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 authorities and civic groups 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.

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.