Israel’s aid blockade and more than 18 months of fighting are pushing Gaza’s children to the brink, the United Nations children’s agency Unicef says.

Children in the enclave have not only faced relentless bombardment, but are also being deprived of essential goods, services and lifesaving care, Unicef Executive Director Catherine Russell said in a statement.

“With each passing day of the aid blockade, they face the growing risk of starvation, illness and death – nothing can justify this,” Russell said. “The sea they used for fishing has been restricted. Bakeries are closing, water production is declining, and market shelves are almost bare.”

In the past month, she said, families have been forced to choose between showering, cleaning, and cooking as access to water is quickly deteriorating.

Vaccines are also running out, Russell warned, and diseases are spreading rapidly.

“Malnutrition is also on the rise,” she said, adding that more than 9,000 children have been admitted for treatment of acute malnutrition since the beginning of the year.