Israel’s war on the Gaza Strip has been the deadliest year of conflict for women and children anywhere in the world over the past two decades, according to an analysis released Tuesday as Israeli forces continued to bombard the Palestinian enclave and launched a ground invasion of Lebanon.

The global humanitarian group Oxfam noted in its new report that Israel’s U.S.-backed assault on Gaza has killed more than 6,000 women and 11,000 children, estimates that the organization deemed “conservative” given that the figures don’t include the tens of thousands of kids who are missing.

Many children who have survived Israel’s year-long assault thus far have been left with debilitating psychological and physical trauma. Umaiyeh Khammash, a physician who directs the West Bank-based group Juzoor, said Tuesday that more than 25,000 children in Gaza “have either lost a parent or become orphans, leaving them in deep emotional distress.”

Oxfam also outlined in broad strokes how Israel has obliterated Gaza’s civilian infrastructure, pointing to estimates showing that, on average over the past year, Israeli forces have bombed homes every four hours, shelters for displaced people every 17 hours, schools and hospitals every four days, and aid distribution points and facilities roughly every two weeks.

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