During Ramadan last month, several neighborhood families slaughtered a lame horse and used its meat for kebabs because they could not afford beef or lamb; some mornings, Reem al-Ghora did not wake her daughters for the predawn, prefast meal, she said, “because there was no food.”

A report issued Aug. 27 by the United Nations mission in Gaza questioned whether the 139-square-mile area will be “a livable place” in 2020, citing shortages of food, water, electricity, jobs, hospital beds and classrooms amid an exploding population in what is already one of the most densely populated patches of the planet. But for thousands of Gaza’s poorest residents, like those who live in the forlorn crop of cinder-block or rusted-zinc shacks built illegally on government land and known as the Forgotten Neighborhood, “It’s unlivable before then — even today,” as Ms. Hjila put it.

There are certainly less-livable slums in Africa, South Asia or in Delhi, India’s financial center, or Cairo, just across the desert, but here in Gaza poverty is a particular kind of political football. Some see it as a sure sign that Israeli restrictions on trade, fishing and travel make the place a concrete prison. Others say Gaza already attracts far more attention and international aid than other impoverished regions of the world, and that it is corruption, mismanagement and infighting among Palestinian factions that repress Gaza’s living standards.

The Forgotten Neighborhood, where about 40 families have settled over the past four years near a municipal slaughterhouse in southern Gaza City, is an extreme case. Much of the strip has seen a building boom since Israel eased its blockade two years ago, and the smuggling tunnels from Egypt are thriving once again after being closed briefly last month because of a terrorist attack on the border.

But despite these increased economic opportunities, the report by the United Nations office in Gaza says the situation is worse now than in the 1990s and due to deteriorate further as the population surges to 2.1 million over the next eight years. The United Nations report found that gross domestic product per capita was down (to $1,165 in 2011 from $1,327 in 1994, adjusted for inflation) and unemployment up (near 30 percent over all now, and much higher for women and young people).

Israeli officials have been harshly critical of the United Nations operation in Gaza, which they view as pro-Palestinian and hostile to Israel’s security concerns. In the 2009 Gaza war, Israeli shells killed 40 people at a United Nations-run school in Gaza, which created severe strains between Israel and the organization’s bureaucracy.

Whatever the reasons for Gaza’s economic woes, there is little doubt that some in the territory are suffering.

Last weekend, a desperate 18-year-old who could not find work beyond peddling potato chips set himself on fire outside Al Shifa Hospital and later died of his burns.

Al Shifa, the largest of Gaza’s six public hospitals, is overcrowded and lacking in resources, with 2,000 patients a day for 750 beds; chronic shortages of antibiotics, anticoagulants and even formula for premature newborns; and intubation kits that expired in November 2011. “The only thing available enough here is patients,” mused Dr. Nidal Moussa, a surgeon, during a tour the other day.

Many in the Forgotten Neighborhood and throughout Gaza blame Israel, which captured the territory in 1967 and occupied it until a unilateral withdrawal in 2005, but still controls utilities and regularly strikes people and places it suspects are connected to terrorism. But many also fault the Hamas government, which wrested control of the strip in 2007, for failing to reconcile with the Fatah faction that runs the Palestinian Authority in the West Bank, and for failing to address the problems that plague daily life.

Hamas itself is at a critical crossroads. Hopes for improved relations with Egypt’s new Islamist government, including a proposed free-trade zone, have yet to yield fruit. Attempts at a cease-fire with Israel are constantly thwarted by rogue militant groups. And longstanding support from Syria has disappeared amid that country’s chaos.

That the situation is not far worse is due largely to aid from overseas and, especially, the United Nations, which still provides food aid to some 1.1 million of the 1.64 million residents who remain classified as refugees generations after their families left what became Israel in 1948.