London: Israeli military strikes in Gaza have 鈥渘ormalised鈥� mass casualty events in Western media that previously would have been 鈥渞emembered forever,鈥� the director of the UN Relief and Works Agency for Palestine Refugees in the Near East has said.

Sam Rose was speaking in the wake of the Israeli bombing of an UNRWA-run school in Nuseirat. Local medical workers say at least 40 people were killed.

UNRWA has around 300 schools in Gaza, but none have been able to function as anything other than refugee shelters since hostilities began on Oct. 7.

More than 36,000 people have been killed and hundreds of thousands of Gazans displaced by the fighting.

Rose told The Guardian: 鈥淭here were about 6,000 people sheltering in that school. There are rules of war that we call on all sides of the conflict to adhere to: to protect the inviolability of our installations. There are also principles of distinction, and of proportionality.

鈥淧eople will have been sheltering in the courtyard of the school in the most desperate of conditions and there will have been no warning that this strike has taken place. It happened in the middle of the night about 2 a.m.

鈥淲e鈥檝e seen this time and time again, to the extent that it鈥檚 almost become normalised. In previous conflicts, single incidents like this would cause shock and outrage and would be remembered forever. Whereas it seems in this conflict it will be this one will be replaced by another in a few days鈥� time unless it all comes to an end. So, it almost becomes commonplace and mundane that these things are happening. We have normalised horror.鈥�

Rose added that he was taken aback by 鈥渢he sheer number of people with crutches and wheelchairs with missing limbs, with wounds鈥� during his last visit to Gaza.

He said the conflict is having 鈥減retty dramatic humanitarian consequences鈥� on the enclave, with some areas 鈥渓argely out of control.鈥�

Rose added: 鈥淭here will be a psychological reckoning at some point. People鈥檚 requirement to adjust repeatedly to the realities of life in Gaza is something that no one should have to put up with.鈥�

As the conflict has endured, many thousands of people have sought shelter at UNRWA schools as they are equipped with solar panels and can provide limited amounts of clean water.

However, Israel鈥檚 continued assault on the southern city of Rafah has forced many to flee the area, having previously sought refuge from fighting further north in Gaza City and Khan Younis.

Rafah鈥檚 population, at one point hosting 1.4 million refugees in addition to 270,000 residents, is now believed to be around 100,000.

Rose said: 鈥淭hose that came to Rafah as refugees were the first to leave, followed by families that had lived in the town all their lives.

鈥淲e would basically see women and children sat on the side of the road with their belongings packed up neatly beside them 鈥� mattresses, bags of flour, jerry cans, book, clothes.

鈥淭he guys had gone on to pitch and find a plot of land or connections or whatever. And then they鈥檇 come back later. They鈥檇 hire a truck, and they鈥檇 bring the rest of the family but we saw lots of families, and mainly women and children, sit by the side of the road waiting for help.鈥�

He said aid supplies are insufficient to supply such a high number of refugees with necessary food, shelter and equipment.

Rose added: 鈥淲hat has happened in Gaza is that things have got incredibly bad incredibly quickly, so people have moved from relatively stable to phase five famine conditions in a short period of time.鈥�