Gaza - Gazans are forced to live in bombed-out buildings or camp next to giant piles of trash, a United Nations spokesperson said Friday, denouncing the "unbearable" conditions in the besieged territory.

Louise Wateridge from UNRWA, the UN agency supporting Palestinian refugees, described the "extremely dire" living conditions in the Gaza Strip.

"It's really unbearable," she told reporters in Geneva, via video-link from central Gaza.

Wateridge, who returned Wednesday after four weeks outside the territory, said that even in that time the situation had "significantly deteriorated."

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"Today, it has to be the worst it's ever been. I don't doubt that tomorrow again will be the worst it's ever been," she said.

Nearly nine months into the war between Israel and Hamas, Wateridge said the Gaza Strip had been "destroyed."

She said she had been "shocked" on returning to Khan Younis in central Gaza.

"The buildings are skeletons, if at all. Everything is rubble," she said. "And yet people are living there again."

"There's no water there, there's no sanitation, there's no food. And now, people are living back in these buildings that are empty shells," with sheets covering the gaps left by blown-out walls.

With no bathrooms, "people are relieving themselves anywhere they can."

Israel has killed more than 37,700 people since October, according to data from the health ministry in Gaza.

Wateridge said the struggle to bring fuel into Gaza and distribute it safely was having a knock-on impact on the ability to deliver aid.

"Without the fuel, the humanitarian response really grinds to a halt," she said.

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Wateridge was speaking from a guesthouse as there was no fuel to go out and undertake missions.

About 150 metres away, she said, a pile of around 100,000 tonnes of waste was building up, with makeshift tents pitched all around it.

"The population is living among it," she said. "With the temperatures rising, it's really adding misery to the living conditions."

Wateridge said that before the Israeli assault, sanitation units would clear all the trash from refugee camps to landfill sites.

Now, appeals to the Israeli authorities for access to the landfill sites were frequently denied, she said. And lacking fuel meant even when access was granted, trucks could not go in to clear out the mess.

Wateridge said food insecurity in the territory was having a visible effect on the population.

"When I see my colleagues, my friends here, they're visibly unrecognizable because having such unsustained access to food for so long, you start to age, you look unhealthy, your skin changes color," she said.

Thursday saw the first medical evacuations from Gaza into neighboring Egypt since the Rafah border crossing was closed in early May, when Israeli forces took over the Palestinian side.

The World Health Organization says 10,000 patients need evacuating from Gaza for treatment.

Wateridge said one of her own UNRWA colleagues, Abdullah, had to wait for two months before being evacuated in April. He was injured in a strike and had his legs amputated in late February.

Since then, he had spent weeks in the devastated Al Shifa hospital – once Gaza's largest medical complex – when it was under siege.

And he spent two months waiting in a medical tent, "some days waiting for death," she said. "Multiple times, he very nearly lost his life."

Wateridge said that in late April, she visited Abdullah with a colleague who "donated her blood on the spot to him to keep him alive."

"It is not acceptable for people to be experiencing this and be treated like this."