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A month ago Nariman Salman decided to finally flee northern Gaza and head for al-Mawasi, a narrow strip of coastline at the southernmost end of the territory designated as a “humanitarian zone” by the Israeli military.

The decision was reluctant but unavoidable. When Salman, 42, was reduced to sending her young son around neighbours to beg for a single piece of bread for her pregnant daughter, she knew the family had to leave. Days earlier, her eldest son had been stabbed to death for a bag of flour.

“We were living on rice and beans and grass. My eldest son was gone. The situation was catastrophic … We saw things that we never imagined we would ever see,” she said.

Salman and her surviving children headed south, making their way by foot and cart through the rubble and runs of central Gaza to al-Mawasi, a 16sq km strip of mainly coast and dunes that was five months ago barren and is now home to 380,000 people, aid agencies say.

In October, just weeks after the beginning of the war in Gaza, the Israel Defence Forces (IDF) designated al-Mawasi a “humanitarian area” and told residents of Gaza to evacuate there to avoid being caught up in the offensive launched following Hamas’s attacks into southern Israel which killed 1,200, mostly civilians. The IDF promised “international humanitarian aid will be provided as needed”.

More recently, during fighting around al-Shifa hospital 10 days ago, the IDF told communities around the combat zone to evacuate “to the humanitarian zone in al-Mawasi”.

But any safety in al-Mawasi is only relative to the rest of the territory, where more than 32,000 have died, mostly women and children, during the relentless Israeli offensive, according to local health authorities.

In January, a suspected Israeli airstrike hit a residential compound in al-Mawasi hosting medical teams and their families from the International Rescue Committee and Medical Aid for Palestinians, two NGOs working in Gaza. Last month, during a military operation, an Israeli tank reportedly fired on a house where staff from Médecins Sans Frontières and their families were sheltering, killing two and injuring six.

There are multiple other reports of other injuries in al-Mawasi, most attributed to Israeli bombardment or airstrikes.

Any greater provision of humanitarian aid in al-Mawasi is relative too. In northern Gaza, 300,000 to 500,000 people are threatened with famine, with those most vulnerable, like Salman, facing desperate choices as they seek to survive. In nearby Rafah, there is more food, though prices are prohibitive for many, and some functioning healthcare.

In al-Mawasi, UN agencies and others are able to get some food assistance to the inhabitants of the huge encampment that has sprung up across the dunes and scrubby plain inland but materials for shelter are in very short supply.

Some areas of al-Mawasi are farmland, and still fenced off, increasing crowding further, while UN agencies and international NGOs are occupying most of the guesthouses by the beach.

“There is no real organised assistance,” said one senior aid official. “Sanitary conditions are appalling. Some community organised waste collection [is in place] but very few toilets – people go in the sand or the sea. Water has to be trucked in, ie few wells nearby and no pipes. Water trucks come once a day in Rafah and streams of kids run after them with jerry cans.”

Rafah, the southernmost town of Gaza where another million displaced people are sheltering, is just 4km inland from al-Mawasi, and in the crosshairs of the IDF, who believe thousands of Hamas militants remain there.

Benjamin Netanyahu, Israel’s prime minister, has vowed to launch an assault into Rafah, despite US opposition.

The ceasefire resolution passed at the United Nations on Monday has reassured few in either al-Mawasi or Rafah. Both have been repeatedly hit by Israeli airstrikes and artillery in recent weeks and drones buzz overhead incessantly, day and night. “You lie half-asleep at 3am and feel like you are in a coffin,” said one aid worker in Rafah.

Israel accuses Hamas of using civilians as a human shield. “Hamas keeps putting Gazans in the line of fire. They fire dozens of rockets from the designated humanitarian zone, rockets that often misfire and put even more Gazans at risk,” the IDF said in December. Hamas denies the charge.

The senior official aid said al-Mawasi was “a bit less crowded than a few weeks ago” but aid agencies were bracing for more people to move there in the event of a Rafah operation.

Dr Hatem al-Maghari, the mayor of al-Mawasi, which had a prewar population of just several thousand, said municipal workers had been completely overwhelmed.

“The effort exerted by the municipality crews is truly indescribable, trying to ensure access to ample water and to address the substantial accumulation of waste. Most of my colleagues haven’t been paid for six months and of course the municipality has had no funding for six months,” Maghari said.

“As mayor, my foremost challenge lies in inadequate logistics, a shortage of essential equipment, widespread destruction, and that we can’t import heavy or necessary equipment through the crossings [into Gaza] due to [Israeli] restrictions.”

Yet desperate people like Salman keep coming.

Al-Mawasi has several advantages: its fine soil makes it impossible to dig the tunnels that Hamas has built underneath the rest of Gaza and there are no high-rise buildings. Both factors make the area safer, say those who have sought out the zone.

A final advantage is that al-Mawasi is not Rafah, where many are “petrified” of an Israeli assault.

“We are all very worried about an attack … but we don’t know what to do. Some people went north up to Deir al-Balah but had to come back because there was lots of fighting there,” said a 47-year-old teacher, who did not want to be named.

“We are just waiting for the Israelis to tell us to go, just sitting here waiting for our fate. We do our best to follow the instructions but the people who died they followed the instructions too.”

An Israeli strike late on Monday on a residential building in Rafah where three displaced families were sheltering killed at least 16 people, including nine children and four women, according to hospital records and relatives of the deceased.

Salman, whose eldest son was stabbed when he was robbed of a bag of flour in northern Gaza, has little hope for the coming weeks, months or years.

“I can’t see any future for us … I can’t even see if there is still a future for us,” she said.