Palestinian health experts studying the impact of Israel's blockade of the Gaza Strip say it threatens to cause long-term damage to Palestinians' health, with many children at risk of stunted growth or malnutrition.
In a series of studies published in the Lancet medical journal on Friday, researchers also said Israel's attack on the region in early 2009 had a devastating effect, causing injury, displacement and social suffering, particularly among children.
Stress levels are also high, with women describing the terror of giving birth under siege. "I cannot believe that I did not die," said one woman cited in the research.
Around 1,400 people were estimated to have died and many more injured during the Israeli offensive in the Gaza Strip between December 2008 and January 2009. The health experts described the destruction of infrastructure, including homes, as "unprecedented".
Israel has slightly eased the blockade it imposed on the region soon after Islamist group Hamas, which rejects Western calls to recognize Israel's right to exist, won a Palestinian election in 2006. Restrictions were tightened after Hamas seized power in Gaza the following year.
"The siege of this region continues to be the main obstacle for improvement of the living conditions and the quality of life of the population," said Niveen Abu-Rmeileh of Birzeit University's institute of community and public health in the West Bank.
Despite its blockade, Israel allows medical and humanitarian aid into Gaza and the Israeli military says 7,000 Palestinians visit Israel from Gaza each month for medical treatment for serious conditions.
In a study looking at some of the health consequences of the attack itself and conducted before the embargo easing, Abu-Rmeileh's team analysed health-related quality of life using data from a random survey of about 3,000 Palestinian households.
Almost a third of the sample population was displaced during the war, while 39% of their homes were either completely or partly destroyed. By the end of the study in August 2009, three quarters of the damaged homes had yet to be repaired.
The study also found that more than 70% of households were reliant on food aid, and 57% of respondents whose families received food aid rated quality of life as "less than good" compared with 30% of respondents who did not.
A second study looking at childbirth under siege interviewed five midwives and 11 women about their experiences during the bombings. They described how they coped with fear, violence and uncertainty around them as they waited for labor to begin.
One woman quoted in the study said the worst time was when darkness fell: "I was not thinking like other people in face of death or shelling, but was only thinking of my case. What would happen if I had labor pains at night? How will I manage? They were shelling even ambulances. Nights were like nightmares. Each morning I breathed a sigh of relief that daylight had appeared."
Kholoud Nasser from the Ministry of Education in Ramallah, looked at Palestinian children's diets and the knock-on effects for their health and education.
In a study of around 2,000 children and adolescents, she found that one in four misses breakfast - the main indicator of healthy eating habits – while one in 10 is anemic, and one in 17 is stunted. Around 2% are underweight and 15% are either overweight or obese.
"Comprehensive and effective school nutrition programs that are targeted at all age groups, with special attention to adolescents and girls, are needed because the data for overweight and iron-deficiency anemia are alarming," Nasser wrote in the study.