As Rafah Offensive Grinds On, Hunger in Gaza Spirals

For weeks, the Gaza Strip’s southernmost city, Rafah, was one of the few places where desperate Gazans could find some aid and food. Bakeries sold bread; fuel powered generators; markets were open, if expensive.

But since Israeli forces began an incursion in the city this month — effectively closing the two main crossings where aid enters — Rafah has become a place of fear and dwindling supplies. Bakeries have shuttered. So have malnutrition treatment centers. The price of the firewood that many people now use to cook has doubled. Tomatoes, cucumbers and peppers have grown so expensive that they are sold by the piece, not by the kilogram.

Families hide what canned goods they still have. They eye their emptying sacks of flour, calculating how long they will last.

“There’s always something missing in the tent,” said Ahmed Abu al-Kas, 51, who is sheltering in Rafah with his family. “If we have bread, we don’t have water. If we have firewood, we don’t have some basic vegetables.”

For months, international aid officials and health experts have warned that famine will come for Gaza unless Israel lifts barriers keeping most humanitarian aid out, the fighting stops and vital services such as health care and clean water, which must be in place to fend off malnutrition, are restored.

None of those conditions have been met.

If anything, circumstances have become worse in some places. Little fuel is entering to power the aid operations, hospitals or municipal services. Hundreds of thousands of people have fled Rafah for burned-out buildings and fields farther north, where they have little water or medical care. Buckets serve as latrines. Trash piles up, and families burn it to cook.

Though international aid agencies cannot officially declare whether Gaza meets the technical threshold for famine until more data is collected, the head of the U.N. World Food Program has already said famine has arrived. Even if the floodgates open to aid tomorrow, malnutrition experts say many more people will die — from starvation, or from diseases as simple as diarrhea because their bodies are so weak and medical care is so scant.

“We have never ever seen anything like this anywhere in the planet,” said Janti Soeripto, the president and chief executive of Save the Children U.S.

Usually, aid groups explain, humanitarian crises affect a portion of the population, not everyone. In Gaza, “it is really the entirety of the population” that is under threat, “not just a subset,” said Jeremy Konyndyk, president of Refugees International.

Despite mounting pressure to withdraw, Israel says it must fight in Rafah to dismantle Hamas infrastructure, including tunnels that Israel says enable smuggling from Egypt to Gaza, and to defeat Hamas battalions there. Around 815,000 people have already fled Rafah, and more are likely to do so as Israel expands its campaign to the heart of the city.

‘It’s already very, very late’

Even before the Rafah operation, aid agencies said the amount of aid entering Gaza fell far short of what was needed. Before the war, around 500 aid trucks passed daily through Kerem Shalom and Rafah, the two main crossings into Gaza. But that figure has fallen by around 75 percent since Oct. 7 to around 119 trucks daily, according to United Nations data.

Aid officials and many donor governments, among them the United States, have blamed Israel for tightly restricting aid, including by blocking essential items and imposing a byzantine assortment of security restrictions at nearly every stage of the process. Delays have also come from Egypt, where most of the aid is collected before being sent on to Gaza.

The International Criminal Court’s chief prosecutor requested arrest warrants on Monday for Israel’s prime minister and defense minister, accusing them of using starvation as a weapon of war, among other allegations. He also requested warrants for top Hamas leaders, on charges of crimes against humanity. Neither set of warrants has been issued.

Israel says it is doing its part, arguing that it must thoroughly screen cargo for anything Hamas fighters could use. It says enough aid is entering Gaza and has blamed aid groups for not distributing it faster to civilians — a charge aid officials reject, saying Israeli forces have made it exceedingly difficult to do so.

Israel said on Tuesday that it had inspected and sent 450 trucks through Kerem Shalom on that day alone, faulting aid agencies for not delivering their contents. But aid officials said the pileup amounted to little more than political theater, since the fighting on the Gazan side made it impossible to collect the supplies.

In the meantime, people are dying.

And by the time famine is declared, “it’s already very, very late, and there’s already going to be widespread death,” said Kiersten Johnson, who directs the Famine Early Warning Systems Network, a U.S. government program that tracks hunger in global crises.

“We should not wait for an official famine declaration” to flood Gaza with aid, she said.

Though some food has arrived through three northern crossings into Gaza, it has not filled the gap left by the two southern crossings, Jens Laerke, a spokesman for the U.N.’s humanitarian coordination agency, said last week.

The U.N. World Food Program said that 59 aid trucks had been delivered to warehouses in Gaza as of Wednesday from a U.S.-built temporary pier, and that, to the program’s knowledge, all the contents arrived intact. However, Palestinians intercepted and emptied 11 other trucks that were traveling through the central region of Gaza, the agency said.

“If the crossings stay closed, goods will be scarce and prices will go up insanely,” said Nidal Kuhail, 30, a Gaza resident who has been sheltering in Rafah, noting that he no longer saw aid trucks rolling into the city. “The suffering will increase at every level and we won’t find anything to eat or drink.”

The World Health Organization said this month that 58 children with severe acute malnutrition had been admitted to special treatment centers in Gaza. But since the Rafah operation began, many such centers have closed, while new ones slated to open in northern Gaza have been suspended, the United Nations said.

The Rafah crossing’s closure has also prevented most aid workers and volunteers from entering to reinforce Gaza’s exhausted medical corps and to repair water and sanitation systems.

Some fresh food is entering northern Gaza, where fears of a famine had been strongest. Residents interviewed last week reported seeing canned food, vegetables and flour in local markets. In recent days, trucks have also carried commercial goods into southern Gaza, filling markets with a wide variety of foods, said a U.N. official, who spoke on condition of anonymity because the official was not authorized to do so publicly.

But the war has left many Gazans without means to buy, especially when prices are far higher than they were before the war and have risen further since the Rafah operation. Two shekels once bought three cans of chickpeas but now cover only one, said Mahmoud Marzouq, 29, a Gaza City resident. And because there are often only a few A.T.M.s operating across Gaza, there is little cash to pay with.

Without free aid, people in the south are now facing the same kinds of dire shortages as those in the north contended with for months.

“I’m afraid it will be our turn this time,” said Manal Hijji, 46, who is sheltering in Rafah. “Less money and less food, plus the crossings being closed for longer, is the quickest way to real starvation.”

So when the United Nations distributed canned goods last week, Ms. Hijji hid as many of them as she could under a pile of clothes and bedding, lest her grandchildren go hungry.

Malnourished people are more vulnerable

After seven months of undernourishment, it will take much longer for Gazans to recover now than it would have in the early days of the war, Dr. Johnson said.

“It’s not like people are starving and they eat a good, high-calorie meal and then they’re fine,” said Bushra Khalidi, a policy adviser at Oxfam, an aid group working in Gaza. “You need vitamins, you need supplements, you need a doctor, you need a health care system that works.”

Malnourished people are more vulnerable to diseases picked up from an environment where much of the water is contaminated, sewage systems broken down and trash pickup nonexistent — and most of the health care system too overwhelmed to treat any but the worst injuries.

All those elements require aid. But the aid effort confronts overbearing security restrictions and political roadblocks in both Israel and Egypt, aid officials say.

Cairo considers the region bordering Gaza highly sensitive. It has barred the United Nations from setting up a full-fledged logistics hub and kept aid groups from importing necessary security gear. Egypt has also allowed a tangle of aid channels to sprout, fostering chaos and inefficiency, said aid officials and diplomats who spoke on condition of anonymity to discuss sensitive matters freely.

But Egypt says the flow of aid is ultimately on Israel, holding it “solely responsible for the humanitarian catastrophe” in Gaza, the Egyptian foreign minister, Sameh Shoukry, said in a statement last week.

Israeli inspectors have filled an entire warehouse in Egypt with rejected items, according to aid officials and others, including two U.S. senators, who have seen the warehouse. Those include water purification tablets, solar panels, wheelchairs, oxygen machines and tent poles, they said, adding that food easily passed inspection.

Only this month did Israel circulate a list of items requiring extra scrutiny, according to Ms. Khalidi, who provided the list to The New York Times. Until then, aid officials say, inspectors sometimes rejected an item one day and allowed it the next without explanation. A single barred item can send the entire truck back for reloading and reinspection, they say.

Israeli officials say they must remove some items “to make sure there is nothing in there that Hamas could use to harm Israeli civilians,” said Shimon Freedman, a spokesman for COGAT, the Israeli military agency coordinating aid delivery. He said that rejections were “very rare” and that many rejected items eventually passed into Gaza. The list of screened items, he said, had not changed since the war began.

Israel has “substantially” increased inspection capacity, including by opening new aid crossings and inspection points and extending operating hours at existing ones, he said.

Aid officials dispute that Israel inspects trucks speedily. In March, trucks were taking an average of 20 days to move the 25 miles from the main Egyptian collection point into Gaza, according to Oxfam. Now that the southern crossings are effectively shut, more than 2,000 trucks are stuck in Egypt, 1,574 of which carry critical food items, the Egyptian Red Crescent has said.

“There’s a lot of aid and fuel waiting,” said Bob Kitchen, the vice president for emergencies at the International Rescue Committee. “It feels futile.”

Checkpoints last hours

Once aid convoys are inside Gaza, aid officials say, Israel often bars them from moving or holds them for hours at a checkpoint, sometimes preventing them from reaching their destination before dark, when they cannot operate. Israeli forces have also fired on aid vehicles and killed aid workers despite being informed in advance of their locations, and they have detained Palestinian truck drivers, leaving international aid workers to take the wheel, aid officials say.

Israel’s military has “taken multiple steps” to “enhance the protection of aid workers,” it said in a statement, including using new technology to identify aid vehicles at night. It said it reviews incidents in which it fires on aid groups.

As a result, the number of aid trucks reaching northern Gaza in April — more than 1,700 — was more than four times that in March, Mr. Freedman said.

Mr. Laerke, of the U.N., said the boost was insufficient and short-lived.

The Biden administration, which for the first time suspended arms transfers to Israel over the Rafah operation, has vocally pressed Israel and Egypt to coordinate on reopening the southern crossings.

Some Israelis have called for just that, including more than 80 Israelis who massed for a protest in Jerusalem last week to condemn recent attacks by ultranationalist Israelis on aid convoys.

But for Israeli policymakers, withholding aid may serve as leverage over those holding Israeli hostages as well as a tactic for depriving Hamas of supplies, said Einav Levy, the founding director of the Israeli School of Humanitarian Aid.

“If they are being fed and provided medical support, we are fueling our enemy,” he said.

Iyad Abuheweila, Abu Bakr Bashir, Patrick Kingsley and Natan Odenheimer contributed reporting.