More than a quarter of the hundreds of dead from the Gaza conflict are children and aid groups say the survivors will suffer physical and psychological scars for the rest of their lives.

The Gaza Strip is one of the most densely populated, impoverished corners of the Earth and children make up 56 percent of the 1.5 million population.

Even before the Israeli offensive on the Hamas territory started on 27 December, malnourishment and the winter cold had taken a heavy toll.

Aid workers believe just about every Gaza child has been traumatised by the incessant bombardment which Israel says targets the Islamist rulers and aims to silence the daily rocket fire aimed at the Jewish state.

"They can't play, they can't sleep, they can't go to school. They're traumatised," said Benedict Dempsey of the Save the Children group.

At least 159 children are among the more than 580 Palestinians killed in Operation Cast Lead, according to the latest toll from Gaza emergency services. Whole families have been killed in their shelled homes or in cars trying to get away from the fighting, according to medics.

The Israeli military did not immediately respond to a request for comment on the toll, but Israel insists it is doing all it can to avert civilian casualties, and blames Hamas for launching attacks from populated areas.

Kids are dying

"The bottom line is if you're operating heavy weaponry in a very densely populated area, people who have nothing to do with the conflict will die. Sadly, this includes kids," said Dempsey.

Civilians have virtually nowhere to hide in Gaza. The borders are sealed off under an 18-month-old Israeli embargo. Schools are not safe. Three men were killed in an Israeli strike Tuesday on a UN-run school crowded with refugees.

The attack "underlines the sad reality facing those fleeing the violence that unless there is a lasting ceasefire, there will remain pervasive risks to civilian lives in Gaza," said Chris Gunness, a spokesperson for the UN agency for Palestinian refugees (UNRWA.)

Children are particularly vulnerable.

A child trapped in the rubble of a bombarded building has fewer chances of surviving than a healthy adult, according to aid workers who highlight that Gaza children are already in a weakened state.

"Before this began, there were already 50 000 malnourished children in Gaza. There is no way of knowing how many there are now, but we are very concerned the number is going to rise," said Dempsey.

Food stocks are dangerously low, many families keep washing to a minimum to save water for drinking. Power is out in virtually all of Gaza and many windows have been blown out, leaving residents shivering in the cold nights.

Children are particularly at risk in the grim conditions and aid workers fear many will be scarred for life.

"Children are terribly frightened," said Dempsey. "This will live with them for the rest of their lives. It's the sort of experience they'll never forget. They just don't understand what's happening."

AFP