Aid officials in Gaza believe that “pockets of famine” already exist in the territory, with parents sacrificing remaining food for their children, an apple costing $8 (£6.30) and fuel for cooking almost impossible to find.
UN agencies have said that Gaza urgently needs more humanitarian assistance as Palestinian authorities reported that the death toll in the territory during the Israeli offensive there had risen to more than 24,000.
The World Food Programme, Unicef and the World Health Organization said in a joint statement that new entry routes must be opened to Gaza, more trucks must be allowed in each day, and aid workers and those seeking aid must be allowed to move around safely.
The UN agencies did not directly blame Israel but said aid delivery was hindered by the opening of too few border crossings from Israel, a slow vetting process for trucks and goods going into Gaza, and continuing fighting.
On Tuesday Qatar and France brokered a deal with Israel and Hamas to deliver urgent medication to 45 hostages held in Gaza in return for humanitarian and medical aid for the most vulnerable civilians in the territory.
A spokesperson for the Qatari foreign ministry, Majed al-Ansari, said the deal would mean “medicine along with other humanitarian aid is to be delivered to civilians in the Gaza Strip, in the most affected and vulnerable areas, in exchange for delivering medication needed for Israeli captives in Gaza”.
He did not give details on how much aid would be delivered.
Israel’s war against Hamas in Gaza, launched after the militant group’s 7 October attack on southern Israel that killed 1,200, mainly civilians, has led to massive damage to swaths of the territory and displaced most of Gaza’s 2.3 million population. Many have been forced to move five, six or seven times, losing most of their possessions and money as they seek safety.
In Rafah and Khan Younis, in the south of Gaza, tents and makeshift dwellings cover almost all available ground, with multiple families crammed into apartments, in UN-run shelters in schools or sleeping on the floors of hospitals.
“There’s no food, no water, no heating. We are dying from the cold,” said Mohammad Kahil, displaced from northern Gaza to Rafah.
Hussein Awda, 37, fled northern Gaza after his house was destroyed and had many relatives killed at the beginning of the war.
“It is horrible. We are having just one meal a day, of bread made with flour and salt. Maybe we can get some tinned beans if we can buy it on the black market. Otherwise we are hungry,” said Awda, who has been living with his family in a former vocational training school in Khan Younis that is now home to 35,000 displaced people.
“There is meant to be more aid coming in but we have not seen anything except some fruit, which is very expensive. There is nothing on the markets. We try to eat less because we don’t know when any more food will come.”
Doctors in Gaza said that children, weakened by lack of food, had died from hypothermia and that several newborn babies with mothers who were undernourished had not survived for more than a few days.
“We don’t have the numbers but we can say that children are dying as a result of the humanitarian situation on the ground as well as due to the direct impact of the fighting,” said Tess Ingram, a spokesperson for Unicef, in Rafah.
Many displaced people have no money left after three months of war and cannot afford even basics to make flatbread. Twenty-five kg sacks of flour now cost $50, six times their prewar price. Salt has gone up 1,800%. The only fuel available is wood cut from live trees, which burns badly and is expensive.
Access for aid agencies to the north of Gaza, where 300,000 still live amid the ruins, has been made more difficult by continued fighting.
Aid officials said they strongly suspected that “pockets of famine” existed in northern Gaza, but that a lack of data on child malnutrition and child mortality meant formal criteria for declaring a famine had not been fulfilled. Images posted on social media on Monday showed hundreds rushing to a truck bringing food.
“Almost no aid at all has got up there and there are a lot of people who couldn’t or didn’t want to leave their homes and have been there since day one,” one official told the Guardian.
The UN said on Sunday that less than a quarter of aid convoys had reached their destinations in the north in January because Israeli authorities denied most access.
Israel has blamed the UN and other groups for the problems with aid delivery, claiming supplies were “piling up” in Gaza. Col Moshe Tetro, the head of the Israeli army unit responsible for the delivery of humanitarian aid, said last week there was no food shortage in Gaza and “the reserves in Gaza are sufficient for the near term”.
UN officials said that although the logistic challenges of moving aid across Gaza means there were sometimes backlogs, their warehouses were almost empty at the weekend.
Experts from the Integrated Food Security Phase Classification initiative, which measures famine risk around the world for the UN, NGOs and government, have forecast that at least one in four households in Gaza face “an extreme lack of food, starvation and exhaustion of coping capacities” within three weeks.
In a report published three weeks ago, they also concluded that Gaza would have “the highest share of people facing high levels of acute food insecurity … ever classified for any given area or country” by the agency.
Palestinian authorities said on Tuesday the death toll in Gaza since the start of the war had reached 24,285, with more than 60,000 wounded. Hamas said Israeli strikes killed at least 78 people overnight.
Officials from the health ministry, which does not distinguish between fighters and noncombatants in its tally, says two-thirds of those killed in the war have been women and children.
In Khan Younis, Zaher abu Zarifa wept and cradled a black plastic body bag holding his seven-year-old son, Saif, one of at least 11 bodies brought out at a hospital morgue.
The boy was killed by a missile while playing on a bicycle by a school gate, his father said.
“Forgive me, my son. I could not protect you,” Zarifa repeated. “Forgive me, my son. I could not protect you.”
The Israeli military blames the high civilian death toll on Hamas, which it says deliberately operates out of civilian facilities and uses the population of Gaza as a human shield. Hamas denies the charge.
A barrage of 50 rockets was fired toward Netivot in southern Israel, without causing any casualties, the Israeli military said. Hamas’s armed wing, Izz ad-Din al-Qassam, claimed the attack.