LONDON: The ceasefire in Gaza exists “in name only,” more than 100 humanitarian and human rights organizations warned on Friday.

A year after the agreement took effect, Palestinians continued to face Israeli attacks, widespread hunger and a devastated healthcare system, they said.

In a joint statement marking the first anniversary of the Oct. 10 ceasefire agreement, the organizations said more than 1,400 Palestinians, including at least 327 children, had been killed by Israeli forces over the past 12 months, nearly 2 million people were still in need of shelter, and none of Gaza’s 36 hospitals was fully functioning.

The humanitarian catastrophe was expected to worsen as winter approaches, with many displaced Palestinians facing renewed exposure to cold, heavy rain and flooding, the organizations warned.

Continuing Israeli military operations and restrictions on the delivery of humanitarian aid, medical equipment and reconstruction materials had prevented attempts by families to begin to recover from the war, and left much of the population still living in dangerous and overcrowded conditions.

“The killing and deprivation in Gaza must not be normalized under the cover of a ceasefire agreement,” the joint statement read.

The warning came as US President Donald Trump’s 20-point Gaza peace plan remained stalled. Key provisions, including the disarmament of Hamas, a full Israeli military withdrawal, and a postwar reconstruction process, have yet to be implemented.

Inger Ashing, the CEO of Save the Children International, said a child had been killed almost every day since the ceasefire was announced.

“A ceasefire is meaningless if children are still being killed and families are still unable to rebuild their lives,” she said as she urged governments that supported the agreement to ensure children had access to adequate food, healthcare, shelter and education.

The organizations said more than 80 percent of structures across Gaza had been damaged to some degree, with about two-thirds completely destroyed, leaving hundreds of thousands of families living in tents, makeshift shelters or buildings at risk of collapse.

In September, 21 people, including 12 children, were killed when a damaged building collapsed in Gaza City. Another 45 were injured and saved, despite shortages of heavy equipment to assist with the rescue attempt.

Jan Egeland, secretary-general of the Norwegian Refugee Council, said Israeli restrictions on the entry into Gaza of construction equipment and building materials continued to obstruct recovery efforts.

“It is utterly shameful that a full year after the ceasefire was signed, so little has improved for Palestinians in Gaza,” he said.

The humanitarian crisis has also left more than 18,500 patients, including at least 4,000 children, awaiting evacuation for medical care, and more than 1,000 people have died waiting for treatment, the organizations said.

Israel continues to control about two-thirds of Gaza. Disagreements over the disarmament of Hamas have blocked further withdrawals and the deployment of an international stabilization force. The reconstruction effort has barely begun, with an estimated $71.4 billion needed to rebuild the devastated territory.

Meanwhile, 1.4 million Palestinians were expected to face crisis-level hunger or worse by the end of this year, compounded by shortages of clean water and the destruction of sanitation infrastructure.

The groups also accused Israeli forces of extending their control beyond the withdrawal boundary established under the ceasefire agreement, known as the Yellow Line, further restricting the amount of territory available to displaced Palestinians.

They called on the international community to press Israeli authorities to end all attacks, lift restrictions on aid and reconstruction supplies, and ensure accountability for violations of international law.

“Accountability cannot be swept under the rubble,” said Agnes Callamard, secretary-general of Amnesty International, who warned that Gaza’s recovery could not be separated from the pursuit of justice and the rights of victims.