Families in Gaza were packed up and leaving on Tuesday, fearing that they would be killed by an Israeli bombardment. They were going to a region further south that was already overflowing with displaced people who lacked access to clean water, food, or restrooms.

In less than two months, some were escaping for the third or fourth time.

The conflict between Israel and Hamas has forced the majority of the 2.3 million residents of the Gaza Strip to flee their homes, and the ongoing displacement following the expiration of a week-long truce on December 1 is exacerbating the dire humanitarian situation.

In Khan Younis in southern Gaza, where Israel was launching a long-awaited assault, Palestinians who had sought protection from air strikes by camping in the grounds of the city’s Nasser Hospital were rolling up their tents and loading cars or donkey carts with piles of mats and blankets.

“We are getting ready to leave Khan Younis, heading to Rafah. We have been here for about 50 days,” said Abu Omar, a middle-aged man who left his home in the eastern part of the city and had been sheltering at the hospital camp with his family.

Rafah, further south on the border with Egypt, is one of the last remaining areas where the Israeli military has said civilians could go to escape the fighting, although it has been hit by many air strikes.

“There is no safe place … but at the end, we head to wherever we think there might be a bit of safety,” said Abu Omar, standing by a car whose roof was piled high with possessions.

But in Rafah, displaced people said their living conditions were horrible.