Stopping Famine in Gaza

The Israeli military campaign in the Gaza Strip has pushed many of its residents to the edge of death from starvation and disease. Only a prolonged ceasefire accompanied by a massive aid operation can improve the situation enough to avoid a horrific toll.

What’s new? The Israeli offensive after the 7 October 2023 attack by Hamas has wreaked catastrophe upon the 2.23 million Palestinians in Gaza. Famine is imminent in the enclave’s north, where people lack adequate food, water and shelter. If Israel pushes into Rafah in the south, it could soon loom there, too.

Why does it matter? If Israel continues to assault Gaza, its population and its civil institutions, limit the entry and distribution of humanitarian assistance, and set families against one another, starvation and disease will cause mass death. Leveraging aid to transform Gaza’s political system may tear apart the social fabric, rendering the strip ungovernable.

What should be done? Gaza needs much more aid, with its civil services safeguarding distribution. That is unlikely without a ceasefire. Even absent one, Israel should increase inflow, permit easier movement and stop targeting humanitarian and civic groups handing out assistance even if they are coordinating with Hamas.

Executive Summary

The war in Gaza is far from over, but the fate of many of its residents may soon be sealed: the strip’s north may be facing the world’s worst famine, relative to population size, of the past few decades. Unimpeded, sustained and safe humanitarian access to the whole Gaza Strip, with civil authorities and civic groups allowed to safeguard aid distribution, is needed to prevent this outcome. While Israel let more assistance into Gaza in March, it was not enough. Grimmest is the north, where Israel is targeting Hamas figures and civilians overseeing aid. Should the Israeli army move into Rafah, the strip’s southernmost city, as Prime Minister Benjamin Netanyahu says it will do, the evacuation beforehand, to say nothing of the actual assault, could propel the south into similarly dire straits. Only a prolonged ceasefire can improve access, movement and distribution enough to avoid mass death. Absent one, the only option is mitigating the famine through modest improvements in these areas, with Israel guaranteeing the safety of aid workers regardless of their nationality and political affiliation.

The fighting in Gaza has stalled but the hardship has not. Everyone seems to have misjudged how their actions in this war would play out. Hamas leaders did not expect such a devastating reprisal for the 7 October 2023 attacks in southern Israel, even after the scope and nature of these became clear. Israel, for its part, has found vanquishing Hamas a greater challenge than it bargained for. The tunnel system Hamas dug underneath Gaza is bigger than anticipated. Hamas’s battalions are greatly weakened, but its fighters continue to inflict casualties on Israeli forces, returning repeatedly to areas that the army has ostensibly cleared. Disagreements in Israel’s war cabinet, as well as between the political and military echelons, are hampering the war effort. Netanyahu is widely seen as dragging out the conflict to stay in power and avoid facing corruption charges.

The severity of the crisis is staggering. Some 33,000 people are dead, with many thousands more presumed lost. Famine’s toll could be even greater, since it causes large and rapid loss of life, brought on by the collapse of food, health, water and social systems. Recorded deaths from malnutrition are still few, but images of children’s hauntingly skeletal corpses show hunger’s terrible effects. When the famine threshold is crossed, the death spike starts with the very young, the elderly and the chronically ill before spreading among the population. Recent acute malnutrition numbers are not only alarmingly high but, in the words of a famine expert, “jaw-dropping” in their rate of increase over the past two months, especially among children under five. Water, sanitation and health services have completely broken down, unlike during previous Hamas-Israel wars. But in the wake of 7 October’s horror, Israel cast aside the humanitarian playbook. Measures that delivered life-saving aid in the 2008-2009 and 2014 wars – like temporary truces allowing aid distribution and funnelling aid to Gaza through Israel – were discarded.

Instead, Israel imposed a siege it has inadequately relaxed since. There are many reasons why: to deprive Hamas of resources; to try turning the strip’s population against the movement; to avoid logistical tangles; and to channel the Israeli public’s fury about 7 October. Israel acknowledges that Gaza faces a crisis but disputes its severity and denies responsibility. To the contrary, it argues, it has made unparalleled efforts to safeguard civilians, and to let in more aid, particularly in the last two weeks of March. Israel maintains that fault lies with aid agency failures and Hamas’s corruption. Yet this contention does not hold up. Inefficiency and corruption at al-Arish, Egypt’s main Sinai port, have hampered operations, but they do not explain why at least 7,000 trucks are backed up in the peninsula or why so few get permission to drive to Gaza’s north. Nor, U.S. officials say, is it apparent that Hamas is stealing aid. It would not be surprising if theft were occurring – people with guns do not usually starve first – but there is no evidence of that.

The U.S. has also badly misread the situation. It tried to convince Netanyahu’s government that facilitating humanitarian aid and otherwise protecting civilians would help Israel attain its war aims. With deaths in Gaza mounting and the war costing Biden politically, the U.S. has significantly sharpened its criticism but so far has shown little openness to using the most powerful levers at its disposal – money and weapons. It abstained at the UN Security Council on a temporary ceasefire resolution, only to downplay the vote as “non-binding”. Airdrops and the floating pier the U.S. is building will be insufficient to get Palestinians in Gaza what they need, especially because Israel’s aid providers suspended activity after Israeli airstrikes killed seven World Central Kitchen workers on 1 April. The U.S. has bet that a temporary ceasefire and hostage release will unlock aid and create momentum for calm. Thus far, negotiations have struggled to make headway.

Israel’s approach to aid distribution, especially in the north, has been a fiasco. It has not coordinated military with humanitarian action, endangering aid workers and recipients, and frequently halting convoys. It has attacked civilian police, citing links to Hamas, and compelled their retreat, which leaves supplies vulnerable to plunder, whether by profiteers or the desperately hungry. It has tried to work around the international aid system and its protocols for famine prevention and response, doling out assistance on an ad hoc basis in hopes of building a network to administer Gaza on its behalf after the war. It directs aid to big families who agree to embrace its agenda, while targeting those who refuse, risking damage to Gaza’s social fabric in a way that a U.S. official noted is reminiscent of Mogadishu in the early 1990s.

Israel announced welcome steps after its strikes on the World Central Kitchen workers. Opening the Ashdod port for aid shipments; facilitating access to Gaza through the Erez crossing on the strip’s northern boundary; restoring some water flow from Israel; speeding passage of assistance from Jordan through the Kerem Shalom crossing; and improving coordination of military operations with humanitarian activities are exactly the kind of measures that are needed. Now the imperative is to ensure they are not a limited reaction to placate critics but the start of the urgent, massive, coordinated response needed to prevent famine. Additional changes will be necessary to enable aid distribution, especially with the breakdown in public order. Despite the damage to Gaza’s civilian police, they are still broadly effective when permitted to function and the least politicised of the strip’s security services. Police commanders often have ties to Hamas, but even Palestinians vehemently opposed to the movement say aid distribution improves on their watch.

Since October, Crisis Group has advocated for a ceasefire centred on a political agreement. The 7 April announcement that Israel has withdrawn most of its ground forces from Gaza is a positive sign. But the priority today is to address the humanitarian crisis through a surge in aid, measures to permit freer movement in Gaza, particularly for aid agencies, and reliance on civil authorities and civic groups to protect and facilitate distribution. Realistically, such steps will work only with a ceasefire. But failure to achieve a ceasefire cannot excuse inaction. Imports still should be increased to the extent possible, aid convoys permitted to pass safely and movement restrictions relaxed. Israel should stop targeting civic leaders and Gaza officials involved in safeguarding aid and overseeing distribution. True, some are linked to Hamas. But given that no other feasible option exists, the alternative is accelerating death from starvation, coming atop the already extraordinary levels of suffering in Gaza.

Gaza/Jerusalem/Tel Aviv/Washington/Brussels, 8 April 2024
I. Introduction

At the Gaza war’s outset, Israeli leaders envisaged a campaign that would destroy Hamas – or at least eliminate its military and topple the Gaza government – and retrieve the hostages taken by the group on 7 October 2023. The war cabinet went even further in its objectives, saying the war would end the threat of terrorism emanating from the strip. But the Israeli offensive has not gone as promised. Even though Prime Minister Benjamin Netanyahu still speaks of “total victory”, the consensus among Israeli and U.S. intelligence agencies is that, while the war will break its organised battalions, Hamas will survive as an insurgent or guerrilla force.[1] [1] “Israel-Gaza war: Netanyahu says Hamas leaders are ‘all dead men’, insists on total victory”, Deutsche Presse-Agentur, 12 March 2024.

The offensive in Gaza’s north was enormously destructive, damaging or knocking down at least 70 per cent of the area’s buildings.[1] To facilitate its campaign, Israel ordered the evacuation of the 1.2 million people in northern Gaza, including from Gaza City, formerly the largest Palestinian conurbation, forcing them to flee south. It bombed buildings harbouring or suspected of harbouring Hamas assets, while also striking the tunnels used by the Islamist group to conceal weapons, personnel, captives and tactical movements in preparation for ambushes. Israel’s use of heavy armour, which offered more protection for its soldiers, incurred major destruction in residential and agricultural zones. So did its clearing of swathes of the strip – in urban areas to protect its forces, along stretches of the border with Israel to create a 1km buffer zone and across the strip’s 6.5km width south of Gaza City, bisecting the enclave. Dubbed the “Netzarim corridor” after a former settlement nearby, the 2km-wide clearing, when completed, will serve as an operational foothold and enable Israel to control north-south movement.[2] [1] “Gaza Strip in maps: How life has changed”, BBC, 22 March 2022. In just over two months, Israel knocked down more buildings in Gaza than the Syrian regime, backed by Russian airstrikes, did in Aleppo from 2013 to 2016 and the U.S.-led coalition battling ISIS did in Mosul, Iraq and Raqqa, Syria in 2017. “Israel has waged one of this century’s most destructive wars in Gaza”, Washington Post, 23 December 2023. Israel’s campaign may have damaged or destroyed nearly as much or more of northern Gaza than the Allies destroyed of Cologne (61 per cent), Dresden (59 per cent) or Hamburg (75 per cent) in World War II. “Military briefing: The Israeli bombs raining on Gaza”, Financial Times, 6 December 2023. Israel said such firepower – in early November already more than twice that of the nuclear weapons the U.S. dropped on Hiroshima and Nagasaki – was necessary to destroy the tunnels, given their depth and the absorptive capacity of Gaza’s soft soil, which muffles the explosive force. For the firepower estimate, see “Israel hits Gaza Strip with equivalent of two nuclear bombs”, Euro-Med Human Rights Monitor, 2 November 2023. For Israel’s claim, see “Inside the tunnels of Gaza: The scale, and the sophistication, of Hamas’ tunnel network”, Reuters, 31 December 2023.

[2] “Israeli road splitting Gaza in two has reached the Mediterranean coast, satellite imagery shows”, CNN, 8 March 2024.

After a seven-day pause that ended 1 December to enable hostage/prisoner exchanges and the entry of humanitarian aid, Israel expanded its ground campaign to the south. It pushed first into Khan Younis and then into central Gaza, including the city of Deir al-Balah and the Maghazi refugee camp. Israel did not order the wholesale evacuation of the population in these areas but rather divided the territory into zones, instructing residents to flee as its army advanced. It said it employed this operational segmentation – and lesser firepower – in deference to U.S. pressure to protect civilians.[1] This new tactic notwithstanding, up to 54 per cent of Khan Yunis has been damaged or destroyed.[2] [1] Crisis Group interview, Tel Aviv, January 2024.

[2] “Gaza Strip in maps: How life has changed”, op. cit.

East Khan Younis, where 54 per cent of buildings have been destroyed or
damaged just three months after Israel’s push into the city. Salah al-Din Road, one of Gaza’s two north-south arteries before the war, runs vertically through the image. CRISIS GROUP / PLANET LABS PBC

Israel continues to threaten an invasion of Rafah, Gaza’s southernmost city and the last part of the strip that has not yet seen an Israeli ground operation, but it faces both political pushback from the U.S. and practical obstacles. Khan Yunis remained a battle zone for more than four months after Israel turned its attention to the south. Hamas has resurged in the north, in areas the army claimed to have cleared, leading Israel to mount new operations there. In addition, long-term mobilisation is taxing for the army, which relies on a core of conscripts and a larger pool of reserves. Israeli leaders must also consider the possibility of major hostilities with Lebanon’s Hizbollah on Israel’s northern border, tension with Iran and the damage to the economy done by depleting the work force for months on end. Having withdrawn forces from Gaza and let reservists go home, the army will need to bolster its ranks before launching another major assault.

Israel nevertheless insists that it will take Rafah, in order to root out Hamas militants who have taken refuge there and cut the enclave off from the Egyptian border as well as the arms that pass through tunnels underneath.[1] The population of the Rafah region was 275,000 before the war, but today it hosts up to 1.4 million people, more than half of Gaza’s total inhabitants. The U.S. has pushed Israel not to invade Rafah, particularly without a convincing plan to protect civilians, which it has not seen.[2] But regardless of the scheme Israel comes up with, and regardless of whether the U.S. endorses it, it cannot be credibly humane.[3] There is no way to relocate so many weak and desperate people, especially since so much of the rest of Gaza has been razed. Israel has said it will not displace Palestinians into the Sinai Peninsula, though Egypt has begun to build a walled enclosure near its border with Gaza (as a contingency, Cairo says).[4] [1] “Israel plans risky mission to seize last Gaza border it doesn’t control”, The Wall Street Journal, 13 January 2024.

[2] Crisis Group interview, Washington, February 2024.

[3] The Famine Review Committee of the Integrated Food Security Phase Classification concluded that famine was likely to occur also in Gaza’s southern and central regions in the event of a rapid, indiscriminate Rafah offensive alongside a poorly executed civilian mass evacuation. “Gaza Strip: Conclusions and Recommendations”, Famine Review Committee, March 2024.

[4] See Summer Said and Jared Malsin, “Egypt builds walled enclosure on border as Israeli offensive looms”, The Wall Street Journal, 15 February 2024; and “Egypt says displacement is unacceptable, but will deal with civilians humanely”, Reuters, 17 February 2024.

Rafah region on the southern Gaza Strip border with Egypt. Makeshift tents mushroomed as hundreds of thousands of displaced Palestinians took refuge there. Al-Mawasi, next to the sea, was declared a safe zone by Israel but still comes under attack. CRISIS GROUP / PLANET LABS PBC

Another conundrum is how Israel will reconcile its stated war aims with battlefield realities. To be sure, the war has taken a heavy toll on Hamas. Eighteen of its 24 battalions have taken heavy casualties. Israel claims that up to 15,000 Hamas fighters (half the total number) have been killed or wounded severely enough that they will not return to battle; U.S. estimates are lower.[1] But even though Israel’s ground campaign has broken Hamas’s command and control, as well as its capacity to mount coordinated manoeuvres, the army will not be able to destroy all the tunnels under the strip. Nor will it be able to prevent Hamas cells from launching rocket-propelled grenades and planting explosives, much less stop shooting attacks. In early April, Hamas again fired rockets into Israel.

Meanwhile, the war’s humanitarian costs continue to mount, and with them reputational and political damage to Israel and its partners. Israel’s warfighting strategy provides for using massive firepower, including against civilian infrastructure deemed hostile, a category which Israel sees as encompassing most of Gaza.[2]Israel’s loose targeting protocols bespeak an approach to international humanitarian law that appears to stretch beyond recognition the requirement of proportionality – which holds that the harm done to civilians and civilian objects should not be excessive in relation to the military advantage obtained. Legal experts also note that Israel’s claims to have acted lawfully in attacking normally protected sites such as a hospital and a refugee camp are at least in some cases less than fully persuasive.[3] [1] Crisis Group interviews, Tel Aviv and Washington, March 2024. The Israeli newspaper Haaretz has cast doubt on the Israeli government’s claims to have killed 9,000 Hamas fighters. “Israel created ‘kill zones’ in Gaza: Anyone who crosses into them is shot”, Haaretz, 31 March 2024.

[2] This strategy finds its roots in the so-called Dahiya doctrine, first laid out by Gadi Eisenkot, a top Israeli general, during the 2006 war between Israel and Hizbollah. Israel heavily bombarded the suburbs of southern Beirut, where Hizbollah has many facilities, during that campaign. See Ishaan Tharoor, “The punishing military doctrine that Israel may be following in Gaza”, Washington Post, 10 November 2023.

[3] On these questions, see, eg, Brian Finucane, “Is Washington Responsible for What Israel Does with American Weapons?”, Foreign Affairs, 17 November 2023.
” Many Israelis … are inclined to see all Palestinians in Gaza as complicit with Hamas. “

By way of justifying its actions, Israel points to the extent of the tunnel network and its proximity to civilian infrastructure, as well as the intermingling of civilians with combatants.[1] Many Israelis, indeed, are inclined to see all Palestinians in Gaza as complicit with Hamas.[2] This attitude is reflected in leaders’ aggressive, dehumanising language as well as the video footage circulated in social media of soldiers celebrating such things as looting homes and even killing Palestinians.[3] Some of this rhetoric has become fodder for international legal proceedings, including a case brought by South Africa under the Genocide Convention before the International Court of Justice. The Court ordered provisional measures against Israel including with respect to the facilitation of humanitarian assistance. The decision did not have a substantial impact on the ground, however, leading the Court to tell Israel to take more steps to let in aid, including by opening additional land crossings, after deaths from acute malnutrition began.[4]

This report offers an in-depth study of the conditions that have put Gaza on the edge of famine, followed by a clarion call to action to save the enclave’s people from the worst ravages of mass hunger. It is based on scores of interviews with UN and other humanitarian agency staff, including aid workers with extensive experience in Gaza and other war zones, Israeli, Palestinian, U.S., and European officials, and independent experts in food security and other relevant fields, as well as numerous residents from every part of the strip. Roughly half the interviewees were men and half women. The report also draws upon UN and other reporting on the humanitarian crisis. It is rooted in Crisis Group’s decades of work on the Israeli-Palestinian conflict, including field research on past wars centred in Gaza and detailed study of the politics surrounding the issue in Washington and at the UN.[5] [1] Crisis Group telephone interview, Israeli defence official, 14 March 2024.

[2] An Israeli official contended that given how extensive the tunnel system is, many civilians must have taken part in its construction. Crisis Group interview, Tel Aviv, February 2024.

[3] Alessandro Accorsi, “How Israel mastered information warfare in Gaza”, Foreign Policy, 11 March 2024. See also tweet by Muhammad Shehada, @muhammadshehad2, 5:04am, 9 March 2024.

[4] The Court wrote, “Israel shall: (a) take all necessary and effective measures to ensure, without delay, in full co-operation with the United Nations, the unhindered provision at scale by all concerned of urgently needed basic services and humanitarian assistance, including food, water, electricity, fuel, shelter, clothing, hygiene and sanitation requirements, as well as medical supplies and medical care to Palestinians throughout Gaza, including by increasing the capacity and number of land crossing points and maintaining them open for as long as necessary; and (b) ensure with immediate effect that its military does not commit acts which constitute a violation of any of the rights of the Palestinians in Gaza as a protected group under the Genocide Convention, including by preventing, through any action, the delivery of urgently needed humanitarian assistance”. Order of 28 March 2024, Application of the Convention on the Prevention and Punishment of the Crime of Genocide in the Gaza Strip (South Africa v. Israel).

[5] See, eg, Crisis Group Middle East Briefing N°90, A Way Out for Gaza, 9 December 2023; Crisis Group Commentary, “A Second October War in Israel-Palestine”, 9 October 2023; Crisis Group Middle East Report N°225, Beyond Business as Usual in Israel-Palestine, 10 August 2021; and Crisis Group Commentary, “The Israel-Palestine Crisis: Causes, Consequences, Portents”, 14 May 2021. See also Richard Gowan, “The Double Standards Debate at the UN”, Crisis Group Commentary, 7 March 2024.

Anatomy of a Humanitarian Emergency

The Israeli response to Hamas’s attack has exposed the people of Gaza to hunger, disease and other forms of privation.[1]In January, Jan Egeland, secretary general of the Norwegian Refugee Council, described the situation in the strip as “one of the worst humanitarian crises faced by any civilian population this century”.[2] Today, Gaza is much, much worse off than it was then. According to reports, some 33,000 Palestinians have been killed in the campaign; over 70 per cent are women and children.[3]The entire strip is facing acute food insecurity and limited access to water, sanitation and health facilities. Nearly one third of the population is suffering catastrophic food insecurity; in northern Gaza, the number rises to 55 per cent. Mortality lags, since starving people do not necessarily die immediately. Within months, on the current trajectory, the numbers will rise to 50 per cent and 70 per cent, respectively.[4] The damaged and ruined physical plant includes not only homes but also schools, hospitals, government offices and nearly every type of facility vital for service provision.[5]

The siege imposed by Israel after the 7 October attack, loosened only insufficiently since, is the original and main factor behind this devastation. Intensifying the blockade it had imposed in 2007, Israel completely stopped movement through the strip’s two main crossings into Israel: the Erez pedestrian crossing, which sits on the enclave’s northern border, and Kerem Shalom, which facilitates truck traffic and lies farther south on the border with Egypt. Together with Cairo, it also nearly halted passage through the Rafah pedestrian and vehicular crossing into Egypt. The Erez closure denied passage to aid agency personnel.

[1] Crisis Group Briefing, A Way Out for Gaza, op. cit.

[2] Statement from Jan Egeland, Secretary General of the Norwegian Refugee Council, 15 January 2024.

[3] “Hostilities in the Gaza Strip and Israel – Reported Impact Day 145”, OCHA, 22 March 2024. See also “Gender Alert: The Gendered Impact of the Crisis in Gaza”, UN Women, January 2024.

[4] “IPC Global Initiative – Special Brief – Gaza Strip”, Integrated Food Security Phase Classification (IPC), 18 March 2024.

[5] As of 16 December, the Financial Times estimated the damage in Gaza as a whole to range from 36 per cent to over 45 per cent. This report uses the high end of the range since the newspaper’s study concluded some time ago, with considerable additional destruction doubtless occurring since then. “Visual analysis: The wastelands in Gaza’s two biggest cities”, Financial Times, 21 December 2023.

The siege blocked all aid and commercial traffic into Gaza. Previously, that traffic came through Kerem Shalom for goods transiting Israel (formerly 70 per cent) and Rafah, through the Salah al-Din gate, for those coming through Egypt (formerly 30 per cent). Before 7 October, Kerem Shalom, was the main entry point for both aid and commercial goods, accommodating an average of 400 trucks a day, including 45 bearing fuel.[1] More than 80 per cent of all trucks passing through Kerem Shalom carried wares supplied by Israeli companies.[2] Operating at maximum capacity, the Rafah crossing let some 145 trucks per day (though only three days per week). On average 500 trucks, most of them carrying commercial cargo, transited the two crossings, with occasional peaks of up to 700.[3]

Israel also cut electricity supply to the strip and embargoed fuel deliveries, which are vital not only for transport but for running the generators that provide back-up power for Gaza’s essential services.[4] The embargo paralysed nearly every facet of life, from desalination and sewage treatment to bakeries, refrigeration and medical care, with respites only during sporadic fuel deliveries.[5] Israel has permitted fluctuating but always inadequate levels of fuel. On 6 December, Israel announced it would permit deliveries of 120,000l per day, but in February, aid officials estimated the daily average at 100,000l.[6] UNRWA, the UN Relief and Works Agency for Palestine Refugees, estimates that it alone needs 160,000l per day for basic humanitarian operations.[7] [1] Crisis Group telephone interviews, UN aid officials, October 2023.

[2] “Factsheet: Kerem Shalom Crossing”, Gisha Legal Center for Freedom and Movement, March 2020.

[3] Aid trucks operated by humanitarian organisations bore only around 5 per cent of monthly deliveries. Many humanitarian agencies contracted with private companies to bring in goods, making it difficult to draw a precise distinction between aid and commercial deliveries.

[4] The power was already inadequate for Gaza’s needs. In September, the UN reported that locales throughout the strip were receiving an average of fourteen hours of electricity per day. Israeli electrical lines were bringing in around 28 per cent of the wattage Gaza would have needed to cover 24 hours per day, while Gaza’s only power plant, which relies on diesel shipped from Israel, was generating another 16 per cent of that total. “Gaza Strip Access and Movement”, UN Office of the Coordinator for Humanitarian Affairs (OCHA), September 2023.

[5] The only alternative to a functioning electrical grid or generators running on diesel or petrol are small-scale solar projects – which Israel has also struck and, in any case, cannot meet the population’s needs. “Israeli forces target solar panels at Gaza’s al-Shifa hospital”, Al Jazeera, 6 November 2023.

[6] “Following US pressure, Israel approves increase in fuel delivery to Gaza”, Times of Israel, 7 December 2023. A week later, Egypt said it had agreed with Israel to raise the amount to 189,000l daily, but Israel did not confirm. “Egypt to boost daily fuel supply to Gaza Strip amid ongoing humanitarian aid efforts”, Anadolu Agency, 14 December 2023.

[7] Crisis Group telephone interviews, aid officials, February 2024. “Hostilities in the Gaza Strip and Israel – Flash Update #45”, OCHA, 20 November 2023. Crisis Group telephone interview, UNRWA official, November 2023.

The siege limited Gaza’s water supply. Israel turned off the three pipelines that brought in just under 15 per cent of Gaza’s total water needs, a small portion of which was quickly restored. Within a week, the four seawater desalination plants that supplied the rest of Gaza’s water shut down for lack of fuel.[1] By 20 December, UNICEF estimated that children in southern Gaza had access to only 1.5-2l of drinking water per day – a severe deficit when measured against the World Health Organisation’s (WHO) recommendation of 50l daily, 15l of which are necessary for basic cleaning and consumption in emergencies and 3l for simple survival.[2]

Damaged infrastructure and a shortage of containers limited those in tents and shelters to the small amounts their few vessels could store, exacerbating the crisis.[3] People resorted to using brackish or saline water from agricultural wells – unsafe sources – which resulted in infectious skin diseases and caused diarrhoea and dehydration, especially among children.[4] Dehydrated mothers have struggled to produce the milk needed to keep their newborn babies alive.[5] These problems are still present in the north and, to some extent, the centre, where people continue to drink well water. The situation in Rafah is better, owing to the local desalinisation plant and the wider availability of plastic jerrycans, though people still must queue for water. In early April, Israel announced the restoration of the Nahal Oz pipeline to the north, which had previously no access to clean water.[6] Wastewater treatment remains out of commission.

[1] “Hostilities in the Gaza Strip and Israel – Flash Update #23”, OCHA, 29 October 2023. A UAE-funded desalination plant across the border in Egypt went online on 19 December. It eased the shortage in Rafah, but the destruction of Gaza’s infrastructure means the benefit was primarily local. “Parched Gaza residents praise water tasting ‘like sugar’ from Egypt”, Reuters, 21 December 2023.

[2] “‘Barely a drop to drink’: Children in the Gaza Strip do not access 90 per cent of their normal water use”, press release, UNICEF, 20 December 2023. See also “The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response”, Sphere, 2018.

[3] Crisis Group interviews, Rafah, January 2024.

[4] “Explainer: Water Supply & Fuel Relationship in the Gaza Strip”, UN WASH Cluster, 14 November 2023.

[5] “Lives in Peril: Gaza’s Pregnant, Nursing Mothers and Children Face Imminent Danger Amid Desperate Water Shortage”, ActionAid, 17 October 2023.

[6] As of mid-March, only one of the three pipelines bringing water from Israel was functional, at 42 per cent. Three of four desalination plants were at least in part online. “Hostilities in the Gaza Strip and Israel – Flash Update #160”, OCHA, 15 March 2024. “UN says Israel approved reopening of 20 bakeries, water pipeline in northern Gaza”, Times of Israel, 6 April 2024.

The health sector has largely collapsed. The secretary general of Médecins Sans Frontières, Christopher Lockyear, told the UN Security Council on 22 February that “there is no health system to speak of left in Gaza”.[1] The damage to medical facilities and lack of supplies amid rising casualties compels doctors to resort to triage. (Israel justifies its operations in and around hospitals by accusing Hamas of using them for military purposes, though it has not always provided adequate information to evaluate these claims.) Their means are limited, giving rise to harrowing situations such as doctors conducting amputations without anaesthesia.[2] Basic items are in terribly short supply: gauze, for instance, is sterilised and reused for the next patient. Israeli border officials occasionally reject items such as scalpels, saline solution and oxygen tubes, citing their dual-use potential, that is, the possibility that they might be used as weapons or to make weapons.[3] As of late March, only ten of Gaza’s 36 hospitals were even minimally functioning.[4]

Maternal health is gravely threatened. Malnutrition and dehydration afflict nearly 60,000 pregnant women, and across the strip, 90 per cent of children under two, as well as 95 per cent of pregnant and breastfeeding women, suffer severe food poverty.[5] Many pregnant women are severely anaemic, increasing the risk of harm to mother and child. About 180 women give birth every day, many in shelters with no privacy, in public bathrooms or in unheated tents.[6] In several hospitals there is no anaesthesia for women who require C-section procedures. Infections and waterborne diseases among newborns are common due to unsanitary conditions and lack of water.[7] [1] “MSF to UN Security Council: The people of Gaza need an immediate and sustained ceasefire now”, Médecins Sans Frontières, 22 February 2024.

[2] Crisis Group interviews, physicians in Gaza, Rafah, February 2024.

[3] Crisis Group interviews, international humanitarian agency officials, October-November 2023 and February 2024.

[4] Post on X (formerly Twitter) by Tedros Adhanom Ghebreyesus, WHO director-general, @DrTedros, 7:57am, 30 March 2024.

[5] “Thousands of pregnant women in Gaza suffer from malnutrition, health authorities say”, The New York Times, 10 March 2024; “Children’s lives threatened by rising malnutrition in the Gaza Strip”, WHO, 19 February 2024.

[6] “Women in Gaza give birth in tents and public bathrooms”, The Wall Street Journal, 6 February 2024.

[7] “100 days of darkness in Gaza: Urgent focus on maternal and reproductive health needed”, CARE, 12 January 2024.
” Infections are straining the entire health system, largely because of malnutrition and cramped conditions. “

Infections are straining the entire health system, largely because of malnutrition and cramped conditions. Sanitation facilities are dismal. At IDP sites in Rafah, there is one toilet for every 341 people. Showers are available at less than 40 per cent of sites; where they are present, there is one shower for roughly every 1,300 people.[1] Without access to menstrual pads and running water, some women resort to using tent material to manage their periods.[2] Already a month into the conflict, humanitarian agencies warned of the imminent and rapid spread of communicable diseases.[3] By mid-March, the health cluster had recorded nearly 300,000 cases of acute diarrhoea and nearly 525,000 cases of acute respiratory infection.[4] In February, at least 90 per cent of children under five suffered from at least one infectious disease and 70 per cent had diarrhoea with a two-week span.[5]

Water and electricity shortages in Gaza are longstanding, but famine is new. The March assessment of the Integrated Food Security Phase Classification (IPC), like the report of Famine Early Warning Systems Network (FEWS NET) released the same day, suggests that famine is imminent.[6] Northern Gaza has already more than met the first two criteria for declaring a famine (percentages of people enduring extreme food consumption gaps and children suffering from acute malnutrition) and possibly also the third, concerning the non-trauma mortality rate, most often due to malnutrition and disease.[7] The IPC estimated that 210,000 people in the north will soon face famine. The visual evidence is striking: the emaciated bodies of malnourished children; the gaunt neighbours unable to recognise one another; the desperate people swarming food trucks despite often deadly violence.[8] [1] “Humanitarian Needs and Response Update, 27 February-4 March 2024”, OCHA, 5 March 2024.

[2] “Another layer of misery: Women in Gaza struggle to find menstrual pads, running water”, NPR, 11 January 2024. Overcrowded shelters and lack of sanitation facilities also expose women and girls to increased risks of violence, abuse and exploitation. “Gaza Crisis: Gender Based Violence Concerns and Priorities. Information & Advocacy Note”, GBV Sub-cluster, 20 October 2023.

[3] “The Unfolding Water Catastrophe in Gaza”, Oxfam, 13 November 2023; and “Explainer: Water Supply and Fuel Relationship in the Gaza Strip”, op. cit.

[4] “oPt Emergency Situation Update”, WHO, 7 October 2023-12 March 2024.

[5] “Nutritional Vulnerability and Situational Analysis/Gaza”, Global Nutrition Cluster, February 2024.

[6] The IPC is a global partnership that classifies the severity of food insecurity crises on a standardised scale. It is widely regarded as the gold standard for famine assessment. “IPC Global Initiative – Special Brief – Gaza Strip”, IPC, 18 March 2024. FEWS NET, supported by USAID, is a food insecurity early warning network. “Gaza Strip Targeted Analysis”, FEWS NET, 18 March 2024.

[7] Israel issued a response to the IPC report alleging that it contains several inaccuracies and methodological flaws, but without refuting its findings. Famine occurs when three indicators (food consumption, acute malnutrition in children and non-trauma morality, principally from malnutrition and disease) rise above certain thresholds (respectively 20 per cent, 30 per cent and two persons per day per 10,000 persons). Israel’s response does not mention any of these terms, much less contest the IPC’s analysis or disprove its conclusion that famine is imminent. “Food and Food Security in the Gaza Strip – Response to the IPC Report”, op. cit.

[8] Crisis Group telephone interview, March 2023.

The war has demolished Gaza’s food system. Before 7 October, 60 per cent of Gaza’s food was imported. But from 1 January to 25 February, aid provided only 15 per cent of the minimum daily kilocalorie requirements in northern Gaza, virtually all of which went to the North Gaza region, leaving Gaza City with only one food distribution in almost two months. Rafah fared better, with 56 per cent of its minimum daily needs covered. Khan Yunis theoretically did better still at 93 per cent, but fighting in the city stopped many people from getting food. Deir al-Balah in the strip’s centre was best off, at 219 per cent of the minimum, partly because it benefited from rations that Israel prevented from moving north.[1] In March, particularly in its second half, aid availability rose.[2] The war has crippled much of the strip’s agriculture, which previously produced much of the remaining 40 per cent of food for consumption. Fruits and vegetables have long been inexpensive in Gaza because Israel often blocked their export. One person said, “That’s how we survived. Now I buy one cucumber and one tomato for my whole family to share”.[3]

The search for food has become increasingly time-consuming, expensive and dangerous. Cost has skyrocketed, with the prices of many items up ten times or more since 7 October, and even more in the centre and especially in the north, putting provisions out of reach for many. Back in December, Crisis Group staff watched people in Rafah leave empty-handed after queueing for flour for ten hours at a time on four consecutive days.[4] Now in the north, where up to 300,000 remain, people must often choose between starvation and bullets.[5] Aid convoys and distributions are frequently deadly, due to Israeli strikes, competition among the hungry for supplies and vendettas after previous violence.

On the eve of the war, UNRWA, already facing a budget shortfall, provided food in Gaza to over 1.2 million registered refugees, most of whom are descendants of those made homeless in the 1948 war.[6] Today, UNRWA and the World Food Program (WFP) also give aid to those internally displaced by the fighting. The aid rolls have swelled even as the amount of food available has diminished. Following Israel’s accusations of UNRWA staff involvement in the 7 October attacks, the U.S. and other donors suspended funding. While some funding was later reinstated, the contributions from the U.S., historically UNRWA’s largest donor, were not restored. The budget crunch and Israel’s restrictions make the agency’s long-term viability unclear – even as World Central Kitchen and Anera, the two largest charities operating in Gaza, which between them provided some 2 million meals a week, suspended operations after Israel killed seven of the former organisation’s workers on 1 April.[7] [1] “Gaza Strip Targeted Analysis”, op. cit., p. 11.

[2] Crisis Group interview, UNRWA official, 20 October 2023. See also “IPC Global Initiative – Special Brief – Gaza Strip”, op. cit.; “Hostilities in the Gaza Strip and Israel – Flash Update #73”, OCHA, 19 December 2023; and “Gaza’s food crisis”, The New York Times, 29 January 2024.

[3] Crisis Group interview, Rafah, January 2024.

[4] Crisis Group observations, December 2023.

[5] OCHA puts the number of displaced people staying in northern shelters at 130,000. “State of Palestine – Internally Displaced Persons”, OCHA. The Gaza government says the number is 600-700,000, but that is almost certainly an exaggeration.

[6] On UNRWA’s pre-war financial crisis, see Crisis Group Middle East Report N°242, UNRWA’s Reckoning: Preserving the UN Agency Serving Palestinian Refugees, 15 September 2023.

[7] “What does restored funding mean for UNRWA’s future?”, CBC News, 12 March 2024. For background, see Daniel Forti, “Why Donors Should Not Suspend Aid to UNRWA”, Crisis Group Commentary, 7 February 2024. On World Central Kitchen and Anera, see “Fears for Gazans as aid groups halt work over deadly Israeli strike”, BBC, 4 April 2024.

While, at the outset, food scarcity promoted a communal ethic of sharing and compassion, today it more noticeably leads to disorder. Desperation and opportunism have followed the absence of law enforcement. Much of the strip has seen a breakdown in public order, as local police do not dare appear in uniform for fear of being targeted by Israeli forces. Hamas took the lead in forming local emergency committees to maintain a modicum of order and facilitate aid delivery, but under attack from Israel, the committees announced the suspension of activity.[1] Warehouses and trucks sometimes have been pillaged by hungry people – “spontaneous self-disbursement” as the UN euphemistically says – as well as by criminals who steal food to resell in the market.[2]

Occasional internet and mobile communication blackouts have stoked further chaos. Emergency responders are unable to find the injured and delivery trucks to locate aid distribution sites when the pertinent information, delivered through text messages, suddenly stops arriving.[3] When Gaza’s telecommunications falter, a senior aid official said, assistance in effect halts. Israel prevents aid agencies from importing the communications equipment that is standard for humanitarian agencies in much of the world, since it appears on the dual-use list.[4] [1] “اللجانالعشائريةبغزةتعلنوقفتأمينالمساعدات” [The tribal committees in Gaza announce the stoppage of aid facilitation], Al Jazeera, 31 March 2024.

[2] Crisis Group interview, UNRWA official, 31 October 2023.

[3] “Hostilities in the Gaza Strip and Israel – Flash Update #22”, OCHA, 28 October 2023. See also tweet by the Palestine Red Crescent Society, @PalestineRCS, 1:14pm, 31 October 2023.

[4] Crisis Group interview, aid official, New York, February 2024.
III. The Roots of Famine (I): Access

Israel and Hamas have fought before, but this war has been different. During the escalations in 2008-2009 and 2014, Israel agreed to temporary ceasefires (unilateral in the former case, both unilateral and negotiated in the latter) to admit aid, mainly through Kerem Shalom, though fighting made distribution difficult and aid groups criticised the efforts as inadequate. Emergency measures such as a bonded warehouse near Kerem Shalom allowed aid to continue flowing. Now, however, Israel is determined to change the rules of the game with Hamas – to destroy it. To this end, it cast aside the aid playbook that had kept people fed, if not enough, in previous wars. A UN official said:

Gaza is not a humanitarian operation in the proper sense of the term. The best practices have been stripped away. What’s left is humanitarian opportunism to meet whatever needs we can, with limited resources, within a security environment that we can’t plan for. Meanwhile, everyone is now needy. It’s hard to figure what “most vulnerable” means or even what to do once we figure that out, since when we dispatch aid, it is with the expectation that it won’t be able to get where it’s going, will be taken by the desperate, or struck by the Israelis.[1]

From the war’s earliest days, Israel conditioned access to Gaza on the return of its hostages. A few days after Defence Minister Yoav Gallant declared Gaza closed to “everything”, including food and medicine, the Israeli energy minister, now foreign minister, Israel Katz, tied humanitarian aid to the release of captives.[2] When U.S. President Joe Biden later that month personally pressed Israel to allow “life-saving humanitarian assistance” into Gaza, Prime Minister Netanyahu agreed to only derisory amounts – twenty trucks daily instead of the average 500 trucks that had been entering before the war, despite the much greater need – and only from Egypt, not directly from Israel, whence most goods had been arriving before 7 October.[3] [1] Crisis Group interview, New York, January 2023.

[2] On 9 October 2023, Gallant announced that Israel would not permit food, electricity or fuel to enter the strip. “Everything is closed”, he said. Times of Israel, 9 October 2023.

[3] “No power, water or fuel to Gaza until hostages are freed, says Israel minister”, The Guardian, 12 October 2023.

For months, Israel made substantial relief for Gaza’s 2.23 million people contingent on securing concessions on the hostages. The linkage formed the basis of the “humanitarian pause”, the seven-day period starting on 24 November 2023 during which Hamas freed 105 hostages and more aid entered Gaza than during any other week since the 7 October attacks.[1] It also undergirded the agreement for Israel to send medicine for its 129 hostages held by Hamas in exchange for allowing more medicine to enter Gaza for the Palestinians living there.[2] [1] Ibid.

[2] “Israel and Hamas are in talks to deliver medicine to hostages in Gaza”, The New York Times, 11 January 2024.
” [Egypt’s] officials view Gaza’s crisis as first and foremost a political issue, not a humanitarian one. “

Egypt therefore emerged as the sole channel for aid and humanitarian staff, which came via the Sinai Peninsula and its main airport at al-Arish. Cairo never wanted to be the balm for Gaza’s distress. Egyptian officials fear the mass displacement or expulsion of Palestinians from the strip to Sinai, but they also fret about Gaza becoming an Egyptian ward – or worse, an Egyptian province. The country’s officials view Gaza’s crisis as first and foremost a political issue, not a humanitarian one. As they see it, the best answer is a ceasefire, not a massive aid operation.[1]

Cairo has ample reason to worry. The arrival of hundreds of thousands of Palestinian refugees likely would associate the country with the stigma of a second Nakba (or “catastrophe”, as the mass displacement during the 1948 war is known in Arabic) and, more broadly, threaten to destabilise Egyptian politics. Cairo is already jittery about security in the Sinai because of a lingering, decade-old jihadist insurgency and a general wariness of Hamas.[2] While it has largely succeeded, for now, in suppressing the insurgency, it fears that militancy may be rekindled by an influx of angry Palestinians with whom Egyptian jihadists could mix, especially if surviving Hamas fighters and sympathisers come to Sinai along with the other refugees.

The same tensions also militated against ramping up aid delivery from Egyptian territory. After Cairo designated al-Arish International Airport on 12 October as the reception centre for aid shipments destined for Gaza, it took a month of tricky negotiations to obtain President Abdelfattah al-Sisi’s signoff on expanding the northern Sinai facility for the UN to coordinate a stepped-up response.[3] The presence of hundreds if not thousands of international aid workers poses a security challenge, since they could be soft targets or, alternately, used as cover to smuggle in weapons or militants. For a country with a strong state that prizes central control, the UN logistics hub also raises concerns about sovereignty. As a humanitarian agency official said of places with big aid operations, “We tend to take over”.[4]

Crucially, Egypt requires that its own authorities and the Egyptian Red Crescent take delivery of the aid, cross-load and inspect the cargo, and transfer the goods for Israeli inspection. Despite permitting the UN to establish the hub, Cairo refuses to allow international staff to run logistics, though it does allow a handful of UN technicians to embed with the Red Crescent to help with cross-loading. Still, the number of staff is insufficient. A UN official said personal relationships had improved but the bureaucratic impediments were still significant.[5] Another issue is the corruption allowing merchants to purchase priority spots in the queue of trucks that stretches many kilometres into the Sinai, which inflates consumer prices and sometimes introduces goods unsuitable for a starving population.[6]

After al-Arish, the next stage of the journey is Israeli inspection. Until Kerem Shalom reopened on 7 December, Israel was inspecting cargo at Nitzana, a village in Israel near the Egyptian border, about 40km south of Kerem Shalom. In November, the U.S. provided new scanning equipment for Nitzana to move trucks through faster, though it did not raise the average daily throughput. The number of trucks jumped to nearly 200 daily during the seven-day humanitarian pause that started on 24 November – not because of any technology but because Israel partially lifted its back-to-back inspection regime, allowing some trucks to skip Nitzana and keep driving into Gaza. Trucks, unusually, also entered at night. “The rules were bent”, said an aid official, “because of the politics”.[7] With Hamas threatening to bring the pause to a premature end because Israel was not admitting the agreed-upon number of trucks, the procedures suddenly became more flexible.

[1] Crisis Group interviews, Egyptian officials, Cairo, November 2023.

[2] See the Egypt section in Crisis Group Commentary, “The Gaza War Reverberates across the Middle East”, 4 November 2023.

[3] “Egypt designates El-Arish airport as Gaza aid hub, denies Rafah border crossing closure”, Ahram Online, 12 October 2023.

[4] Crisis Group telephone interviews, OCHA and WFP officials, October 2023.

[5] Crisis Group telephone interviews, humanitarian organisation official, 8 December 2023 and 14 January 2024. Some problems have been resolved. The Egyptian Red Crescent, regardless of the donor, had been repackaging and branding its logo on arriving cargo without itemising the contents, which was prolonging inspection at Israeli checkpoints. In early December, however, the UN together with the Red Crescent introduced a tracking system, based on QR codes, for trucks destined for Gaza, showing their contents and location. Crisis Group telephone interviews, UN agency officials, October-December 2023. Crisis Group interviews, UN agency and International Federation of the Red Cross officials, Amman and Cairo, November 2023.

[6] Crisis Group interviews, Gaza, December 2023 and January 2o24.

[7] Crisis Group interview, aid official, December 2023.

But that did not last. The overall number of trucks remained low, even after Kerem Shalom was reopened for inspections on 7 December and passage into Gaza on 17 December. Henceforth, NGO and UN traffic was inspected at and entered Gaza through Kerem Shalom, while Egyptian and Palestinian Red Crescent traffic was inspected at Nitzana and entered via Rafah. Aid agencies hoped that the opening of Kerem Shalom would allow for additional routes, including a humanitarian corridor via Jordan. After weeks of negotiations, a pilot collaboration between Jordan and the WFP in December saw 46 aid trucks from Jordan get into Gaza through Kerem Shalom in December. Aid officials praised the efficiency of the operation, though it took several months for Israel to approve further use of the route, reportedly because of concern that the Israeli public might react negatively if assistance began flowing into the strip.[1]

Checks include a combination of explosive-sniffing dogs, scanners and visual inspection. Before the war, the process could take as little as five minutes per truck, while it currently can take up to two hours. Delays stem from many factors. Inexact manifests and unclear packaging, sometimes the result of the Egyptian Red Crescent rebranding at al-Arish, can force offloading to identify the cargo. Military operations sometimes lead to closure, as on 22 December, when an Israeli drone strike killed four Palestinians at Karem Abu Salem, the Gaza side of Kerem Shalom, including the crossing director, Bassam Ghaben. An Israeli official claimed that soldiers had seen weapons on the Palestinian side of the crossing, though as people in Gaza point out, sidearms are necessary to ward off looters or even to stop Palestinians from attempting to rush across the border.[2]Other such reported threats have likewise shut down the crossing.

Aid officials and diplomats report that procedures are inconsistent, particularly for items that Israel deems to be dual-use. Inspectors apply varying restrictions, which are communicated informally if at all.[3] Though the official list of prohibited items is out of date, Israel has not released a new one amid the emergency. Among the items routinely barred are building materials, including cement and certain metals, because they were used to construct tunnels. But the lack of guidance often leaves aid agencies guessing what they can bring in and what they cannot.[4] Israel occasionally still bans the import of tent poles, even as agencies struggle to shelter the displaced, and sometimes rejects tinned food, saying militants might use the tins in improvised explosive devices.[5] When a dual-use item is rejected, the entire truck carrying it, including approved items, is often turned away. Agencies are not always told which item Israel rejected, and if they are informed, whether Israel rejected the item or a component thereof. If a truck is turned back, it must get back in line with thousands of others. Average wait time is twenty days.[6]

When U.S. Senators Chris Van Hollen and Jeff Merkley toured Rafah in early January, they visited a warehouse containing items rejected by Israel, including kits for delivering babies because they contained scalpels, oxygen cylinders and gas-powered generators. When the Israeli official responsible for the crossing was questioned about medical equipment like the rejected items the senators had just seen, he insisted they were not prohibited.[7] [1] “WFP delivers first aid convoy from Jordan to Gaza”, press release, WFP, 20 December 2023. Crisis Group telephone interview, aid official, 15 February 2024. In February, a poll indicated that 72 per cent of Israelis oppose aid to Gaza so long as Hamas continues to hold hostages. “Israeli protesters block aid convoys bound for Gaza”, France 24, 19 February 2024.

[2] “Hamas claims head of Gaza border crossing killed in Israeli airstrike”, Times of Israel, 22 December 2023; “Gaza-bound aid trucks endure grueling wait at border”, France 24, 22 December 2023.

[3] Crisis Group interviews, humanitarian agency officials, October-November 2023.

[4] Gisha, an Israeli group that promotes freedom of movement for Palestinians, is suing the Israeli government to obtain information about Israel’s current policy on the entry of goods to Gaza. “Freedom of Information requests regarding entry of goods to Gaza”, Gisha Legal Center for Freedom of Movement, 12 February 2024.

[5] Crisis Group interviews, UN humanitarian agency officials, October-December 2023. See also “Factsheet Kerem Shalom”, Gisha Legal Center for Freedom of Movement, March 2020. Crisis Group telephone interviews, UN humanitarian agency officials, October 2023.

[6] “Inflicting Unprecedented Suffering and Destruction”, Oxfam, 15 March 2024.

[7] “Cumbersome process and ‘arbitrary’ Israeli inspections slow aid delivery into Gaza, US senators say”, ABC News, 6 January 2024. The Israeli official said, “I want to make it clear we are not refusing anything that is underneath four headlines … food, water, medical supplies and shelters”, despite the fact the senators had just seen the rejected items.
” As the U.S. turned up its criticism of how little aid is getting in, the number of trucks entering rose, but progress was uneven. “

As the U.S. turned up its criticism of how little aid is getting in, the number of trucks entering rose, but progress was uneven. After unprecedented public rebukes from the U.S., and just days before the IPC and FEWS NET released their famine assessments, Israel announced that it would “flood the zone” with supplies. It permitted aid from Morocco, which landed at Ben Gurion Airport in Tel Aviv, to be transferred to the Palestinian Red Crescent at Kerem Shalom. It also allowed a six-truck WFP convoy to enter northern Gaza.[1] In subsequent days, more trucks went into Gaza, though their cargo was still much less than what is needed. In early April, after the strikes on the World Central Kitchen workers prompted sharply negative reactions from abroad, Israel pledged to admit yet more aid, including, at least temporarily, through the Erez crossing.

Increased access is vital, but aid officials argue the number of trucks is a “false metric” for gauging the sufficiency of humanitarian assistance. The number of kilocalories Gaza’s population needs to survive is known. But the number of trucks required to meet that need depends on many factors, which tend to vary over time, including food’s caloric content, truck size and pallet size; wastage and maldistribution; and the accuracy and consistency of manifest reporting. Potato chips, soda and candy are particularly poor choices for a malnourished population, as is frozen chicken in a compromised cold chain, all of which have been included in commercial shipments to Gaza since October.[2] Also crucial is distribution once the aid enters Gaza. Especially in the north, distribution has been an enormous problem.

[1] “UN and Morocco deliver humanitarian aid to Gaza via land routes through Israel”, Times of Israel, 13 March 2024.

[2] Crisis Group telephone interview, aid official, 26 February 2024. Crisis Group interview, food security expert, 14 March 2024.

IV. The Roots of Famine (II): Distribution

The mere entry of goods does not guarantee distribution to the areas where they are most needed. Goods cannot be stored or transported securely due to Israel’s refusal to grant permission, military operations and looting by the desperately hungry. In some places vehicles can barely move at all: Rafah and the surrounding area is so densely packed that many roads are impassable. An expanse of people stretches over most of Rafah all the way to the Mediterranean, with space at such a premium that some of the displaced camp not far from the water’s edge.[1]

The biggest impediment to movement is Israel’s military campaign. Israel in effect disabled “deconfliction” – or coordinating military and humanitarian activities to ensure safe delivery of assistance in conflict zones.[2] The deconfliction system, at least until the killing of the seven World Central Kitchen workers on 1 April, has been run on Israel’s side by the Coordination of Government Activities in the Territories (COGAT), a defence ministry body. Although aid groups still sent planned movements and facility locations to COGAT, as World Central Kitchen did, the army limited itself largely to confirming receipt of this information. It no longer guaranteed safe passage or told the agencies whether it intends to strike one of their facilities or the immediate vicinity, although it tended to issue evacuation orders 30-120 minutes prior to a planned attack.[3]

This laxity explains why Israel has killed some 200 aid workers, including from international NGOs, since 7 October.[4] Nearly all have been Palestinians, though the deaths of six foreign nationals (who were Australian, Canadian, Polish, UK and U.S. citizens) working for World Central Kitchen have attracted the most attention globally. The 1 April incident forced Israel to issue a rare admission of responsibility, in which it acknowledged that, when the three vehicles transporting the aid workers were struck, they were travelling on a route approved by the army.[5] An Israeli investigation revealed that the drone operators who killed the workers were unaware that the army had greenlighted the trip, confirming a longstanding suspicion among aid agency staff.[6] World Central Kitchen promptly pulled out of Gaza (with Anera following suit), concluding that all its employees were in danger, Israeli deconfliction procedures notwithstanding.

[1] Crisis Group interview, Rafah, January 2024.

[2] Since the war began, the only deconfliction channel still functioning has been the military-to-military mechanism between Israel and Jordan, which has allowed Jordan to drop aid packages from the air. Deconfliction arrangements must also be made for the naval corridor the U.S. has proposed for bringing supplies to Gaza.

[3] Crisis Group interviews, humanitarian agency officials, Amman, Cairo and by telephone, October-November 2023.

[4] Aid Worker Security Database, Occupied Palestinian Territories.

[5] “Israel blames misidentification for strike that killed Gaza aid workers”, The Wall Street Journal, 3 April 2024.

[6] “Before WCK strike, aid groups had warned of peril to Gaza relief workers”, Washington Post, 5 April 2024.
” No area of Gaza is safe for staging aid or its distribution. “

No area of Gaza is safe for staging aid or its distribution. After calling on northerners to move south, Israel proposed to establish a “safe zone” in al-Mawasi, a patch of desert along the coast without infrastructure, with U.S. support. Aid agencies rejected the proposal, refusing to build anything in the area, since, they said, there is no guarantee Israel will not strike al-Mawasi and civilians are not free to move there safely. The agencies’ chiefs wrote on 15 November, “concentrating civilians in such zones in the context of active hostilities can raise the risk of attack and additional harm”, enumerating the conditions under which they would cooperate with the endeavour.[1] In parallel, Israel identified some 150 shelters it said would not be hit, including UNRWA schools and public buildings, but Crisis Group was unable to locate anyone in Gaza who knew which of the many facilities in which the population has taken shelter numbered among the 150.[2]

With UNRWA schools overloaded, several UN agencies offered a counterproposal: that commercial buildings such as festival halls and stadiums as well as remaining government facilities be deconflicted with Israel as alternative shelters.[3] Israel refused. Instead, following the resumption of hostilities on 1 December, Israel unilaterally declared Rafah and al-Mawasi relocation zones, meaning that it called on the population of Khan Younis and other areas to flee there to avoid the ground invasion in the south. In late December, it instructed Palestinians in the north-central strip (which itself had previously been designated a safe area, during Israel’s campaign in the north) to flee to the south-central part. Among these areas, Israel called only al-Mawasi a “safe” zone. That label notwithstanding, people in Rafah told Crisis Group that al-Mawasi has been bombed and the ground operation extended there as well.[4] As for overcrowded Rafah, it, too, has been hit many times.

[1] “Humanitarian Chiefs Will Not Take Part in Unilateral Proposals to Create ‘Safe Zones’ in Gaza – Statement by Principals of the Inter-Agency Standing Committee”, UN Development Programme, 16 November 2023.

[2] Crisis Group interviews, Rafah, December 2023. “Israel says there are 150 shelters in Gaza that it won’t target in addition to al-Mawasi safe zone”, Times of Israel, 8 December 2023.

[3] Crisis Group telephone interviews, UN humanitarian agency officials, November 2023.

[4] Crisis Group telephone interviews, December 2023 and January 2024.

Among those hit are Gaza’s civilian police, who kept responsibility for ensuring order during the war’s first months.[1] The police were more active in Gaza’s centre and south, though they returned to some parts of the north cleared by Israel.[2] They guarded warehouses, among other places, accompanied convoys to prevent theft by criminals or the hungry, and watched over work at aid distribution points. But in early February, Israel struck several police cars in Rafah, killing up to nine officers. Among the dead was a senior police officer who likely had ties to Gaza’s Internal Security Agency, which, under the auspices of the interior and national security ministry, is responsible for domestic intelligence matters, like the Shin Bet in Israel or the Federal Bureau of Investigation in the U.S. During this period, Israel dropped flyers in Rafah depicting a destroyed Palestinian police car that read, “Our message is clear: the Israeli security services will not allow the security apparatuses of Hamas to continue working”.[3] In Israel’s eyes, there is no distinction between Gaza’s civil authorities and Hamas combatants.

Police across the strip then withdrew, which ten days later forced the WFP to announce a halt in aid delivery to the north as convoys faced “complete chaos and violence due to the collapse of civil order”.[4] Days later, UNRWA, too, stopped operations as its trucks could not safely pass through crowds of famished people.[5] The U.S. and UN asked Israel to stop targeting the police, with the U.S. saying a “total breakdown of law and order” would turn Gaza into “Mogadishu”. Israel refused, citing its anti-Hamas campaign.[6]

The assaults on Gaza’s civilian police created a vacuum for both law and order and humanitarian purposes, which presented Israel with an opportunity to pilot its day-after plan for controlling Gaza.[7] Netanyahu presented this plan to the war cabinet on 22 February; it calls for recruiting prominent families to administer Gaza after the shooting stops. The Supreme Council for Tribal Affairs in Gaza publicly rebuffed Israel’s overture, as did virtually all the families Israel contacted.[8] Yet the plan still reverberated. It was apparently an early Israeli effort to coordinate with a Gaza City family that resulted in the first of what Palestinians now call “flour massacres” – the tragedy that unfolded on 29 February, when 118 starving Palestinians were killed as they mobbed a food convoy organised by merchants at Israel’s request and escorted by the Israeli army.[9] [1] The civil police, who form part of Gaza’s interior ministry, have a decent reputation in Gaza. They are perceived as less politicised than other security services (which is not to say unpoliticised). They have a strong professional reputation for criminal investigation, which, according to a Gaza researcher, is due to their information sharing with Hamas intelligence units. Crisis Group telephone interview, 29 March 2024.

[2] “Palestinian police in Gaza appear in uniform despite conflict with Israel”, Anadolu Agency, 14 December 2023.

[3] “Gaza aid disruption poses risk to Israel-Hamas hostage deal”, The Financial Times, 28 February 2024.

[4] “UN food agency pauses deliveries to the north of Gaza”, WFP, 20 February 2024.

[5] “UNRWA suspends aid to northern Gaza amid ‘collapse of civil order’”, The Guardian, 24 February 2024.

[6] The reference to Mogadishu evokes the early 1990s, when warlords fought over turf in the Somali capital after the state collapsed. “U.S. officials warn: Gaza ‘is turning into Mogadishu’”, Axios, 24 February 2024. When an Israeli army officer responsible for civilian coordination was asked the next month about targeting civil police, he replied, “Hamas police is Hamas. … And we won’t allow Hamas to control the humanitarian assistance”. “What to know about Gaza’s police force, which Israel is targeting”, The Washington Post, 21 March 2024.

[7] A senior Israeli official called the humanitarian effort a testing ground for post-war administration. “Israeli official confirms plan for locals to run ‘humanitarian pockets’ in Gaza”, Times of Israel, 22 February 2024.

[8] The Council was founded in 2012 to resolve social problems in Gaza. Abbas announced he would dissolve the Council in 2019, accusing it of working in support of his rival Muhammad Dahlan. No record of the dissolution exists, however, and the Council continued its activity despite Abbas’s announcement. “Abbas dissolves tribal affairs committee in Gaza”, Al-Monitor, 19 September 2019.

[9] Crisis Group telephone interviews, Gaza City residents, March 2024. See also “Israel helped organize convoy that ended in disaster”, The New York Times, 2 March 2024.
” Hamas countered Israel’s efforts with a mix of coercion and co-optation. “

Hamas countered Israel’s efforts with a mix of coercion and co-optation. It threatened anyone who cooperated with Israel – reportedly kidnapping eight members of a family as a warning – while also pursuing its own, more successful outreach.[1] Including in meetings at al-Shifa Hospital, it organised families, neighbourhood groups and political factions – including from Fatah, Hamas’s main rival – into its own emergency committees to maintain security and oversee aid distribution.[2] Food distribution for several days went off more smoothly on its watch.[3]

Israel struck back against both the organisers and the committees, starting on 18 March with its raid on al-Shifa Hospital, killing several figures who were instrumental in the aid effort. Among those killed were government officials, the heads of emergency committees and members of emergency committees, the most senior of whom was Brigadier General Faiq Mabhouh.[4] Hamas described Mabhouh as a police official in the Gaza government, while Israel accused him of leading the northern branch of “Hamas’s Internal Security Forces”, a formulation that blurs the line between Hamas as a militant organisation that fights Israel and Hamas as a non-state actor that runs a government in Gaza.

Not surprisingly, Hamas and Israel see this distinction differently. For Hamas, it is key: its Internal Security Agency answers to the Gaza government, as opposed to the movement’s military intelligence service, which is part of the Qassam Brigades, its combat battalions. That said, the Internal Security Agency plays a role in regime security, as opposed to the civil police, who focus on combating crime and upholding public order.[5] For Israel, the distinction is irrelevant: however Hamas might choose to divide its personnel and define areas of responsibility, Israel holds them all to belong to a single militant organisation that must be destroyed. For Israel, maintaining public order and even handing out humanitarian aid is tantamount to terrorism if Hamas is involved. After Israel killed the leaders of Rafah’s emergency committees, it issued a statement that explained, “The senior figures were representatives of Hamas leadership in Rafah, working to coordinate Hamas’s humanitarian operations and responsible for all movement activities and communication with Hamas activists on the ground”.[6]

By the end of March, Israel’s strikes on the emergency committees had killed more than 70 people waiting for aid convoys, eventually forcing the committees to stop working.[7] Among those killed were representatives of some of the same families that Israel had previously approached for cooperation. Israel also targeted the committee Hamas formed in Rafah to stop theft and war profiteering.[8] Israel contends that it went after people integral to Hamas’s war effort.[9] But the more likely motive was Israel’s concern that Hamas, via the Gaza government, remained in control of governance, of which food distribution is a highly visible element.

Israel further constrained the distribution of aid on 25 March, when it announced, a week after the IPC famine assessment, that it would not approve any more UNRWA aid convoys to Gaza’s north. It took this step even though the agency is the logistical backbone of relief efforts in the strip, underscoring its longstanding intent to put an end to UNRWA operations.

[1] Crisis Group telephone interviews, Gaza City residents, March 2024. Armed clashes between Hamas and family members were reported. The head of the family was killed. Hamas is widely said to be responsible for the death, but Hamas and the family both deny the claim.

[2] Al-Shifa Hospital houses a security office under the authority of Gaza’s Interior and National Security Ministry, which is the ministry that oversees both the civilian police and the internal security agency. Hamas used this office to coordinate emergency committees and aid oversight, contributing to the presence of many Hamas figures at the hospital during Israel’s mid-March raid.

[3] Crisis Group telephone interviews, Gaza City residents, March 2024.

[4] On the range of figures associated with the aid effort assassinated by Israel, see “Israeli airstrike kills 23 aid distribution committee members in northern Gaza”, Mada Masr, 20 March 2024. On Mabhouh, see Telegram post by al-Hadath newspaper, 10:02am, 18 March 2024; and tweet by Israel Defense Forces, @IDF, 8:53am, 18 March 2024. Within days, Majors Raed al-Banna and Mahmoud al-Bayoumi, both police officers involved in aid coordination, were also killed.

[5] “A Comprehensive Reference Guide to the Palestinian Security and Justice Sectors”, Geneva Centre for Security Sector Governance, August 2023.

[6] “IDF says airstrike in Rafah killed 3 senior officers in Hamas’s emergency committee”, Times of Israel, 20 March 2024. Similarly, Israel accused Mabhouh of responsibility for “synchronising” Hamas units in Gaza. “Top Hamas operative killed in hospital raid, army says”, Times of Israel, 18 March 2024.

[7] “اللجان العشائرية بغزة تعلن وقفتأمين المساعدات” [The tribal committees in Gaza announce stoppage of aid facilitation], op. cit.

[8] Crisis Group telephone interviews, Gaza City residents, March 2024.

[9] “Top Hamas operative killed in hospital raid, army says”, op. cit.

V. Israel’s Enabler

The U.S. since early in the war has voiced concerns about civilian protection, aid access and distribution mechanisms. While its remonstrations helped slow the tempo and intensity of Israel’s military campaign, and persuaded Israel to admit more kilocalories through the crossings, Gaza today still faces famine. The Biden administration contends that civilian protection and aid are not only compatible with but can facilitate Israel’s pursuit of its war objectives. Israel so far has chosen a different approach.

Current and former U.S. officials say they back the objectives of recovering the hostages and preventing another 7 October. For the war’s first five months, whatever disagreements the U.S. may have had with Israel’s methods, it sought to reconcile them through dialogue. Thus, the U.S. has kept the arms spigot on, and fiercely defended Israel at the UN, while pressing Israel privately (and, in some cases, publicly) to increase the aid flow and better protect civilians during fighting. Officially, the U.S. has dismissed any connection between releasing hostages and ramping up assistance to Gaza. But at least some U.S. officials appeared to be operating on the premise that aid would increase substantially only as part of a ceasefire agreement that includes setting the hostages free.[1]

Seen from Gaza, U.S. exhortations to improve aid access and distribution have achieved little. The administration convinced Israel to allow in more fuel and to open Kerem Shalom for importing aid – but acute malnutrition continues to rise. Israel operationally segmented the south of Gaza to enable a measure of deconfliction – but Khan Younis is now largely depopulated and much of it destroyed, as the north was. The UN says deconfliction has improved only marginally since the U.S. toughened its talk about the issue in December.[2] Israel is using smaller ordnance in the south than it did in the north, but that choice has a tactical logic: buildings are smaller, and airstrikes must account for soldiers’ movement on the ground. The U.S. enabled Israel to proceed with a military strategy that is close to maximalist, while taking a minimalist approach when it comes to addressing humanitarian concerns – which is the opposite of what famine prevention requires.

[1] White House Coordinator for the Middle East and North Africa Brett McGurk plainly described the aid-for-hostages equation in November, saying “We have been working to get humanitarian aid into Gaza increasingly, but the surge in humanitarian relief, the surge in fuel, the pause in fighting, will come when hostages are released. … [W]e aim to double th[e] amount [of aid] as soon as possible and see it grow exponentially from there. But I want to just stress: the hostages are released, you will see a significant, significant change”. IISS Manama Dialogue, 18 November 2023. Days later, the White House clarified that the U.S. does not support conditioning aid, saying McGurk had meant that a ceasefire providing for return of Israeli hostages would ease aid distribution in Gaza. “White House walks back McGurk’s aid-for-hostages link”, Politico, 20 November 2023. The equation, however, seems to remain central for some in the administration, as in this particularly infelicitous comment by White House National Security Communications Advisor John Kirby, who not only connected the return of hostages to the provision of life-saving aid to a territory on the brink of famine, but also stated that the latter is more important: “What we want: a temporary ceasefire for about six weeks that will allow us to get more aid in and, more importantly, get all those hostages back with their families where they belong and reduce the violence. That’s the deal on the table”. “Press Briefing by Press Secretary Karine Jean-Pierre and White House National Security Communications Advisor John Kirby”, 5 March 2024.

[2] Crisis Group interview, UN official, New York, February 2024.
” Secretary of State Antony Blinken went so far as to say that protecting Gaza’s civilians should be Israel’s “number-one priority”. “

As the severity of Gaza’s emergency grew over the course of February, along with the domestic political fallout for the Biden administration, the U.S. sharpened the tenor of its objections to Israel’s course. Secretary of State Antony Blinken went so far as to say that protecting Gaza’s civilians should be Israel’s “number-one priority”.[1] Vice President Kamala Harris called Gaza’s situation “inhumane” and rejected Israeli “excuses” for not allowing in more aid, including through land crossings.[2] President Biden addressed the Israeli leadership directly: “Humanitarian assistance cannot be a secondary consideration or a bargaining chip. Protecting and saving innocent lives has to be a priority”.[3] Senior figures in Biden’s Democratic Party have begun criticising Prime Minister Netanyahu himself. Chuck Schumer, the Senate majority leader and a politician with a strong pro-Israel record, even gave a speech calling for fresh elections in Israel to replace Netanyahu’s government.[4]

More concretely, unable to compel Israel to allow sufficient aid through land routes, the U.S. decided to pursue alternatives. As a U.S. official said, “We’re not waiting on the Israelis”, ostensibly indicating Washington’s resolve.[5] The U.S. joined Jordan and France in airdropping food into Gaza, though food security experts say the supplies are a drop in the bucket compared to the need – and the falling packages are demonstrably deadly.[6] During his annual State of the Union address, Biden announced the U.S. would build a floating pier, operational only in May, and which would not obviate the need for land crossings, to facilitate a maritime corridor from Cyprus.[7] In their insufficiency for addressing Gaza’s needs, these gestures highlighted that the U.S. was, in fact, “waiting on the Israelis” to open the land crossings.

In announcing its own steps, the administration also acknowledged that it had reached the limits of its influence or, at least, the limits of the levers it seemed prepared to pull. The levers that matter most to Israel are money, weapons and the political umbrella that the U.S. provides at the UN.

Regarding weapons and aid, the U.S. has appeared to be interpreting its way around, or otherwise skirting, legal and policy provisions that typically apply in this sort of situation. Relevant domestic laws relating to compliance with international law and ensuring access to humanitarian aid include the Arms Export Control Act, the Leahy laws (Section 362 of Title 10 and Section 2378d of Title 22) and Section 620I of the Foreign Assistance Act.[8] Relevant policies include the Conventional Arms Transfer Policy, Civilian Harm Incident Review Policy and the recently issued National Security Memorandum 20. All these statutes and policies are intended to either ensure oversight of the use of U.S. defence articles or block the U.S. from funding or arming countries engaged in activities that may violate international law, restrict access of U.S. humanitarian assistance or contribute to civilian harm. Rigorously applying any of them, were the administration so inclined, could mean cutting aid to Israel or relying on available exceptions.[9]

It is uncertain what leveraging stronger U.S. pressure on Israel could achieve, but the Biden administration, at least so far, has not tried to find out. Whatever qualms the White House might have, it remains committed to Israel’s defence and qualitative military edge in the Middle East, particularly with a conflict with Lebanon’s Hizbollah or directly with Iran still potentially on the cards.[10] Many of Biden’s political advisers are concerned that a frontal clash with Israel could entail a domestic political cost. His administration’s steadfast support of Israel, in this view, might be alienating some of its constituents, but it is a tried-and-true path with known political upsides that historically have outweighed any risk. Senator Schumer’s call for new Israeli elections notwithstanding, applying meaningful pressure – particularly in the form of aid conditionality, including through the implementation of U.S. law and policy – would be a significant shift for Biden.

The World Central Kitchen incident may have nudged the administration in this direction. Washington’s palpable anger led it, for the first time, to publicly moot a policy change.[11] Senior U.S. officials have said aid could be on the table.[12] Such a move would not be unprecedented. President Ronald Reagan suspended certain arms transfers to Israel, including due to Israel attacking civilians in Lebanon, and President George H.W. Bush halted loan guarantees to push back against Israeli settlement building.[13] Yet thereafter aid to Israel became sacrosanct. The question is whether its standing has shifted again.

There are good reasons why conditioning aid to Israel might not work and might even backfire. The U.S. could lose whatever leverage it still has, whether regarding Gaza or Lebanon (where it is trying to stop exchanges of fire between Hizbollah and Israel from escalating). Israel does not use many of its bigger-ticket armaments in Gaza; certain other weapons, including at least some of what it might use if it invades Rafah, it can produce itself – albeit more slowly and at higher cost. More generally, external pressure is often ineffective when a country considers its vital national security interests to be at stake, which is how Israeli leaders cast the need for a Rafah ground invasion (though it is far from clear that success in Rafah would translate into victory in the war overall). As he has already, Netanyahu could make political hay from a clash with the U.S., positioning himself as persevering – under duress from Israel’s closest ally – in a campaign most Israelis see as a necessity.

[1] See, eg, “Blinken to Israel: Reducing Gaza casualties an ‘absolute imperative’”, Al-Monitor, 8 January 2024.

[2] Harris said, “People in Gaza are starving. The conditions are inhumane, and our common humanity compels us to act. … [T]he Israeli government must do more to significantly increase the flow of aid. No excuses. They must open new border crossings. They must not impose any unnecessary restrictions on the delivery of aid. They must ensure humanitarian personnel, sites and convoys are not targeted. And they must work to restore basic services and promote order in Gaza so more food, water and fuel can reach those in need.” Remarks by Vice President Harris Commemorating the 59th Anniversary of Bloody Sunday, White House, 3 March 2024.

[3] President Joe Biden, “2024 State of the Union Address”, White House, 7 March 2024.

[4] Schumer has represented New York state in the Senate since 1999. Previously, he was in the House of Representatives. In his speech, he said Netanyahu had “lost his way by allowing his political survival to take precedence over the best interests of Israel”. “Majority leader Schumer calls on Israeli government to hold elections”, Senate Democrats, 14 March 2024.

[5] “Background Press Call on Humanitarian Aid for Gaza Ahead of the State of the Union”, U.S. National Security Council, 7 March 2024.

[6] As an expert said, “Nobody is going to argue with more kilocalories going into Gaza. But you need to ask whether feeding, say, one meal a week to a starving person is worth killing five people by dropping food on their heads”. Crisis Group interview, New York, 13 March 2024.

[7] The U.S. proposal involves creating a Defense Department-led mission to construct a temporary floating pier, costing millions of dollars, that might be able to provide two million meals a day for people in Gaza. Yet logistical hurdles, including the shallow waters off Gaza’s coast, lack of port facilities and the complexities of transferring aid from ships to shore, may limit the route’s effectiveness. Questions also remain about who will ensure the aid shipments’ safe passage and who will oversee the distribution once it reaches Gaza. Despite these issues, the maritime corridor could address some logistical bottlenecks, allowing for pre-inspection of cargo in Cyprus and potentially facilitating the clearance of items Israel classifies as dual-use.

[8] Sarah Harrison and Mairav Zonszein, “Shireen Abu Akleh’s Killing Raises Questions about U.S. Security Assistance to Israel”, Just Security, 16 December 2022; Brian Finucane, “Section 620I: No Military Assistance to States Restricting U.S. Humanitarian Assistance,” Just Security, 19 March 2024.

[9] Sarah Harrison, “Biden’s New Policy on Security Assistance, NSM-20, Will Not Save Gaza”, Lawfare, 14 February 2024; Brian Finucane, “Not Reassuring: NSM-20 and the Limits of Law-of-War Assurances in the Transfer of U.S. Arms”, Just Security, 13 February 2024.

[10] “Israel’s Qualitative Military Edge and Possible U.S. Arms Sales to the United Arab Emirates”, Congressional Research Service, 26 October 2020. “The concept of QME (independent of its application to Israel) dates back to the Cold War. In assessing the balance of power in Europe, U.S. war planners would often stress to lawmakers that, because countries of the Warsaw Pact had a numerical advantage over U.S. and allied forces stationed in Europe, the United States must maintain a ‘qualitative edge’ in defense systems. The concept was subsequently applied to Israel in relation to its Arab adversaries. In 1981, then-U.S. Secretary of State Alexander Haig testified before Congress, saying, ‘A central aspect of US policy since the October 1973 war has been to ensure that Israel maintains a qualitative military edge’”.

[11] Secretary of State Blinken said Biden demanded that Israel “announce a series of specific, concrete and measurable steps to address civilian harm, humanitarian suffering and the safety of aid workers” and that “U.S. policy with respect to Gaza will be determined by [its] assessment of Israel’s immediate action on these steps”. “Secretary Antony J. Blinken at a Solo Press Availability: Remarks to the Press”, U.S. State Department, 4 April 2024.

[12] “Biden suggests the U.S. could condition military aid to Israel over the Gaza humanitarian crisis”, NBC News, 4 April 2024.

[13] Brian Finucane, “Is Washington Responsible for What Israel Does with American Weapons”, Foreign Affairs, 17 November 2023. See also “Bush rejects Israel loan guarantees”, The New York Times, 18 March 1992.
” Israel relies particularly heavily on U.S.-made air munitions and related guidance kits. “

That said, the notion that Israel is only minimally susceptible to aid leverage is implausible, considering the quantity of weaponry the U.S. has sent to Israel since the start of the war. Israel relies particularly heavily on U.S.-made air munitions and related guidance kits. Washington also plays a pivotal role in maintaining Israel’s qualitative military edge, not to speak of the financial and other support it provides for Iron Dome, Israel’s state-of-the-art air defence system. If Israel did not urgently need U.S. weapons, it would not be asking for so many and the State Department would not be fast-tracking deliveries. Whether Israel’s sensitivity to aid conditionality would be enough to convince it to change course on Gaza is an open question, but the possibility ought not to be dismissed out of hand.

The U.S. is more likely to first use a third lever to alter Israel’s calculus: lifting its veto at the UN Security Council. Since the 7 October attacks, in keeping with longstanding U.S. practice, the Biden administration has shielded Israel from international censure and allowed the Israeli military campaign to proceed when much of the world wanted it stopped.[1] A possible sign of change of heart came on 25 March, when, after five months and ten different resolutions put to vote, the Council finally adopted one demanding a ceasefire, 2728. The resolution, jointly drafted by the Council’s ten elected members, demanded an “immediate ceasefire for the month of Ramadan”, leading “to a lasting sustainable ceasefire” as well as the immediate release of the hostages. The U.S. abstained in this vote after China and Russia had vetoed its own draft resolution several days before.

Though the U.S. abstention irritated Netanyahu, the resolution has not affected the fighting. After the vote, the U.S. called the resolution “non-binding”. Many states and scholars disputed this characterisation, yet without an enforcement mechanism, it matters little to Israel whether the resolution is “binding” or not.[2] [1] On 18 October 2023, the U.S. vetoed a resolution condemning the Hamas assault and calling for a humanitarian pause, supporting the latter measure only with Israel’s acquiescence more than a month later. Two months later, in December, U.S. removed the teeth from what would become Security Council Resolution 2720. In negotiations Abu Dhabi watered down the draft resolution’s language on a ceasefire (from calling for one to calling for creating the conditions for one) and replaced the provision for an independent inspection mechanism outside Israeli control with a clause asking the Secretary-General to appoint a senior humanitarian and reconstruction coordinator, albeit with an ambiguous mandate, to facilitate the delivery of aid “at scale”. In the end, the U.S. abstained in the vote.

[2] The U.S. argued that the text is non-binding because it lacked mention of Chapter VII authorisation or the word “deciding”, which was necessary, the U.S. claimed, to make the resolution binding under Article 25 of the UN Charter. Several member states and international legal scholars retorted that the resolution’s language – “demands” – is sufficient to fall under Article 25. These states primarily cited precedents such as the International Court of Justice’s 1971 decision regarding Namibia in making their case. “Mozambique & Others on Security Council’s Adoption of Gaza Ceasefire Resolution”, UN Press Stakeout, 25 March 2024. The debate hinges on differing interpretations of the UN Charter and the legal traditions to which one adheres.

VI. What Can and Should Be Done

It is impossible to reconcile, on one hand, Israel’s stated goals of destroying Hamas and toppling the government with, on the other, saving what remains of Gaza and preventing famine. Israel and the world face a stark choice. With Hamas significantly degraded but resistant, Israel with no path to decisive victory, and famine imminent, the alignment between moral and political imperatives is clear: the war must end.

To stave off famine, three changes are critical: dramatically increasing the flow into Gaza of goods, materials and humanitarian staff, particularly those crucial for famine response, to levels not previously considered; ensuring their freedom of movement throughout the strip, particularly in the north; and allowing Gaza’s civil authorities to safeguard distribution. None of these measures will work without the others, and all are likely moot without a ceasefire because the scale, coordination and rapidity of the response now required are incompatible with fighting anywhere in the strip. If securing a comprehensive ceasefire with a release of all hostages proves infeasible, a prolonged ceasefire getting some hostages out and more aid in would at least mitigate the rapid mass death from starvation and disease that is looming.[1] Recovery from malnutrition is uncertain, often interrupted by setbacks. It frequently lasts longer than the six-week pause the parties are reportedly discussing. Still, six weeks is better than nothing – especially if the period can be extended indefinitely, as the U.S. reportedly hopes to do.[2] [1] Hardin Lang and Jeremy Konyndyk offer sensible ideas compatible with the approach here. “The Looming Famine in Gaza and How to Stop It”, Foreign Affairs, 1 March 2024.

[2] Crisis Group interview, senior U.S. official, Washington, 10 March 2024.
” The urgency of the emergency is also the reason that UNRWA should not be sidelined, let alone shut down. “

The enormity of the crisis means a much larger response is necessary today than would have been necessary even a few months ago. A food security expert explained the escalating needs with a train metaphor: it takes a lot more force to stop an accelerating runaway train going downhill than a train under control on flat terrain.[1] If access to and movement within Gaza remain limited, with so many people malnourished and so many sectors needing repair, choosing which goods to send in and which not to will be tantamount to deciding who will live and who will die. Every day that passes without an adequate response means that the mortality curve will get steeper.

The urgency of the emergency is also the reason that UNRWA should not be sidelined, let alone shut down. While allegations against UNRWA staff warrant serious, independent examination, the agency is the logistical backbone of aid efforts and the primary provider of most of what is needed for famine prevention, especially food, health and water. If Israel completely rejects UNRWA leading the famine response in Gaza, the WFP, which has ramped up its work in Gaza since October, might be able to do the job, partnering with UNRWA in the background. WFP could never assume UNRWA’s quasi-governmental functions because its mandate does not encompass the breadth of essential services that UNRWA provides. But WFP is a global leader in famine response, which is what the moment demands.

[1] Crisis Group interview, food security expert, 16 March 2024.

Access of Goods and People to Gaza

There is no longer time to straighten out the snarled logistics resulting from re-routing the supply chains through al-Arish. Airdrops and a new floating pier are neither sufficient nor fast enough. Adopting the favoured expression of U.S. officials, Israeli army spokesman Daniel Hagari said Israel would “flood the area, flood it with humanitarian aid”.[1] That is exactly the right idea, and indeed, in March more aid entered Gaza than in any month since September, averaging nearly 160 trucks daily through 27 March. Israel rightly notes that more food trucks are now entering Gaza daily than before the war. While this trend is positive, it misses a larger issue: Gaza’s needs have surged far beyond food.

Famine prevention and response requires the provision of food, including therapeutic and supplementary foods for treating acute malnutrition, health care, safe water and sanitation services. Given the interconnected nature of the challenges, all must arrive simultaneously to prevent mass death. Treating acute malnutrition is not simply a matter of eating more calories. Food must be nutritionally appropriate for vulnerable groups, such as children, the elderly, and pregnant and nursing women. Equally critical is access to clean water and sanitation since starvation makes people highly susceptible to infectious disease, with epidemics more likely when people lack access to safe water and there is no sanitation. The lack of fuel is another important issue. Most of what has reached northern Gaza in recent weeks is flour, but without clean water and an energy supply to help turn it into bread, it will not provide much nutritional benefit to malnourished children.

Any chance of stopping the famine will require a big course correction. If the worst is to be avoided, Gaza needs an immediate, substantial improvement in access by road, to allow entry of:

Humanitarian aid. Hundreds more trucks a day are necessary. Yet the critical factor is not how many trucks get in but whether the goods they carry can meet Gaza’s needs.[2] Achieving this increase will require opening additional crossings into Gaza to circumvent obstacles like the breakdown of public order. With speed of the essence, food and basic goods must be transported along the shortest and most efficient route into Gaza, especially the north. A northern corridor is needed for rapid delivery of life-saving assistance directly to people at immediate risk of famine, if not suffering it already. The only way to establish such a corridor is to increase transshipment through the port of Ashdod in southern Israel, which Israel has said it will do temporarily, and ideally prepare Ben Gurion Airport to receive large shipments of humanitarian assistance. 

Israel recently experimented with Crossing 96, a military gate just south of Gaza City. It also has said it will open Erez (which was damaged in the Hamas-led attacks) and has examined the possibility of reopening the Karni crossing (which was closed in 2011 and sealed in 2022). Any or all of these could be used so long as entry is efficient. The southern corridor already in use also needs to be upgraded, including by streamlining imports. If through al-Arish, Egypt ideally would permit international staff experienced in aid distribution to participate fully instead of only advising. Egypt and Israel should also increase the number of trucks crossing at Rafah and Kerem Shalom up to the logistical maximum – every day – without interruption, including by protests on the Israeli side of Kerem Shalom, which Israelis have periodically staged to prevent the entry of humanitarian aid into Gaza.[3] Use of the Jordan corridor, which has been among the most efficient, should be increased, as Israel committed in early April to do.
Commercial food imports. Gaza’s food system depends on a functioning local market. Before the war, agricultural produce came from inside the strip itself. Many fields have been destroyed, and humanitarian agencies cannot deliver perishable yet nutrient-dense foods like fruit and vegetables at scale, leaving commercial trucking as the only option. The commercial sector’s role is not to halt famine, but given the dire circumstances, its shipments must align with humanitarian efforts and address the needs of a starving population. Priority spots in the queue must not be for sale under any conditions. 
Other vital materials. Food alone is never enough to prevent or respond to famine, since the lack of basic services and infrastructure – including health care, sanitation and water supply – has become so severe as to exacerbate malnutrition and disease. Gaza needs WASH (water, sanitation and hygiene) kits, specialised therapeutic and supplementary foods (which it lacks because this degree of malnutrition is new in Gaza), and a rebuilt health sector. Some of the materials required to repair these sectors appear on the dual-use list, and are therefore prohibited, as is standard humanitarian communications equipment that is necessary because Gaza’s communications infrastructure is damaged. These restrictions should be lifted.
Humanitarian personnel. Staff with the requisite skills must be able to enter and exit Gaza and bring with them standard humanitarian communications equipment.
Utilities. The electricity and remainder of the water that Israel formerly supplied should be restored. 

As for how these changes would be made, appointing a senior official to oversee and coordinate aid efforts, as it seems Israel might do, would be an additional positive step.[4] But it is imperative that Israel do so quickly and in a way that facilitates the massive response that is necessary. Now is not the time for an ad hoc aid campaign built from scratch, mobilising individual countries to make contributions coordinated and overseen by Israel. There is no shortage of international organisations, such as WFP, that are experts in famine response and accustomed to dealing with emergencies in places far bigger than Gaza.

If there were ever a time to contemplate an exception to the usual rules, it is now. During the humanitarian pause in November, amid threats from Hamas to end it early due to fewer trucks entering than agreed, some vehicles were allowed to bypass inspections and come into Gaza directly through Rafah. If Israel resists showing again that level of flexibility, it could agree to a single inspection upon cargo’s first entry into the country, forgoing a second inspection involving an offloading/loading procedure at the land crossing from Israel into Gaza.

[1] “Israel will try to ‘flood’ Gaza with aid from multiple entry points, says IDF”, Times of Israel, 13 March 2024.

[2] WFP puts the number of trucks daily required to meet Gaza’s food needs alone at 300, while Oxfam estimates about 220 (so long as there is no wastage or unequal distribution). FEWS NET calculates that the strip’s kilocalorie minimum requirement could be met with fewer trucks daily – less than 100. These discrepancies demonstrate that, as noted above, small differences in assumptions can a make big difference in results. “Aid trucks entering Gaza must double to meet basic needs, WFP says”, Reuters, 6 March 2024; “People in northern Gaza forced to survive on 245 calories a day, less than a can of beans”, Oxfam, 4 April 2024; Crisis Group correspondence, FEWS NET staff, 1 April 2024.

[3] For instance, “Protesters hold up aid to Gaza, as government faces rising domestic pressure”, Times of Israel, 24 January 2024.

[4] Prime Minister Netanyahu is reportedly considering the step. Crisis Group telephone interview, Israeli army adviser, 20 March 2024. See also “Official: Netanyahu likely to appoint Gaza aid czar amid frustration with Israeli effort”, Times of Israel, 24 March 2024.

Distribution within Gaza

Even the greatly enhanced entry of goods and people into Gaza will not help address the famine unless they can move easily around the strip and aid can be distributed in a smooth and efficient manner. So long as fighting continues, it is hard to imagine that happening.

The deconfliction process, which is necessary during both active conflict and a ceasefire, must be made fit for purpose – supporting and safeguarding aid operations to guarantee the secure delivery of assistance, rather than being exploited as a means of hindering them.[1] Deconfliction has always been dicey in Gaza, though it has worked better in the past. An aid official related that in other places she had worked, aid agencies could communicate directly with military field commanders, whereas in Gaza, aid agencies must communicate through COGAT, which acts as an intermediary. She likened COGAT to “a switchboard without an operator”: agencies inform COGAT of planned activities, but they are not thereby assured of protection. The army is supposed to inform them of imminent strikes in areas where they are working, but it has not always done so. When it does, the warnings often come too late to keep aid workers and recipients safe.[2] Another aid worker said, “It is easier to ensure deconfliction with a militia in rural South Sudan that has one single satellite phone than it is with the [Israeli army] at this point”.[3]

The killings of the World Central Kitchen workers compelled a welcome change. The UN henceforth will coordinate directly with Israel’s southern command.[4] [1] During active conflict, the main purpose is to prevent incidents between civilians and humanitarian operations by coordinating movements and activities. During a ceasefire, it still might be necessary to ensure safe passage for humanitarian aid particularly if, as seems likely, the Israeli military remains inside Gaza and controls movement between the north and south.

[2] Crisis Group telephone interview, February 2024.

[3] Crisis Group telephone interview, 3 April 2024.

[4] “UN says Israel approved reopening of 20 bakeries, water pipeline in northern Gaza”, Times of Israel, 6 April 2024.
” Gaza’s civil institutions and existing governance structure … are by far best positioned to safeguard aid and supervise distribution. “

Safeguarding goods and providing oversight over aid distribution are no less consequential for addressing famine. The breakdown of public order has made violence at distribution points a daily occurrence. The greater the disorder, the higher the likelihood that a disproportionate share of aid will be seized by those who are physically strongest, rather than reaching the more vulnerable populations at the highest risk of death during a famine, including young children, the elderly and individuals with chronic illnesses. That is what Israeli attacks have encouraged by forcing the Supreme Tribal Council and emergency committees to withdraw, at least until Israel permits UNRWA, the Palestinian Red Crescent and other major international agencies to operate consistently, hoping that their presence would protect committee members from assassination. Despite the deaths and injuries in their ranks under Israeli fire, Gaza’s civil institutions and existing governance structure – the civilian police and emergency committees – are by far best positioned to safeguard aid and supervise distribution.

Also mooted to protect aid is an Arab force. Proposed by Gallant, the idea appears unlikely to find support in Arab capitals. Unless coordinated with Hamas, the introduction of foreign troops would create even more chaos and bloodshed around distribution.[1] In any case, denying food to people who are starving unless the food is delivered by a favoured political actor is unworkable. Israel should let Gaza’s civilian police coordinate aid.

A ceasefire would make it far more tenable for Israel to stop its attacks on the police and emergency committees. For Israel, letting the civilian police or Hamas retain control of any facet of governance would be tantamount to defeat – hard to swallow no matter what, but perhaps feasible as part of a deal to return the hostages. It is impossible to imagine that Israel, without a ceasefire, could be persuaded to refrain from targeting senior police officers, with links to Gaza’s Internal Security Agency, who coordinate with families and other groups.

Without a ceasefire, the possibilities are more limited. Deconfliction should still be improved. The U.S. still should push, much harder than it is now, for Israel to stop targeting civil police and the committees that oversee aid distribution, almost all of whose members are civilians. Hamas, for its part, should keep any police officer with ties to the Internal Security Agency away from aid coordination.

[1] “Israel pushes for multinational force to secure delivery of Gaza humanitarian aid”, Haaretz, 29 March 2024.

VII. Conclusion

The goal of toppling Hamas cannot justify abetting a famine that could claim tens of thousands of lives or more. Driven by fear and anger toward Hamas, Israel has crossed lines that seemed inviolable before 7 October 2023. In the process, it has implicated its allies, especially Washington. Nonetheless, crossing the line into provoking a famine does not warrant crossing another into exacerbating it, which is where things are headed despite the improvements of the past month.

Turning toward a massive relief effort does pose risks, both for Israel’s war cabinet, which would have to confront hostile public opinion, and for the military. But after nearly six months of war, Hamas is in no condition to mount an attack like that of 7 October and is unlikely to regain such capacity anytime soon. Considering how much time that it would take Hamas to rebuild a force capable of coordinated operations, and with Israel certain to enhance its border defences and likely to keep soldiers stationed in Gaza for some time, the risks of allowing Gaza’s existing civil and governance infrastructures to operate are manageable. If one is concerned about Hamas’s resurgence, there will be ample time to counteract it. Not so famine.
” As the humanitarian crisis worsens, so, too, Israel’s standing in the world will fall. “

The political fallout from an escalating famine could turn out to be more difficult for Israel to navigate than the operational challenges posed by Hamas’s continued presence in Gaza. Israel’s efforts to deflect responsibility for the famine have not been successful. As the humanitarian crisis worsens, so, too, Israel’s standing in the world will fall. Already its closest allies are turning against the war effort. While Israel might anticipate that the world will eventually drift back into indifference, the implications of mass death by starvation are more severe.

Israel’s campaign in Gaza has reached a dangerous tipping point. With every passing day, the possibility of halting an irreversible catastrophe recedes and the chances of envisioning a political horizon for peacefully resolving the Israeli-Palestinian conflict look ever more remote. Urgent now is an end to the war, or at least a prolonged ceasefire and a much greater flow of emergency aid into the strip, protected by Gaza’s existing civil authorities and civic groups. The alternative is grim: the depopulation of Gaza, not through displacement to Egypt, but through war-induced starvation.