Mohammed Nasser, 28, had had enough. He was at the Gaza Strip’s Rafah crossing, about to leave through Egypt for Turkey on a tourist visa, having saved $650 for Egyptian officials to ensure him a place at the front of the queue. He used the Arabic word for emigration: hijra.

“I will not come back to Gaza,” said the electrician. “Here, even if you are experienced, there is no work.” Hoping one day to be joined by his wife and three young children, he really plans to be smuggled by sea to Greece and then to Sweden. Would that be dangerous? “No more dangerous than here,” he said, smiling thinly. “My wife tried to prevent me from going but she couldn’t.”

There is little doubt how Nasser (not his real name) would answer the question posed by a UN report in 2012. Seeking to alert the international community to the need for fundamental change, it was called “Gaza 2020: A Liveable Place?”. Seven years of continuing blockade and two devastating Israeli military onslaughts later, just how “liveable” for its two million residents is this embattled and enclosed coastal strip?

The fragility of the current uneasy and informal ceasefire was underlined on Thursday. The beleaguered Israeli prime minister Benjamin Netanyahu, fighting off a leadership challenge within his party, was rushed to a bomb shelter during a campaign meeting when a rocket was fired from Gaza. Israel swiftly bombed Hamas targets.

Yet most Palestinians in Gaza are more preoccupied by the day-to-day struggles imposed by the blockade and de-development than fears of another military escalation. When the UN published its 2012 report, unemployment was already 29%. Now the World Bank puts it at 53% (and 67% for young Gazans). Almost half the population subsists on less than $5.50 per day, compared with just 9% in the West Bank.

Nasser is not the only one to seek a better life elsewhere. The UN report estimated that more than 1,000 extra doctors would be needed for Gaza’s fast growing population by 2020. Yet, according to the Hamas ministry of health, 160 qualified doctors have left in the past three years.

Sara Al Saqqa, 27, a general surgeon at the main Shifa hospital, would join them if not for her elderly mother. Employed by the de facto Hamas government, she is paid, because of salary cuts, $300 every 40 days. “ I would leave for good if I had the choice, and I think every doctor shares the same idea.” She admitted that “we hate ourselves for wanting to leave” during medical emergencies such as the serious injuries inflicted by the weekly border protests which have resulted in the deaths of some 215 Palestinians. But she added: “You need to think about yourself and your future. If the situation was a little better, a lot of people would not leave.”

As well as seepage through Rafah, a daily shuttle now takes the few Palestinians with permits to travel abroad via Amman in Jordan. It is even more difficult to get to the West Bank, where Netanyahu seems determined to prevent the Palestinian population increasing, even though the Oslo accords officially designated Gaza and the West Bank as a single entity.

This affects even medical patients. Razan al Eneen, 21, had her cancerous thyroid removed last year by surgeons in Gaza; but because post-operative radio-iodine therapy is unavailable here, she was treated in Hebron in February. Since August she has been due to go back to Hebron, a mere 50 miles away, for a full body scan, and further treatment if necessary, but she has been refused the necessary permit to travel four times. Contacted by the Observer, the Israeli military’s civil affairs division, Cogat, said on Friday that she would be permitted to travel to yet another appointment on 7 January.

A more incidental illustration of the “big prison”, as Gazans see it, was the cancellation of the Palestinian FA cup final because Khadamat Rafah FC was denied – for purported security reasons roundly rejected by the club – Israeli permits for the team to play its second leg in Nablus. The winners would have qualified to play in the Asia Champions’ League in Qatar. The captain, Ahmed Dohair, 36, said: “It was very important to have the chance of representing the Palestinians abroad, and we trained hard. We had to overcome [the team’s] disappointment.” This seems to have worked; Khadamat Rafah FC is still leading the Gaza premier league.

Raji Sourani, head of the Palestinian Centre for Human Rights, said the “bleeding” – a word he prefers to “emigration” – of well qualified Palestinians from Gaza “breaks my heart”. But what he sees as a concerted Israeli effort to make life “intolerable with siege, social and economic suffocation, unemployment, no hope no tomorrow” was not working because most Gazans had not tried to leave.

Next year is supposed to see the construction of three badly needed, internationally funded waste water plants to purify much of the 100,000 cubic metres of raw and semi-treated sewage which is pumped into the Mediterranean every day. But depletion and contamination of the coastal aquifer still means 97% of the mains water supply is undrinkable, requiring most Gazans to rely on trucked supplies at up to five times the price.

Thanks to Israel permitting Qatari-funded fuel for Gaza’s only power station, electricity supply has risen to an average of 12 hours from as little as four hours a day. Israel also has finally allowed around 3,000 Gazans to work in Israel. In 2000, 25,000 were given permits.

A new field hospital, financed by an American charity, close to the Erez border crossing is due to start operating in the spring. Long-barred exports from a once-vibrant private sector are finally trickling out of Gaza, but at about the fifth of the rate before 2007. Qatar is channelling another $20m in handouts to the poorest residents and for job creation schemes. “Qatar is preventing Gaza from total collapse,” said Mkhaimer Abusada, a political scientist at Gaza’s Al Azhar university. Much of this was a response to border protests that began in March 2018 and have resulted in hundreds of Palestinian deaths, he added.

But there are problems with this incremental – and reversible – easing of conditions, brokered by Egypt, between Israel and Hamas, bypassing the Fatah-dominated Palestinian Authority in Ramallah. Netanyahu has defended it to his rightwing base as reinforcing the corrosive Hamas-Fatah split, and making a two-state solution more distant than ever. And it is not remotely enough to reverse more than a decade of blockade-driven economic implosion.

Yet somehow Gaza’s resilience and entrepreneurial spirit survive. At one end is Mohammed Abu Beid, 23, who last year started combing through rubbish skips in search of plastic and aluminium cans to take to a small recycling business – at one shekel (22p) for 70 cans and five shekels for a kilo of recyclable plastic.

At the other, Work Without Borders, a highly successful not-for-profit IT company, houses more than 100 Gaza graduates earning between $500 and $1,500 designing software and apps, mainly for Saudi companies.

In between is Bilal al Omri, 23, who runs a beachside cafeteria. “I saw my friends going to university and then staying at home because they had no job,” he said. “I thought, ‘why study and get nothing?’” His stall brings in 50-60 shekels a day in the summer, but much less in winter.

He dreams of the borders being opened as the international community has repeatedly urged. “I could travel,” he said. “And think of all the tourists that would come here.” But, he added, “material things are not everything. We want dignity, like human beings everywhere.”