Abood Okal woke up Monday morning to messages that took him back to the start of the devastating Israel-Hamas war specifically to Oct. 13, when Israeli jets dropped flyers in northern Gaza telling its more than 1 million residents to flee and he and his family scrambled to leave their homes on short notice.

Okal, his wife and their infant son moved hours away to a house east of Rafah, the town in southern Gaza that has become a refuge for most of the regions displaced people. They eventually left the Gaza Strip to return to Massachusetts, thanks to their U.S. passports. But Okals brother and sister, as well her husband and young children, are stuck at the house where he stayed, and earlier Monday they told him they received new flyers, stating Israels demand for Palestinians to flee Rafah, which Israels government has threatened for months to invade despite warnings that it would cause a bloodbath.

Okal described familiar chaos as he has tried from afar to help his loved ones find safety.

They packed up what they could, and the men went out to look for a spot to pitch tents, he told HuffPost. Theres zero spots. They may spend the night where they are because there is no place to go.

Meanwhile, his sister Eman reported increased bombardment in the area, including shelling by tanks that sounded like they were targeting her civilian neighborhood. Some of those sheltering with her took what they could carry and just began walking west, Okal said, which reminded her of Palestinians fleeing their historic homes with no plan for their future amid the creation of the state of Israel in 1948.

Everyone is getting up and leaving because now its been a few times of this throughout the war, he said. Everyone knows in 48-72 hours, things will turn very grim if you havent left, thats a blanket excuse for the Israeli army to say, You cant blame us for carpet-bombing.

Israel put a humanitarian spin on its Monday move to expand its U.S.-backed ground invasion of Gaza to Rafah, which it casts as a military necessity to pursue the Palestinian militant group Hamas in retaliation for its Oct. 7 attack on Israel, which killed 1,200 people. It said its directive to move affected only about 100,000 people in a limited section of Rafah and that it had designated zones where they would be shielded.

But observers familiar with conditions on the ground say the approach, which President Joe Biden has expressed concern about but has not yet taken tangible steps to alter, ignores the unique risk of a battle for Rafah that would subject already desperate civilians to inconceivable danger.

In particular, Israel highlighted two areas as safe zones, Al-Mawasi on Gazas southern coast and sections of Khan Yunis in the center of the strip, neither of which residents nor aid groups believe can safely or humanely accommodate the huge flow of people who are already on their way out of Rafah.

Its not about finding a safe location: Everybody knows the whole safe zones [idea] is BS, Okal said. His family members could not find a free spot, even in Al-Mawasi, in their Monday hunt, he added, criticizing unfulfilled Israeli promises of temporary accommodations for Palestinians.

Even before todays evacuation orders, Al-Mawasi was uninhabitable. Our team members report tents stretched endlessly under scorching sun with no relief in sight and no electricity, water or aid, Tjada DOyen McKenna, CEO of the charity Mercy Corps, said in a Monday statement. She added that a recent heatwave there had killed a 5-year-old girl and that insect-borne disease is widespread in the area.

Meanwhile, Jan Egeland, the secretary-general of the Norwegian Refugee Council aid group, issued a bleak prediction about the effect of the growing fighting in Rafah, which as of Monday evening U.S. time involved heavy airstrikes and the targeting of a crossing point between Gaza and Egypt that is vital for humanitarian staff and supplies.

The aid system is bound to collapse, leaving those fleeing the advancing Israeli forces vulnerable to hunger and suffering, Egeland said . Palestinian authorities estimate the Israeli campaign has killed 35,000 Palestinians already.

No Confidence

Israels apparent plan for defeating Hamas in Rafah while abiding by humanitarian norms involves several steps. Each is complex and could easily go wrong, condemning civilians to death.

It begins with travel.

Every person in Rafah has likely already lacked sufficient food for months, with somewhere between a quarter and a half of the people suffering famine-level hunger, according to the worlds top food security tracker . Starvation makes people weaker, as do injuries from months of Israeli bombings in various parts of Rafah and the stress of displacement and life in a war zone.

Those complications are even more challenging for the group that comprises nearly half of Rafahs population: 600,000 children.

If you think about seven months of war and the impact on children, the nature of this evacuation is different because children are exhausted, traumatized and in many cases sick and injured, said Tess Ingram of the United Nations agency for children (UNICEF). Her organization says 65,000 of those children have a pre-existing disability, while 78,000 (and counting, as births continue in Gaza at a rate of 183 per day) are less than 2 years old.

When Ingram visited Gaza last month, doctors there told her a growing number of babies were being born malnourished, unwell or generally weak, reflecting their mothers state. That means more babies than ever need to be in incubators, creating an enormous challenge to moving them, she said.