What is UNRWA? Here’s what to know about the largest aid organization in Gaza.

The U.N. agency that has been aiding Palestinian refugees for the past 74 years said on Thursday that it had begun to significantly reduce its operations in the Gaza Strip after nearly exhausting its fuel reserves, exacerbating a humanitarian crisis that the agency’s top official described as “hell on Earth.”

The United Nations Relief Works Agency for Palestinian Refugees, or UNRWA, said in a statement that it had to reduce water supplies, as well as to cut down on fuel it provided to power generators, medical centers and bakeries.

“We can skimp or ration to an extent, and we have bought ourselves some more hours doing this,” Hector Sharp, the UNRWA head of field legal office, said from Gaza. But Gaza will run out of fuel at some point and “the world will, I hope, sit up and say, ‘We are going to send fuel.’ But it will be too late.”

Here’s a closer look at the organization and its work.

Why was UNRWA set up?

Originally intended to provide temporary relief, UNRWA was established in 1949 to assist Palestinians who fled or were expelled from their homes during the 1948 Arab-Israeli war. Palestinians are the only refugee group whose support is not handled under the broader mandate of the Office of the United Nations High Commissioner for Refugees.

The agency has been operating in Jordan, Lebanon, Syria, West Bank and the Gaza Strip, providing health care, food, jobs, emergency loans, housing assistance and education to millions of Palestinians. It is funded almost entirely by voluntary donations by U.N. member states, with the United States and the European Union countries providing most of the financing.

What is UNRWA’s relationship with Israel?

Israel has objected to UNRWA’s definition of Palestinians as refugees, and has been especially vocal against extending that category to those born in the Gaza Strip. Prime Minister Benjamin Netanyahu went as far as to call for the disbanding of UNRWA, accusing it of perpetuating rather than solving the Palestinian “refugee problem.”

“The Israelis believe that Arab nations, especially, want the Palestinian refugee problem to remain unresolved, so that there’s a constant reminder of the Palestinian tragedy,” said Ahron Bregman, a senior teaching fellow at King’s College London who specializes in the Arab-Israeli conflict. “UNRWA, as the Israelis see it, is a tool to keep the Palestinian refugee problem unresolved.”

But some experts said that despite the hostile public remarks, Israel actually needed UNRWA in the Gaza Strip to provide stability in the region. “Behind the scenes Israel has often favored UNRWA’s work,” said Dr. Anne Irfan, an expert on Palestinian refugee rights at the University College London. “The agency has been providing services that otherwise Israel would have had to provide as an occupying power.”

Most of UNRWA’s staff on the ground are Palestinians. Since Oct. 7, 39 of them have been killed, many of them in their homes or while doing their jobs, the agency says. Another 22 have been injured, and thousands more remain in harm’s way as they continue providing aid to civilians amid Israeli airstrikes.

What does UNRWA do?

UNRWA mainly provides services and funding for those registered as Palestinian refugees in the Gaza Strip, the West Bank, Jordan, Lebanon and Syria. (The Office of the United Nations High Commissioner for Refugees is responsible for Palestinian refugees outside UNRWA’s areas of operation.)

It is a major employer in a region where almost half of adults remain unemployed. It also runs schools for almost 300,000 children and provides emergency loans and housing assistance.

“Essentially, for the last few decades we have been operating a parallel government in Gaza,” Mr. Sharp said. “We had an education department, a health care department. We were building more schools, health care clinics. We had projects to build roads and playgrounds.”

And since Israel began retaliating for the Hamas assaults of Oct. 7, the agency — which has been aiding Palestinian refugees for the last 74 years — has become a lifeline for more than a million displaced Palestinians. Almost 630,000 of them found shelter in 150 buildings that previously housed UNRWA-operated schools, and thousands seek medical help every day in UNRWA-run clinics.

Megan Specia contributed reporting.