turned-shelters in the south. The schools — overcrowded, strewn with trash, swarmed by flies — have become a breeding ground for infectious diseases.

Since the start of the war, several hundred trucks of aid have entered Gaza through the southern Rafah crossing, but aid organizations say that's a drop in the ocean of need. For most people, each day has become a drudging cycle of searching for bread and water and waiting in lines.

The sense of desperation has strained Gaza's close-knit society, which has endured decades of conflict, four wars with Israel and a 16-year blockade since Hamas seized power from rival Palestinian forces.

Some Palestinians have even vented their anger against Hamas, shouting insults at officials or beating up policemen in scenes unimaginable just a month ago, witnesses say.

Western and Arab officials are gathering in Paris to find ways to provide aid to civilians in Gaza

"Everywhere you go, you see tension in the eyes of people," said Yousef Hammash, an aid worker with the Norwegian Refugee Council in the southern town of Khan Younis. "You can tell they are at a breaking point."

Supermarket shelves are nearly empty. Bakeries have shut down because of lack of flour and fuel for the ovens. Gaza's farmland is mostly inaccessible, and there's little in produce markets beyond onions and oranges. Families cook lentils over small fires in the streets.

"You hear children crying in the night for sweets and hot food," said Ahmad Kanj, 28, a photographer at a shelter in the southern town of Rafah. "I can't sleep."

Many people say they've gone weeks without meat, eggs or milk and now live on one meal a day.

"There is a real threat of malnutrition and people starving," said Alia Zaki, spokesperson for the U.N.'s World Food Program. What aid workers call "food insecurity" is the new baseline for Gaza's 2.3 million people, she said.

Famed Gazan dishes like jazar ahmar — juicy red carrots stuffed with ground lamb and rice — are a distant memory, replaced by dates and packaged biscuits. Even those are hard to find.

Each day families send their most assertive relative off before dawn to one of the few bakeries still functioning. Some take knives and sticks — they say they must prepare to defend themselves if attacked, with riots sporadically breaking out in bread and water lines.

"I send my sons to the bakeries and eight hours later, they've come back with bruises and sometimes not even bread," said 59-year-old Etaf Jamala, who fled Gaza City for the southern town of Deir al-Balah, where she sleeps in the packed halls of a hospital with 15 family members.

Civilians flee north Gaza or shelter at a hospital as Israel and Hamas battle in the city

One woman told The Associated Press that her nephew, a 27-year-old father of five in the urban refugee camp of Jabaliya in northern Gaza, was stabbed in the back with a kitchen knife after being accused of cutting the line for water. He needed dozens of stitches, she said, speaking on condition of anonymity for fear of reprisals.

The violence has jarred the tiny territory, where family names are linked to community status and even small indiscretions can be magnified in the public eye.

"The social fabric for which Gaza was known is fraying due to the anxiety and uncertainty and loss," said Juliette Touma, a spokesperson for the U.N. agency for Palestinian refugees.

Israel cut off water to Gaza shortly after the Hamas attack, saying its complete siege would be lifted only after the militants released the roughly 240 hostages they captured. Israel has since turned on pipelines to the center and south, but there's no fuel to pump or process the water. The taps run dry.

Those who can't find or afford bottled water rely on salty, unfiltered well water, which doctors say causes diarrhea and serious gastrointestinal infections.

"I cannot recognize my own son," said Fadi Ihjazi. The 3-year-old has lost 5 kilograms (11 pounds) in just two weeks, she said, and has been diagnosed with a chronic intestinal infection.

"Before the war he had the sweetest baby face," Ihjazi said, but now his lips are chapped, his face yellowish, his eyes sunken.

At shelters, the lack of water makes it hard to maintain even basic hygiene, said Dr. Ali al-Uhisi, who treats patients at one in Deir al-Balah. Lice and chicken pox have spread, he said, and on Wednesday morning alone he treated four cases of meningitis. This week, he's also seen 20 cases of the liver infection hepatitis A.

"What worries me is that I know I'm seeing a fraction of the total number of cases at the shelter," he said.

For most ailments, there is no treatment — zinc tablets and oral rehydration salts vanished the first week of the war. Frustrated patients have assaulted doctors, said Al-Uhisi, who described being beaten this week by a patient who needed a syringe.

Sadeia Abu Harbeid, 44, said she missed a chemotherapy treatment for her breast cancer during the second week of the war and can't find painkillers. Without regular treatments, she says, her chances of survival are dim.

She hardly eats, choosing to give most of the little food she has to her 2-year-old. "This existence is a humiliation," she said.

Across Gaza, rare scenes of dissent are playing out. Some Palestinians are openly challenging the authority of Hamas, which long has ruled the enclave with an iron fist. Four Palestinians across Gaza spoke to AP on condition of anonymity for fear of reprisals about what they've seen.

A man who was told off by a Hamas officer for cutting the bread line took a chair and smashed it over his head, according to an aid worker in line. In another area, angry crowds hurled stones at Hamas police who cut in front of a water line and beat them with their fists until they scattered, according to a journalist there.

Over the past few night in Gaza City, Hamas rockets streaming overhead toward Israel have prompted outbursts of rage from a U.N. shelter. In the middle of the night, hundreds of people have shouted insults against Hamas and cried out that they wanted the war to end, according to a 28-year-old sleeping in a tent there with his family.

And during a televised press conference Tuesday, a young man with a dazed expression and bandaged wrist pushed his way through the crowd, disrupting a speech by Iyad Bozum, spokesman for the Hamas-run Interior Ministry.

"May God hold you to account, Hamas!" the man yelled, shaking his wounded hand.

Gaza's future remains uncertain as Israeli tanks rumble down the ghostly streets of Gaza City with the goal of toppling Hamas. Palestinians say it will never be the same.

"The Gaza I know is just a memory now," said 16-year-old Jehad Ghandour, who fled to Rafah. "There are no places or anything I know left."