\n<\/p>\n
For weeks, the Gaza Strip\u2019s 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.<\/p>\n
But since Israeli forces began an incursion in the city this month \u2014 effectively closing the two main crossings where aid enters \u2014 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.<\/p>\n
Families hide what canned goods they still have. They eye their emptying sacks of flour, calculating how long they will last.<\/p>\n
\u201cThere\u2019s always something missing in the tent,\u201d said Ahmed Abu al-Kas, 51, who is sheltering in Rafah with his family. \u201cIf we have bread, we don\u2019t have water. If we have firewood, we don\u2019t have some basic vegetables.\u201d<\/p>\n<\/div>\n<\/div>\n
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.<\/p>\n
None of those conditions have been met.<\/p>\n<\/div>\n<\/div>\n
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.<\/p>\n
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<\/a>. Even if the floodgates open to aid tomorrow, malnutrition experts say many more people will die \u2014 from starvation, or from diseases as simple as diarrhea because their bodies are so weak and medical care is so scant.<\/p>\n \u201cWe have never ever seen anything like this anywhere in the planet,\u201d said Janti Soeripto, the president and chief executive of Save the Children U.S.<\/p>\n<\/div>\n<\/div>\n Usually, aid groups explain, humanitarian crises affect a portion of the population, not everyone. In Gaza, \u201cit is really the entirety of the population\u201d that is under threat, \u201cnot just a subset,\u201d said Jeremy Konyndyk, president of Refugees International.<\/p>\n 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.<\/p>\n 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<\/a>.<\/p>\n 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.<\/p>\n<\/div>\n<\/div>\n The International Criminal Court\u2019s chief prosecutor requested arrest warrants on Monday for Israel\u2019s prime minister and defense minister, accusing them<\/a> 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.<\/p>\n<\/div>\n<\/div>\n 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 \u2014 a charge aid officials reject, saying Israeli forces have made it exceedingly difficult to do so.<\/p>\n 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.<\/p>\n In the meantime, people are dying<\/a>.<\/p>\n And by the time famine is declared, \u201cit\u2019s already very, very late, and there\u2019s already going to be widespread death,\u201d said Kiersten Johnson, who directs the Famine Early Warning Systems Network, a U.S. government program that tracks hunger<\/a> in global crises.<\/p>\n \u201cWe should not wait for an official famine declaration\u201d to flood Gaza with aid, she said.<\/p>\n 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.\u2019s humanitarian coordination agency, said last week.<\/p>\n<\/div>\n<\/div>\n 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\u2019s 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.<\/p>\n \u201cIf the crossings stay closed, goods will be scarce and prices will go up insanely,\u201d 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. \u201cThe suffering will increase at every level and we won\u2019t find anything to eat or drink.\u201d<\/p>\n 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.<\/p>\n<\/div>\n<\/div>\n The Rafah crossing\u2019s closure has also prevented most aid workers and volunteers from entering to reinforce Gaza\u2019s exhausted medical corps and to repair water and sanitation systems.<\/p>\n<\/div>\n<\/div>\n 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.<\/p>\n 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.<\/p>\n 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.<\/p>\n \u201cI\u2019m afraid it will be our turn this time,\u201d said Manal Hijji, 46, who is sheltering in Rafah. \u201cLess money and less food, plus the crossings being closed for longer, is the quickest way to real starvation.\u201d<\/p>\n 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.<\/p>\n<\/div>\n<\/div>\n 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.<\/p>\n \u201cIt\u2019s not like people are starving and they eat a good, high-calorie meal and then they\u2019re fine,\u201d said Bushra Khalidi, a policy adviser at Oxfam, an aid group working in Gaza. \u201cYou need vitamins, you need supplements, you need a doctor, you need a health care system that works.\u201d<\/p>\n<\/div>\n<\/div>\n 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 \u2014 and most of the health care system too overwhelmed<\/a> to treat any but the worst injuries.<\/p>\n All those elements require aid. But the aid effort confronts overbearing security restrictions and political roadblocks in both Israel and Egypt, aid officials say.<\/p>\n<\/div>\n<\/div>\n 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.<\/p>\n But Egypt says the flow of aid is ultimately on Israel, holding it \u201csolely responsible for the humanitarian catastrophe\u201d in Gaza, the Egyptian foreign minister, Sameh Shoukry, said in a statement last week.<\/p>\n Israeli inspectors have filled an entire warehouse in Egypt with rejected items, according to aid officials and others, including two U.S. senators<\/a>, 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.<\/p>\n<\/div>\n<\/div>\n 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.<\/p>\n<\/div>\n<\/div>\n Israeli officials say they must remove some items \u201cto make sure there is nothing in there that Hamas could use to harm Israeli civilians,\u201d said Shimon Freedman, a spokesman for COGAT, the Israeli military agency coordinating aid delivery. He said that rejections were \u201cvery rare\u201d and that many rejected items eventually passed into Gaza. The list of screened items, he said, had not changed since the war began.<\/p>\n Israel has \u201csubstantially\u201d increased inspection capacity, including by opening new aid crossings and inspection points and extending operating hours at existing ones, he said.<\/p>\n 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.<\/p>\n \u201cThere\u2019s a lot of aid and fuel waiting,\u201d said Bob Kitchen, the vice president for emergencies at the International Rescue Committee. \u201cIt feels futile.\u201d<\/p>\n 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<\/a> aid vehicles and killed aid workers despite being informed in advance<\/a> of their locations, and they have detained Palestinian truck drivers, leaving international aid workers to take the wheel, aid officials say.<\/p>\n<\/div>\n<\/div>\n Israel\u2019s military has \u201ctaken multiple steps\u201d to \u201cenhance the protection of aid workers,\u201d 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.<\/p>\n As a result, the number of aid trucks reaching northern Gaza in April \u2014 more than 1,700 \u2014 was more than four times that in March, Mr. Freedman said.<\/p>\n Mr. Laerke, of the U.N., said the boost was insufficient and short-lived.<\/p>\n The Biden administration, which for the first time suspended arms transfers to Israel over the Rafah operation, has vocally pressed<\/a> Israel and Egypt to coordinate on reopening the southern crossings.<\/p>\n 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.<\/p>\n<\/div>\n<\/div>\n 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.<\/p>\n \u201cIf they are being fed and provided medical support, we are fueling our enemy,\u201d he said.<\/p>\n Iyad Abuheweila, Abu Bakr Bashir, Patrick Kingsley and Natan Odenheimer contributed reporting.<\/p>\n<\/div>\n<\/div>\n\u2018It\u2019s already very, very late\u2019<\/h2>\n
Malnourished people are more vulnerable<\/h2>\n
Checkpoints last hours<\/h2>\n