Gaza has become worse than hell on earth, the head of the International Committee of the Red Cross has told the BBC.

In an interview at the ICRC's headquarters in Geneva, the organisation's president Mirjana Spoljaric said "humanity is failing" as it watched the horrors of the Gaza war.

Speaking in a room close to a case displaying the ICRC's three Nobel Peace Prizes, I asked Ms Spoljaric about remarks she made in April, that Gaza was "hell on earth", and if anything had happened since to change her mind.

"It has become worse… We cannot continue to watch what is happening. It's surpassing any acceptable, legal, moral, and humane standard. The level of destruction, the level of suffering.

"More importantly, the fact that we are watching a people entirely stripped of its human dignity. It should really shock our collective conscience."

She added that states must do more to end the war, end the suffering of Palestinians and release Israeli hostages.

The words, clearly carefully chosen, of the president of the ICRC carry moral weight.

The International Red Cross is a global humanitarian organisation that has been working to alleviate suffering in wars for more than a century and a half.

It is also the custodian of the Geneva Conventions, the body of international humanitarian law that is intended to regulate the conduct of war and protect civilians and other non-combatants. The most recent version, the fourth Geneva Convention of 1949, was adopted after the Second World War and was intended to stop the mass killing of civilians from happening again.

Israel, I reminded her, justifies its actions in Gaza as self-defence.

"Every state has a right to defend itself," she said.

"And every mother has a right to see her children return. There's no excuse for hostage-taking. There is no excuse to depriving children from their access to food, health, and security. There are rules in the conduct of hostilities that every party to every conflict has to respect."

Did that mean that the actions of Hamas and other armed Palestinians on 7 October 2023 - killing around 1200 and taking more than 250 hostage - did not justify Israel's destruction of the Gaza Strip and the killing of more than 50,000 Palestinians?

"It's no justification for the disrespect or hollowing out of the Geneva Conventions. Neither party is allowed to break the rules, no matter what, and this is important because, look, the same rules apply to every human being under the Geneva Convention. A child in Gaza has exactly the same protections under the Geneva Conventions as a child in Israel."

You never know, Ms Spoljaric added, when your own child might be on the weaker side and will need these protections.

The ICRC is a reliable source of information about what is happening in Gaza. Israel does not allow international news organisations, including the BBC, to send journalists into the territory. The reporting of the more than 300 ICRC staff in Gaza, 90% of whom are Palestinians, forms a vital part of the record of the war.

Ms Spoljevic, the ICRC president, has been talking every day to their team leader in Gaza. The ICRC surgical hospital in Rafah is the closest medical facility to the area where many Palestinians have been killed during chaotic aid distribution by the Israel and US-backed Gaza Humanitarian Foundation (GHF).

Like the UN, the ICRC is not taking part in the new operation. A fundamental flaw of the new system is that it funnels tens of thousands of desperate, starving civilians through an active war zone.

Ms Spoljevic said there was "no justification for changing and breaking something that works, with something that doesn't seem to be working".

In the last few days, the ICRC surgical teams at their field hospital in Rafah near the GHF zone have been overwhelmed at least twice by the volume of casualties in the turmoil of the food operation.

"Nowhere is safe in Gaza. Nowhere. Not for the civilians, not for the hostages," said Ms Spoljevic. "That's a fact. And our hospital is not safe. I don't recall another situation that I have seen where we operate in the midst of hostilities."

A few days ago, a young boy was hit by a bullet coming through the fabric of the tent while he was treated.

"We have no security even for our own staff… they are working 20 hours a day. They are exhausting themselves. But it's too much, it's surpassing human capabilities."

The ICRC said that in just a few hours on Tuesday morning its Rafah surgical teams received 184 patients, including 19 people dead on arrival and eight others who died of their wounds shortly afterwards. It was the highest number of casualties from a single incident at the field hospital since it was established just over a year ago.

It happened around dawn on Tuesday. Palestinian witnesses and ICRC medics reported terrible scenes of killing as Israeli troops opened fire on Palestinians who were converging on the new aid distribution site in southern Gaza. It was "total carnage" according to a foreign witness.

An official statement from the Israeli military described a very different picture. It said "several suspects" moved towards Israeli forces "deviating from the designated access routes". Troops "carried out warning fire… additional shots were directed near a few individual suspects who advanced towards the troops".

A military spokesperson said they were investigating what happened. It has denied shooting Palestinians in a similar incident on Sunday.

Ms Spoljaric said the ICRC was deeply concerned about talk of victory at all costs, total war and dehumanisation.

"We are seeing things happening that will make the world an unhappier place far beyond the region, far beyond the Israelis and the Palestinians, because we are hollowing out the very rules that protect the fundamental rights of every human being."

If there is no ceasefire, she fears for the future of the region.

"This is vital. To preserve a pathway back to peace for the region. If you destroy that pathway forever for good, the region will never find safety and security. But we can stop it now. It's not too late."

"State leaders are under an obligation to act. I'm calling on them to do something and to do more and to do what they can. Because it will reverberate, it will haunt them, it would reach their doorsteps."

The ICRC is considered the custodian of the Geneva conventions. The fourth, agreed after the Second World War, is designed to protect civilians in wars.

The Hamas attacks on Israel on 7 October 2023 were, she said, no justification for current events.

"Neither party is allowed to break the rules, no matter what," Ms Spoljaric said.

Israel launched a military campaign in Gaza in response to Hamas' cross-border attack, in which about 1,200 people were killed and 251 others were taken hostage.

At least 54,607 people have been killed in Gaza since then, including 4,335 since Israel resumed its offensive on 18 March, according to the territory's health ministry.

Appealing to parties to stop the hostilities, she said: "We cannot continue watching what is happening.

"It defies humanity. It will haunt us."

She called on the international community to do more. "Every state is under the obligation to use their means, their peaceful means, to help reverse what is happening in Gaza today," she said.