Untangling the Reality of Famine in Gaza

Executive Summary

The 11 months since Hamas’ brutal attack on Israel have been a perpetual humanitarian disaster for Palestinians in Gaza, with severe deprivation throughout the population and humanitarian leaders warning of persistent famine risk. As the crisis has worsened, it has also become increasingly politicized, with the government of Israel promoting a counter-narrative downplaying the severity of conditions, and emphatically rejecting famine warnings as overblown. The issue of famine risk, and the question of who is responsible, remains a driving force in U.S. and global policy toward Gaza. 

The humanitarian effects of Israeli government obstruction of aid have been a major factor in diplomatic decision-making around Gaza, influencing the UK’s decision to suspend arms transfers to Israel and becoming a central focus of a U.S. review of arms transfers under the National Security Memorandum-20 (NSM-20) process. The question of famine risk also continues to shape ongoing International Criminal Court (ICC) and International Court of Justice (ICJ) processes. If the risk of famine were overblown, as the Israeli government claims, it would be of great relevance to these diplomatic and legal processes.

Contrary to the official Israeli pushback, research and analysis by Refugees International has corroborated evidence of a severe hunger crisis in Gaza and found consistent indications that famine-like conditions occurred in northern areas during the first half of 2024. Refugees International also found that the ebbs and flows in hunger conditions are closely linked to Israeli government restrictions and concessions on aid access, and to the conduct of the Israeli military. International pressure on the Israeli government in March and April, following warnings of imminent famine in parts of Gaza, prompted a series of Israeli concessions around aid and commercial access. 

These shifts enabled a brief period of stabilizing conditions in April that altered the rapidly worsening hunger trajectory seen in February and early March, and that likely deferred an otherwise imminent descent into widespread famine. However, this improvement was short-lived, and conditions have again been deteriorating badly since the Rafah offensive in May. Without a more widespread and enduring course-correction on aid access, civilian protection, and humanitarian security, there remains a grave risk of famine conditions spiraling once again.

Recommendations

To Warring Parties:

• Immediately agree to a mutual ceasefire and release all hostages and civilian detainees; cease all escalations and actions that deteriorate or undermine efforts to reduce the suffering of civilians and end the war.
• Adhere to international humanitarian law; refrain from misuse of, or attacks on, humanitarian operations and facilities; and cease all attacks on civilians and civilian infrastructure.
• Allow UN and humanitarian agencies safe, robust, and consistent access to populations-in-need in all parts of Gaza.

To the Government of Israel:

• Open additional border crossings for sustained humanitarian access, and restore essential services to prevent further famine risk.
• Cease forced evacuations, which degrade humanitarian response capacity and greatly worsen the vulnerability of Palestinian civilians.
• Ensure that IDF forces rigorously adhere to deconfliction protocols to ensure safe movement for humanitarian aid and personnel throughout Gaza.
• Lift all restrictions on essential aid items and UN agencies or mutually-agreed neutral parties to oversee inspections, following precedents from Syria and Yemen.

To the Biden Administration:

• Fully use U.S. government leverage, up to and including the suspension of arms transfers and invoking section 620I of the Foreign Assistance Act, to halt forced evacuations and ensure continuous humanitarian aid access across Gaza.
• Secure a ceasefire and the release of all hostages and civilian detainees, halt forced evacuations, and restore aid access and civilian protection in Gaza.

Methodology

Refugees International conducted research in Egypt, Jordan, Israel, and remotely in Gaza in January, May, and June 2024 to assess the risk of famine and interview Palestinian families impacted by the crisis firsthand. This included interviews with government officials in Israel and Jordan, humanitarian officials, and staff of international NGOs involved in the cross-border aid response for Gaza as well as people inside Gaza and Palestinians who were evacuated during the war. This paper is further informed by ongoing research and advocacy that Refugees International has conducted since the onset of the conflict in October 2023 in coordination with international and local partners.

The qualitative research reflected in this report corroborates analysis by the Integrated Phase Classification (IPC) process–the standard global framework for classifying food insecurity and malnutrition–and illustrates how IPC projections fit into the broader emergence of famine risk in Gaza. 

The Trajectory toward Starvation

The trajectory of Gaza’s hunger crisis can be broken down into several key phases. The initial besiegement and aid obstruction in the first three months of the war laid the groundwork for famine risk. The second phase, roughly January to March 2024, was a period of intensifying deprivation in northern Gaza, as security threats and Israeli policy left the north almost entirely cut off. That situation prompted IPC warnings of imminent famine in mid-March. Phase three, from late March through early May, saw several shifts in Israeli behavior as international and U.S. pressure crescendoed. Those concessions helped to defer an imminent descent into widespread famine, but the improvements proved short-lived. The fourth, and current, phase began when the IDF initiated a major assault on the town of Rafah in early May and ordered a series of subsequent evacuations within the so-called humanitarian zone over the summer. This caused mass re-displacement, and a huge and ongoing deterioration in humanitarian operational capacity that, if sustained, again risks pushing many Palestinians definitively past the famine threshold. 

Central to this analysis is an understanding of how the three key famine indicators—food consumption, malnutrition, and mortality—tend to progress sequentially. Prolonged famine-level shortfalls in food consumption lead to severe malnutrition, which, if unaddressed, produces accelerating mortality. Famine-level mortality data is usually confirmed only retroactively, meaning that by the time such confirmation is obtained, famine conditions have already persisted for some time. This underscores the importance of early warning and early action, particularly once famine-level food consumption thresholds are surpassed, as they were in Gaza in December 2023. Once those food consumption shortfalls begin producing large-scale malnutrition, as was the case in northern Gaza in February and March, full-blown famine is close at hand. The projection of “imminent famine” in the March IPC report signaled that such famine-level mortality was about to occur. 

Hunger Intensifies: October to December 2023

In the initial months following the Hamas atrocities of October 7, the Israeli government imposed a widespread blockade on aid, commercial imports, and basic service provision that Defense Minister Yoav Gallant characterized on October 9 as a “complete siege on the Gaza Strip. There will be no electricity, no food, no fuel, everything is closed.” Gaza produces relatively little of its own food and is heavily dependent on food imports – so these restrictions rapidly led to punishing food scarcity for many Palestinians in Gaza. In mid-November, the World Food Program estimated that Gaza was only receiving 10 percent of its necessary food supplies due to Israeli restrictions on aid and commercial access. Israeli restrictions on fuel imports had forced the closure of all 130 WFP-supported bakeries across Gaza, prompting what WFP described as a  “crippling halt in bread production” and rendering that important staple food “scarce or non-existent” for many Palestinians. 

Palestinian interviewees told Refugees International that the destruction of Gaza’s food production systems had further complicated efforts to convert food ingredients into actual food products (e.g., baking flour into bread). In November 2023, Israel bombed Gaza’s largest wheat mill, knocking it out of production. Further IDF attacks left many of Gaza’s bakeries either wholly destroyed or partially damaged, severely limiting the local capacity to convert the delivered flour into bread.

During this period, Palestinians shared with Refugees International the immense difficulties they faced in finding food. One Palestinian woman described the stark reality: “You eat only one meal, and it’s not a complete meal. It’s maybe a piece of bread with something—if you’re lucky enough to have it. It’s just enough to keep you alive, but you don’t eat it to enjoy it; we don’t eat for that purpose anymore.” Another Palestinian recounted:

“Children are suffering from a lack of food, and some have even died from malnutrition and the unavailability of medication. Displacement has also left many without their money; people fled their homes with nothing, and now, with prices so high, they struggle to meet even their most basic needs. In essence, if people don’t die from the war, they face the very real threat of dying from hunger.”

The combined effects of Israel’s blockade of Gaza, along with severe restrictions on the movement of humanitarian workers and the widespread devastation of essential infrastructure, services, and food production, began to produce a profound hunger crisis. The situation inside Gaza was exacerbated by rising inflation and a market that became largely depleted due to Israel’s closure of borders, unpredictable border management, and limits on the number of trucks allowed entry each day.

On November 6, Israeli authorities cut off Northern Gaza from the south and restricted UN and aid agencies from accessing the north.

These initial months of deprivation laid the groundwork for the crisis that has followed, creating a food and nutrition deficit from which Gaza has yet to emerge. A short-lived ceasefire in late November enabled a hostage release and brief uptick in aid flows, but not enough to materially change the trajectory of humanitarian needs. Aid inflows improved gradually with the mid-December opening of the Kerem Shalom border crossing, a concession made under U.S. pressure. But even so, aid remained well below minimum requirements.

The first official warning of famine risk soon followed. In late December 2023, the Famine Review Committee (FRC) of the Integrated Food Security Phase Classification (IPC) process concluded that a realistic risk of famine now existed, and that at least a quarter of people in Gaza were experiencing famine-level forms of deprivation already, including an extreme lack of food and exhaustion of coping capacities. 

Warnings Ignored as Famine Gets Underway: January to March 2024

The December IPC warning prompted little immediate change of posture by either the Israeli government or the United States, and humanitarian conditions continued to deteriorate markedly. Access impediments by the Israeli military continued unabated and the following months were marked by a series of high profile IDF strikes on humanitarian operations,¹ including a notorious IDF naval bombardment of a UN food convoy en route to northern Gaza in February. That attack struck a UN aid convoy whose movement had been approved by the IDF, and occurred while IDF forces held the convoy at their own checkpoint. The nature of the attack badly shook the UN’s confidence in the reliability of IDF assurances of safe movement, and forced the UN to suspend aid deliveries along the principal route from southern to northern Gaza. The government of Israel, meanwhile, refused aid groups’ requests to open northern border crossings that would have allowed aid delivery from Israel directly into northern Gaza. 

Northern Gaza rapidly began to run out of food.

Even in southern and middle Gaza, January and February were a period of worsening deprivation. Aid deliveries remained woefully low as Israeli restrictions prevented aid from entering Gaza in the volumes required. Rather than increasing aid access after the December IPC warning, aid volumes actually declined from January into February, as illustrated by UN truck data in the graphic below. At no point did aid deliveries come close to the 500 trucks/day target that the UN assessed was necessary to adequately meet needs in Gaza.² 

On a trip to the region in late February, USAID Administrator Samantha Power cited a need to “dramatically surge” humanitarian aid to Gaza “as conditions continue to deteriorate.” She stated publicly that “two crossings is not enough” (referring to the Rafah and Kerem Shalom crossings into southern Gaza) and called on Israeli officials to open further crossings for aid deliveries. The Israeli government would not heed these calls until months later, once the situation had deteriorated considerably further.

As Israel resisted opening additional crossing points, the Biden administration declined to apply greater pressure on its ally. Instead, the U.S. pursued unorthodox and ultimately ineffective attempts to work around, rather than confront, Israeli government impediments. The United States began joining international airdrops that had been initiated by Jordan, but these provided de minimis volumes of aid that were wholly insufficient to meet the escalating needs within Gaza. During his March 7 State of the Union address, President Biden then announced plans to set up an aid pier to enable aid delivery by sea. However, it quickly became apparent that this initiative would take several months to set up and would not address the spiraling aid shortfalls in the near term. The Biden administration’s focus on the airdrops and the pier was criticized at the time by Refugees International and many other aid groups as diverting political attention from the real priority: pressuring Israel to open additional overland crossing points into Gaza. That concern was widely shared by officials within the Biden administration as well, as a subsequent Inspector General investigation uncovered: 

“Multiple BHA staff noted that using JLOTS [the U.S.-led floating pier in Gaza] was not an option USAID would typically recommend in humanitarian response operations. In addition, multiple USAID staff expressed concerns that the focus on using JLOTS would detract from the Agency’s advocacy to open land crossings in Israel and Egypt, which were seen as more efficient and proven avenues for delivering aid to Gaza.”

Indications Consistent with Famine in February and March

As the United States refused to more forcefully pressure the Israeli government, the crisis continued its dramatic deterioration. Research by Refugees International corroborated IPC findings that the hunger crisis in Gaza became incredibly severe during the February to March period, particularly in the north. People we interviewed in Gaza and those who fled to Egypt recounted multiple indications that much of Gaza was hovering near the famine threshold, and that the worst-deprived areas of Gaza plausibly experienced famine conditions during this period, as overall aid to Gaza dropped to low levels and aid into the north came to a near-complete halt. These telltale famine indications included consumption of non-foods such as grass and animal feed; asset stripping; malnutrition-related deaths; survival sex; and households routinely skipping meals. 

Later public statements by the leaders of both USAID and WFP likewise affirmed that famine conditions had likely occurred that spring. While the lack of access within Gaza prevented the collection of comprehensive data required to confirm a formal famine declaration, the available evidence paints an extremely dire picture. 

Several UN officials Refugees International interviewed similarly reported witnessing famine-like conditions, particularly in northern Gaza. A Palestinian aid worker told us:

“There were many cases of extreme starvation throughout Gaza, especially in the north. After the [November] ceasefire failed and the IDF controlled all access into Gaza, blocking entry points, there were very few supplies for two months… People would go out to get flour, stay out for three or four days [waiting for scheduled convoys], fail, and return home empty-handed, risking their lives for food.”

This dire situation was further highlighted by a UN official who participated in one of the rare convoys heading north: “I went north by Wadi Gaza during the February to March period. The moment we crossed the holding point at Wadi Gaza [the main checkpoint], we encountered large crowds of desperate, hungry people asking for food. It was difficult to get through them. People were visibly showing us [the UN] how hungry they were.” The severe food deprivation sometimes led to chaotic scenes, with people attempting to self-distribute aid from the trucks. A UNRWA aid worker described the tragic outcome of one such incident: “Even when UNRWA sent aid convoys with flour and supplies [to the north], some were looted along the way. When they finally reached distribution points, the Israeli military fired on people trying to receive food aid—blood mixed with flour, it was horrible.” While Refugees International could not independently corroborate this specific attack, such attacks attributed to Israeli forces on aid distribution sites – such as the February “flour massacre” in Gaza City and a March attack on UNRWA’s aid distribution site in Rafah – have been widely reported.

More harrowing signs of starvation emerged when UN officials reported the deaths of 34 Palestinians due to malnutrition and dehydration, the majority of whom were young children. We interviewed an NGO doctor working in the north, whose organization treated two of these cases and emphasized that all of these deaths were fully preventable. However, aid providers were largely barred from accessing these areas, except on rare occasions when a UN convoy managed to deliver medical supplies to hospitals. For months, those suffering from malnutrition in these communities remained virtually invisible, their plight only coming to light later when humanitarians were able to re-establish greater screening capacity.

---

Reaching a Famine Determination

Famine (IPC Phase 5) Definition: Famine is classified as an extreme deprivation of food affecting a population, leading to starvation, death, and destitution. It is officially declared when:

20% or more households cannot access enough food.
30% or more children suffer from acute malnutrition.
Two or more deaths per 10,000 people happen daily due to starvation or related causes

Famine Classification:

Famine can be classified in two ways depending on the quality of evidence:

Phase 5 (Famine) with solid evidence: Declared when reliable data shows key indicators like high mortality, severe malnutrition, and extreme food shortages meet or exceed famine thresholds.
Phase 5 (Famine) with reasonable evidence: This is applied when famine is likely but cannot be fully confirmed due to insufficient evidence, often due to restricted access for data collection or aid delivery. In situations where direct data is limited, but urgent action is required, famine can still be classified using inference from available information.

This approach has been applied in recent famine situations such as Somalia in 2011, Nigeria in 2016, South Sudan in 2016-2017, and Sudan in 2024. In these cases, humanitarian access was restricted, preventing full data collection, but inference from limited data allowed experts to classify famine conditions and prompt urgent action.

---

Coping Mechanisms 

While there has not been an official famine declaration for the February-March period, the conflict and obstructed access made it impossible to collect sufficient data during that period to make a determination. The IPC manual provides detailed guidance for inference of potential famine conditions in instances when access obstacles prevent humanitarians from collecting the level of comprehensive information required for a formal declaration. 

These can include:

· Dramatically reducing daily meals and/or household member sacrificing their own food consumption to prioritize others in their households
· Consuming wild foods or local “famine” foods with adverse nutritional effects
· Engagement in dangerous or detrimental coping strategies to access food
· Large-scale dependence on aid, social networks, or handouts for food

Our interviews with Palestinians who were in Gaza during the reporting period, with those in close contact with family in Gaza, and with aid organizations active in Gaza identified multiple ways in which portions of the population resorted to extreme survival strategies consistent with these indications. These further reinforce reporting from both UN, aid agencies, and famine monitors. While not definitive proof of famine, these indicators demonstrate the plausible presence of famine conditions in that period.

Skipping Meals and Prioritizing Food for Children at the Expense of Adult Family Members

The lack of consistent access to food during the conflict has forced Palestinian families to prioritize feeding children first, at the expense of adult members of the family. Refugees International heard firsthand from Palestinian parents, especially mothers, who routinely did not eat in order to reserve food for their children. This severely impacts the health of parents, and has resulted in abrupt, extensive loss of weight. One Palestinian mother told Refugees International, “We saw many people desperately seeking even a single piece of bread where we were living…During this time, I lost 15 kilos because my husband and I, like most people we knew, prioritized the kids’ meals as a coping mechanism.”

Consuming Animal Feed, Local Weeds and Grasses, and other Non-foods to Survive

In some areas of Gaza, prolonged food scarcity has driven families to desperate measures. Lacking access to food for extended periods, some Gaza residents told Refugees International that they resorted to consuming whatever was available, including non-food items. A resident from northern Gaza reported that his family went without food for 17 days during the early months of the war, with the scarcity lasting nearly four months. To survive, the family ate animal feed, local weeds, and tree leaves. He recounted, “For four months, the north had no food supplies, and people ate tree leaves. I kept four horses on my land, which were killed, and the leftover feed for them helped my brother’s family survive. My brother was too ashamed to admit it, but they had no other choice.”

An aid worker we interviewed further highlighted the severity of the situation, sharing that some of his colleagues, including an UNRWA staff member, endured 24 days without proper food. “All they had was water, salt, and maybe a piece of cucumber or tomato—something so negligible it can’t be called a meal,” he said.

Selling Off All Fungible Assets to Raise Money for Survival

The prices for basic food and non-food items have skyrocketed since the beginning of the war due to scarcity and high demand. Palestinians in Gaza told Refugees International that a 25kg sack of flour with a pre-war cost of $25 at times reached prices as high as $100 across Gaza. In the north, aid workers reported the price of the same bag in March reached over $400 in areas where famine was being reported. While commercial shipments improved food availability, the severe cash shortage in Gaza still made these goods inaccessible for most. The decision by the Israeli government to frequently facilitate commercial shipments rather than prioritizing humanitarian food proved harmful at times, adding further pressure on desperate households to generate funds by whatever means possible. Desperate families resorted to selling their assets—jewelry, cars, land—to afford the exorbitant prices or even to escape Gaza for Egypt. Disturbingly, three aid organizations interviewed by Refugees International separately reported instances of women selling sex to obtain cash for basic necessities.

Paying Exorbitant Fees to Access Bank Funds

Accessing cash in Gaza’s war economy has become increasingly difficult due to the closure of banks and ATMs. Most Palestinians can only access cash through the remaining ATMs or through bank wires via commercial brokers. By March, only six of Gaza’s 91 ATMs were functional, but often lacked cash.  As of July, only four ATMs remained operational inside of Gaza, servicing a population of over 2 million. Those ATMs are reportedly only serviced when the banks have cash reserves available. As a result, Palestinians seeking to access their cash are subjected to extensive wait times and run the risk of being targeted by criminal elements, which reportedly prey on those awaiting cash. For those fortunate enough to have remaining balances in their accounts, cash brokers offer a way to access funds, but at a steep cost. Multiple Palestinians told Refugees International that these brokers charge fees averaging 25 percent. One individual shared, “Even if you want to buy, you won’t have the money because all banks are out. I couldn’t withdraw any money for three or four months. I had to pay $250 to get $1,000 out through an online broker, so 25% of my salary is gone.” 

Devastated Health System and Acute Malnutrition

Our interviews with doctors working in Gaza during the spring confirm severe and widespread malnutrition contributed to elevated mortality. The health system has been devastated by a combination of destructive IDF attacks on nearly all major hospitals, the widespread detention of health workers—some of whom have died in Israeli custody, with others reporting credible accounts of torture—and systematic impediments to importing critical medical supplies, including painkillers and antibiotics.

At Aqsa Hospital in Deir al-Balah, doctors have been forced to treat patients without access to painkillers or antibiotics. Many of these patients, weakened by malnutrition, were unable to survive trauma injuries that would otherwise have been survivable. One doctor recounted his own struggles to obtain adequate protein during his time in Gaza in February 2024, despite being a comparatively well-resourced international worker. He resorted to bringing in large numbers of protein bars for personal consumption, which he eventually shared with patients in hopes of strengthening their bodies for recovery. Despite these efforts, many patients still died. The doctors we interviewed were unequivocal in their assessment that malnutrition directly contributed to the higher mortality rates among their trauma wound patients, even if these deaths are not officially recorded as famine deaths.

Staving off the Worst: Mid-March to May

By late March 2024, the humanitarian crisis in Gaza had reached a critical stage. After showing little action on the initial famine projections in December, the U.S. government began to show greater urgency in March but remained hesitant to apply meaningful pressure on the Israeli government. But over the final two weeks of March, three major events focused greater scrutiny on Israeli aid restrictions and yielded a modest breakthrough on aid access. On March 18, the IPC issued a dire forecast, warning that if the stark deterioration observed through February continued, Gaza would face imminent famine. Malnutrition rates were rapidly accelerating toward famine-threshold levels, having doubled in northern Gaza between January and March. Deaths from apparent starvation were starting to emerge. All evidence indicated a rapidly spiraling hunger crisis, primarily brought on by restrictions on aid and commercial access. In response, USAID Administrator Samantha Power in a March 18 statement declared Gaza was at a “serious risk of famine” and reiterated calls for Israel to open more land routes into Gaza and get land crossings operating at full capacity.

On March 29, the International Court of Justice (ICJ) announced that “Palestinians in Gaza are no longer facing only a risk of famine… but that famine is setting in.” They subsequently ordered the Israeli government to act “without delay” to provide “urgently needed basic services and humanitarian assistance” into Gaza. Israel’s Foreign Ministry Spokesperson responded in a statement that, “Israel will continue to promote new initiatives, and to expand existing ones, in order to enable and facilitate the flow of aid to the Gaza Strip in a continuous and extensive manner, by land, air, and sea, together with UN bodies and other partners in the international community.” 

Then, three days later, on April 1, Israeli forces struck a World Central Kitchen (WCK) aid convoy, killing seven aid workers. This attack prompted a global outcry and a forceful call by President Biden to Prime Minister Netanyahu to protest the action and underscore the protection of humanitarian workers in Gaza. In a significant shift, the United States reportedly set out an “ultimatum” that Israel show greater movement on aid access and civilian protection, or risk losing U.S. support. Secretary Blinken echoed this, saying “If we don’t see the changes we need to see, there will be a change in our policy.” Then, on April 10, Administrator Power acknowledged publicly that famine was likely underway in northern Gaza. This shift in the U.S. approach unlocked several key concessions. Immediately after the Biden-Netanyahu call, Israel reversed months of resistance and agreed to open additional border crossings into northern Gaza, increase aid volumes, and boost commercial inflows. These actions had a meaningful impact, particularly in northern Gaza, where the rapid slide toward famine evident in February began slowing, ultimately leveling off at a pre-famine state.

By the end of April, these changes were yielding visible results. Aid delivery levels reached their highest point since the conflict began, and the Israeli government facilitated more COGAT-organized commercial shipments. In May, Israeli authorities opened the Zakim (Erez West) crossing into northern Gaza and permitted WFP food trucks more frequent access. This improved access to northern areas, though it still fell short of what humanitarian agencies deem necessary. Nevertheless, these moves temporarily stabilized the situation, deferring the mass mortality outcomes that had been projected if the February trajectory had continued.

In late May and early June, Refugees International conducted interviews with Gaza residents and aid organizations. These interviews confirmed that the changes made in March and April had a direct impact on food availability and overall food security, particularly in the north. Although aid access remained uneven and some populations did not benefit from the increased aid, the overall situation in Gaza showed improvement relative to the dire forecast in the March IPC report. 

While the improvements in aid distribution during April were critical in staving off the worst-case scenario, especially in northern Gaza, the concessions by the Israeli government largely froze the crisis at an immediate pre-famine level. Subsequent analysis by the IPC Famine Review Committee (FRC) found that while a territory-wide famine had been temporarily avoided, more than 495,000 people—22 percent of Gaza’s population—still remained in famine-like (IPC Phase V) conditions, and all of Gaza continued to face a high risk of famine. 

While the increased reliance on commercial food shipments had increased food availability in Gaza, our research also found that this did not necessarily translate into corresponding improvement in household food access and consumption. Many of the most impoverished Palestinians lacked the cash to purchase these goods. Moreover, the composition of Israeli-organized commercial food imports was not consistently prioritized toward famine response, with some shipments including less useful products like cigarettes, soda, and candy. This uneven benefit likely contributed to the continued severe food insecurity among some populations, even as the overall situation modestly improved.

This phase of the crisis showed clearly how closely hunger conditions in Gaza hinged on the Israeli government’s position on aid and commercial access to Gaza. The early-April concessions to improve aid access and inflows could have been implemented at any point during the preceding six months of the conflict. Throughout that time, aid organizations, the U.S. government, the International Court of Justice (ICJ), and many other global voices had been urging the Israeli government to take such steps. The government’s refusal to permit these measures—particularly regarding direct aid access to northern Gaza—directly contributed to the emergence of famine-like conditions. Conversely, the subsequent decision to increase aid and improve access in March and April led to a noticeable improvement in conditions. Rather than discrediting the IPC famine projections, the evolution of the situation from February through late April highlights how closely the severity of the crisis has been tied to the actions of the Israeli government.

The Destruction of Rafah: May to June

Sadly the progress in April proved short-lived. In early May, the IDF launched a long-predicted Rafah offensive, coupled with renewed operations in previously “cleared” areas of northern Gaza. Humanitarian organizations had explicitly warned that such an offensive in Rafah would endanger the more than 1 million displaced people sheltering there, and severely disrupt aid delivery throughout Gaza. The U.S. government also warned that a Rafah offensive must take care to avoid excessive displacement or disrupting the humanitarian response. 

These warnings did little to lessen the ensuing humanitarian calamity. As the offensive began, the IDF designated much of Gaza’s southern border region as an evacuation zone, pushing nearly 1.8 million Palestinians to flee. These orders also forced the closure of humanitarian relief operations that had used Rafah as a base for serving most of Gaza. The IDF also seized control of the Rafah border crossing, prompting its immediate and ongoing closure. All aid delivery through the Rafah crossing was halted, leaving an estimated 1,400 aid trucks stranded in northern Sinai, over 75 percent of which carried vital food supplies, according to UN data seen by Refugees International. In total, the entry of food to the south decreased by 85 percent from April to June, during the period of the operation.

The Rafah crossing had previously been the largest cumulative axis of aid and the principal crossing point for humanitarian personnel, badly needed fuel, and cash to fund humanitarian operations. Rafah town had also become the principal shelter for most of Gaza’s population, who were then forced to flee in a haphazard and unsupported manner ahead of the Israeli offensive. It had served as the main hub for aid operations throughout Gaza, hosting humanitarian offices, residences, distribution facilities, and logistical hubs, nearly all of which were abandoned or made inaccessible due to the Israeli offensive.

Over 1 million Palestinians were forcibly displaced in a matter of weeks with no preparation or support. Displaced people had to relocate once again to so-called humanitarian zones in Khan Younis and middle Gaza with only what they could carry. Some fled in cars. Most fled by foot. NGOs were forced to leave behind prepositioned stockpiles of food and water. Shelters were emptied, and some hospitals were forced to evacuate. Meanwhile, an estimated 1.8 million people were forcibly packed into two small strips of land at Mawasi and Deir Balah. The Israeli government claimed this constituted a successful evacuation; in reality it constituted a catastrophic forced re-displacement of people with no advance measures taken to aid, support, shelter, or protect them. Three months later, only 20,000 people remain in Rafah according to internal UN statistics seen by Refugees International. 

Despite U.S. government demands that Israel not undertake the offensive without planning for the safe evacuation of displaced people and the sustainment of humanitarian support to them, the IDF operation failed on both counts. Rather than applying the same forcefulness it briefly demonstrated after the April World Central Kitchen strike, this time the Biden administration signaled no meaningful follow-through to enforce its warnings.

The Rafah offensive marked a turning point for aid operations in southern and middle Gaza. More than three months after the offensive, the Rafah crossing still remains closed, with access to Gaza still heavily restricted. According to OCHA, the daily volume of humanitarian aid entering Gaza has dropped by 56 percent since April, while aid collected via the Kerem Shalom crossing has decreased by over 80 percent in the same period. Those receiving lifesaving food assistance has also dropped from nearly 1.8 million in May to less than 1.1 million in July, a loss of 700,000 people-in-need, according to WFP.

Source: WFP

Deteriorating Once Again: July to Present

Conditions in Gaza have sharply deteriorated since the Rafah operation, exacerbated by Israel’s expanded activities in and around the so-called humanitarian zones. Frequent evacuation orders have triggered further rounds of forced displacement, including the relocation of an estimated 250,000 Palestinians in August alone. This has also forced UN and aid agencies to once again move their operations, this time abandoning facilities in Deir Ballah that they had established after being forced out of Rafah. As of August 19, 86 percent of Gaza is now under mandatory evacuation, with an alarming 30,000 to 34,000 Palestinians crammed into every square kilometer of the so-called safe zone. These overcrowded and unsanitary conditions have fueled outbreaks of sickness, infections, and disease. In July, the poliovirus was detected in standing sewage within areas housing displaced families, and by August, doctors diagnosed the first human case of polio in Gaza—a disease eradicated in the region over 25 years ago. Israel has consented under immense international pressure to a mass UN immunization campaign delivered through a series of “humanitarian pauses” in south, central, and northern Gaza.

The situation in the so-called safe areas is increasingly dire. Over 2 million people are sheltering in catastrophic conditions, as these zones continue to shrink due to ongoing evacuation orders. A UN official told Refugees International, “The so-called safe areas are shrinking. People are told to evacuate whenever the Israeli authorities detect danger. When people are forced to evacuate, aid delivery points close, and partners must relocate and reopen new points elsewhere.” This constant displacement disrupts treatment for vulnerable populations, including children receiving care for malnutrition, who often struggle to reconnect with new aid distribution points. 

Border crossings, particularly at Kerem Shalom, remain insecure and notoriously unpredictable. Even when food successfully reaches the crossing, it often remains stuck in stockyards due to unsafe travel conditions for aid workers within Gaza. The breakdown of civil order has heightened the risk of looting, while Israeli authorities now require IDF approval for nearly all UN convoys before they can move. These coordination issues frequently lead to delays or outright denials of aid deliveries. A UN official recounted, “Traveling from southern Gaza to northern Gaza for a 45-minute training took me from 6:00 AM to 9:00 PM, leaving only one hour to actually conduct the activity. If these steps could be streamlined, it would make a significant difference.”

Aid workers face immense challenges as they navigate active conflict zones and routinely come under fire, largely from Israeli forces, but also Hamas, and other criminal elements within Gaza. The overcomplicated coordination processes and movement restrictions result in life-threatening delays. The Israeli government continues to control what is allowed into Gaza, often prioritizing commercial deliveries over humanitarian aid. With only a few private companies granted access for commercial imports, prices have skyrocketed for low-quality goods—an inadequate substitute for essential aid. 

Meanwhile, the destruction of public services and infrastructure, including hospitals, roads, power plants, and water lines, has deepened the population’s dependency on aid, which remains largely inaccessible.

Divided Aid Response

The split in aid response between southern and northern Gaza further compounds the challenges. Early restrictions preventing aid workers from moving between northern and southern Gaza began early in the conflict, but have since solidified due to Israeli policies. The south relies on the Kerem Shalom crossing, while the north depends on the Erez crossings. Critical humanitarian items are frequently restricted from crossing between these regions, severely hampering food access and complicating the treatment of malnutrition. Nutrition experts report that while some supplies are available to treat malnutrition, there is a significant shortage of supplies needed to prevent it and ensure nutritional diversity. For example, northern Gaza receives only flour, with limited access to essential foods like vegetables, eggs, or proteins, which remain unaffordable due to cash shortages. 

Although some UN agencies have begun providing cash assistance to the most vulnerable communities, expanding these efforts is crucial to improving access to basic foods for families in need. Despite recent efforts by the White House and Israel to boost aid delivery, the scale of hunger remains alarmingly high. Famine monitor – FEWS Net – reported in September, “Regardless of whether or not the Famine thresholds have been definitively reached or exceeded, people across Gaza are already dying of hunger-related causes.” Gaza’s needs far surpass simply sending more aid trucks. Only a fraction of the required aid is reaching Gaza.

Resurgent Malnutrition 

As a result of these cumulative challenges, one UN official told Refugees International that Gaza was “always two weeks away from a famine” due to the IDF’s refusal to normalize free-flowing aid. UN health officials have reported a significant surge in documented malnutrition cases, with a 170 percent increase across Gaza and a staggering 300 percent rise in the northern region. The surge reflects a more comprehensive screening effort for Palestinian children, previously infeasible due to access constraints and security challenges. The new data reveals that many cases of acute malnutrition had gone unreported, as earlier figures had underestimated the crisis’s scale. Between May and July, expanded screening efforts by the UN and its humanitarian partners provided a more accurate—and grimmer—picture of the situation, particularly in the north, where access has been severely restricted since October 7.

Despite these screening improvements, humanitarian efforts remain stymied by ongoing access and security challenges. A UN official noted, “Before the conflict, malnutrition rates were below 1 percent, but now they have risen to 7-8 percent in certain governorates. The north lacked any capacity or programming because malnutrition did not exist there before the war.” Malnutrition screening and treatment services are subject to the same vulnerabilities as other health services, with hospitals frequently hit, threatened, or forced to evacuate.

While many NGOs in Gaza are skilled in mitigating and treating malnutrition, severe aid restrictions and ongoing conflict make it nearly impossible to reach, screen, and treat those in need. As one NGO official stated, “We know how to treat malnutrition, but we aren’t given the opportunity to do it. Severe restrictions and heavy fighting mean we can’t run clinics like we normally would, as we have done in countless other emergencies before, to save lives.”

The risk of famine has not abated, but the humanitarian community’s capacity to respond has been severely diminished relative to what existed in April. 

Evaluating Israel’s Pushback 

Israeli authorities have publicly and privately rejected warnings of famine in Gaza, and reject any link between Israeli government policies and hunger conditions within Gaza. Two documents that Israeli authorities have used to discredit claims of famine and severe food insecurity in Gaza merit particular examination. The first is a document from the Israeli Foreign Ministry attempting to rebut the IPC’s March projections of imminent famine. The second is a pre-print paper, authored by Israeli academics and widely promoted by the Israeli government, that uses non-public government data to argue that sufficient food is entering Gaza.

The Foreign Ministry document lays out a series of arguments seeking to discredit the IPC findings. It argues that the IPC process used a non-standard method to reach its projections; that it ignores Israeli-coordinated commercial shipments and other Israeli actions to facilitate aid; and that it demonstrates bias by focusing on restrictions by the Israeli government but not actions by Hamas.

These critiques are unpersuasive. The non-standard methods applied by the IPC process are necessitated by the extreme difficulty of collecting comprehensive data in Gaza, and by the irregular legal status of Gaza as an occupied territory under international law. Normal IPC protocols mandate the formation of a Technical Working Group (TWG) that includes the government of the state in question – something that is impossible for Gaza given that neither Hamas nor the Israeli government are an internationally recognized governing authority in Gaza. Meanwhile the extensive impediments facing basic humanitarian aid delivery and the frequent IDF strikes on humanitarian actors have made the collection of comprehensive data functionally impossible, and forced the IPC to instead rely in part on inference measures based on the limited data that is available (as discussed above, this is an approved IPC practice per the IPC manual). 

The Foreign Ministry also argues that the March IPC report ignores its actions to facilitate additional aid and commercial inflows in the preceding period. This is a puzzling claim, given that the period leading up to that report saw the lowest aid volumes since early in the war. As referenced above, USAID Administrator Samantha Power affirmed during a visit to the region that aid flows in February were woefully insufficient. This line of argument by the Foreign Ministry also elides the fact that whatever aid was getting into Gaza during this period was not reaching the North – and the IPC analysis was specific that the imminent famine risk was greatest in the North. As for the IPC and the UN’s alleged failure to factor commercial inflows into their reporting, those shipments were quite modest prior to the issuance of the March IPC report and did not increase substantially until May, according to data published months later by the IDF. Furthermore, UN officials told Refugees International that the Israeli government did not transparently share information on the contents of those shipments with the UN or NGO community. The Israeli government has in fact also not shared this detailed data on commercial shipment contents  with the U.S. government, according to several Refugees International interviews over the summer. 

Finally, the allegations of IPC bias in its use of information are unfounded and irresponsible. The Foreign Ministry paper criticizes the IPC process for allegedly disregarding “actions by Hamas which hamper humanitarian assistance and exacerbate food insecurity.” The document cites Hamas’ “launching of rockets, use of tunnels, [and] abuse of hospitals” as omissions relevant to food security analysis. The document does not elaborate on the alleged causal links between these actions and severe population-wide hunger. Elsewhere, Israeli government officials have also alleged that Hamas routinely steals aid, although the government has provided scant evidence of specific incidents of such theft.

Refugees International takes allegations of aid diversion extremely seriously, and in the course of our research, we have frequently asked aid organizations about any Hamas interference with their operations. Any such interference would constitute a clear violation of international humanitarian law. There is a broad consensus that ongoing combat between Hamas and the IDF has disrupted aid flows, but we have found little evidence to support the allegation that Hamas is diverting humanitarian aid at a large scale. 

Senior U.S. officials have repeatedly observed that Israeli authorities have not raised specific instances of diversion of UN or U.S. aid with them. U.S. Envoy David Satterfield articulated to Refugees International in January and later in a public interview in February that, “No Israel official has come to me, come to the administration, with specific evidence of diversion or theft of assistance delivered by the UN in the center of the south of Gaza…The issue of formal diversion or theft directly from UN delivered assistance, no such allegations.” He does, however, draw a distinction between Hamas’ potential influence in dictating aid delivered by the Palestinian Red Crescent in northern Gaza during the first three months of the conflict when the UN was prevented from operating in northern Gaza. Then, on April 10, Administrator Power of USAID acknowledged in a testimony to the Senate Foreign Relations Committee: “We do not have reports of diversion by Hamas from our partners…Israel is not shy about presenting to us evidence of things it finds problematic, and this is not something that has come to our attention.”  

Meanwhile, aid groups have reported to Refugees International that Hamas is not interfering with their aid distribution. Instances of convoys being overrun by crowds were generally indicative of desperate populations seeking to self-distribute aid shipments; this would often occur when aid had not reached cut-off communities for an extended period of time as a result of IDF-imposed movement restrictions. Refugees International did hear reports of Hamas interference with COGAT-organized commercial convoys, reportedly because Hamas perceives those as an effort by the Israeli government to empower clan structures as a political counterweight to Hamas control. Finally, we heard multiple reports that a deterioration in general security had given rise to growing criminality, posing serious risk to aid operations. Criminal gangs involved in smuggling of cigarettes have frequently interfered with aid convoys. But interviewees generally perceived that criminality as distinct from Hamas, and cited several instances in which Hamas elements had actually facilitated safe passage for aid shipments through high-risk areas. 

The other document that has proved central to the Israeli government’s famine counter-messaging is a draft nutrition paper by Israeli academics arguing that sufficient volumes of food have entered Gaza. The paper remains a pre-print, as it has not yet completed peer review nor been published in an academic journal. Its draft status has not prevented the Israeli government from distributing it widely and even submitting it as evidence in Israeli court against a lawsuit by Israeli human rights organizations. 

The pre-print relies on unreleased raw data provided to the researchers by the Defense Ministry. The full data set underpinning the draft paper is not publicly available, and the academic authors have declined to share it with outside academics when asked, providing only aggregate summaries and not the underlying data. The authors concluded that from January through April 2024, food delivered to Gaza supplied the equivalent of 3,163 calories per person per day, 40 percent higher than the accepted humanitarian minimums. 

The pre-print contains a range of major weaknesses. The period covered in its analysis – January to April – presents a conveniently skewed view that ignores the huge food deficits that emerged from October to December and the collapse in aid flows following the Rafah offensive in May. The exclusion of these periods is bizarre if the intent is to provide a faithful picture of cumulative food supply to Gaza.

The pre-print mostly elides the challenges of internal distribution, raising further questions about its credibility. Safe aid access and last-mile distribution within Gaza are among the biggest challenges in combating famine. The paper inaccurately blames these challenges solely on Hamas, while making no reference to multiple IDF strikes on aid groups during the very period covered by the paper (including the infamous World Central Kitchen attack). Had the authors consulted humanitarian organizations working in Gaza, they would have heard that Hamas was not significantly interfering with their aid operations, and the most last-mile distribution challenges relate to IDF conduct and obstacles from the Israeli government. Those obstacles have been extensively documented by multiple organizations, including Human Rights Watch, the Biden Administration’s NSM-20 report, and many aid groups. None of these impediments to last-mile operations are acknowledged as factors in the paper.

Finally, the paper’s analysis relates only to reported entry of food shipments into Gaza – not to actual household level consumption by people in Gaza. While the authors acknowledge that distinction, they do not address or engage with its implications in much detail. As such, even if one takes the paper’s reported food volumes at face value, it does not challenge the basic IPC findings of severe food insecurity across Gaza and famine risk in the worst hit areas. The IPC analysis, by contrast, is informed by actual firsthand research on household food consumption and malnutrition, conducted via direct monitoring (when possible) and by systematic monthly telephone surveys of households in Gaza. The pre-print claims, oddly, that such household consumption data is unavailable, while ignoring that the IPC process (which they dismiss) has collected and utilized exactly that sort of data. This indicates – at best – willful blind spots, and – at worst – outright bias on the part of the authors.

Conclusion

The narrative constructed by Israeli authorities regarding food conditions in Gaza is fundamentally at odds with the observations of humanitarian aid workers inside Gaza and the testimonies of Palestinians who have fled to Egypt, as well as those who remain. Refugees International’s research underscores the profound and traumatic impact of the conflict on Palestinian civilians, despite the official narrative promoted by Israeli authorities. 

Preventing a famine requires more than isolated interventions; it necessitates a sustained effort to alleviate the conditions driving malnutrition and a robust humanitarian response that meets the scale of the crisis. While the temporary improvements in April, prompted by international pressure, demonstrated the direct impact of Israeli government policies and military actions on food security in Gaza, it is far from accurate to label this response as a “success.” Instead, it highlights how critical policy shifts can alter the trajectory of humanitarian crises. 

Since then, conditions in Gaza have again deteriorated significantly, yet without prompting the same level of urgency to improve the situation, increase aid, and protect the lives of Palestinians and the remaining Israeli hostages. The ongoing failure to reach a ceasefire condemns those trapped between Hamas and Israel to an increasingly grim reality. Our findings underscore how closely fluctuations in hunger conditions are tied to Israeli government restrictions and military actions, with the brief respite in April quickly unraveling after the Rafah offensive in May. Without a widespread and enduring course correction on aid access, civilian protection, and humanitarian security, the risk of famine-like conditions re-emerging remains dangerously high.

Endnotes

[1] These also included a January airstrike on an International Rescue Committee residence in the designated humanitarian safe zone of Mawasi and the shelling of a Medecins Sans Frontieres shelter in February, killing and injuring multiple staff members. Human Rights Watch has provided additional documentation on other such attacks.

[2] This data includes only humanitarian shipments, and does not reflect commercial shipments coordinated by the Israeli government. However, per the Israeli government’s own data, those commercial shipments did not begin in meaningful numbers until some time in May – further validating the picture of intense deprivation that developed in February through early March. It is also not clear from Israeli data how many commercial shipments entered the north during this period, as the Israeli government does not publish shipment location data.

Featured Image: A Palestinian mother holds the hand of her baby, who is experiencing malnutrition and lack of medical care in a camp for displaced people in Deir al Balah, Gaza on March 25, 2024. Photo by Ashraf Amra/Anadolu via Getty Images.