As Famine Looms in Gaza, Aid Delivery Remains Difficult and Dangerous

Loay Ayyoub for The Washington Post
Crowds of displaced residents wait for a meal of lentil soup in Rafah, south of the Gaza Strip, on Dec. 18, 2023.

CAIRO – Describing the humanitarian situation in the Gaza Strip in increasingly apocalyptic terms, aid agencies are urging Israel to ease the difficult and often dangerous process of delivering supplies to desperate Palestinians.

Israel has embarked on a public campaign to defend its humanitarian record, blaming the United Nations and Hamas for the crisis.

Famine is looming in Gaza, the United Nations warns. The World Food Program estimates that 93 percent of the population faces crisis levels of hunger. Disease is spreading rapidly. The World Health Organization predicts that the death toll from sickness and starvation in coming months could eclipse the number of people killed in the war so far – more than 24,000, according to the latest count from the Gaza Health Ministry, with the majority women and children.

Aid agencies say the chief factors hampering the delivery of lifesaving assistance to Gazans fall almost entirely under Israel’s control – the Israeli inspection process for aid remains lengthy and inefficient; there aren’t enough trucks or fuel inside Gaza to distribute the aid; mechanisms to protect humanitarian workers are unreliable; and commercial goods have only just begun to trickle in.

Large swaths of Gaza remain off-limits to aid workers. Frequent telecommunications blackouts complicate their work. And the war still rages.

“The humanitarian situation in Gaza is beyond words. Nowhere and no one is safe,” U.N. Secretary General António Guterres told reporters Monday. “Lifesaving relief is not getting to people who have endured months of relentless assault at anywhere near the scale needed.”

Israel insists it is doing everything it can to ease the suffering of civilians. Government spokesman Eylon Levy said last week that Israel had facilitated the delivery “of over 130,000 tons of humanitarian aid.”

“Israel has excess capacity to inspect and process trucks,” he added. “There is no backlog and no limitation on our end.”

On average, 100 to 200 trucks get through to Gaza each day. Before the war, that number was about 500, many carrying commercial goods. After the Hamas attacks on Oct. 7, Israel blocked the entry of commercial trucks to Gaza. The flow resumed in mid-December but has been “limited and sporadic,” said Shiraz Chakera of UNICEF Egypt.

Aid flowing into Gaza has primarily transited the Rafah border crossing with Egypt. While the gates there are operated by Egyptian and Palestinian officials, nothing can enter without an inspection by Israeli officials. Aid groups describe this as a convoluted and time-consuming process.

After an initial Egyptian screening, Egyptian truck drivers take their cargo down a “rough desert road” to the Nitzana crossing between Egypt and Israel, a journey of about two hours, said Amir Abdallah, who supervises convoys for the Egyptian Red Crescent.

The inspection point is open only during the day and is closed on Friday afternoons and Saturdays. Drivers wait in a long line of trucks for their turn to have their load inspected by Israeli agents, who use dogs and a scanning machine.

Items including scalpels for delivering babies, water desalination equipment, generators, oxygen tanks, and tents with metal poles have been rejected, aid workers say, sometimes without explanation from Israeli authorities. When one item on a truck is rejected, the whole truckload must repeat the process, which can take weeks.

Approved loads return to the Rafah crossing, where it can take days for the cargo to be transferred to Palestinian trucks, two Egyptian drivers told The Washington Post.

Aid workers attribute the delays to a lack of Palestinian vehicles – some have been damaged by Israeli strikes – and there’s not enough fuel to go around, according to Shameza Abdulla, senior emergency coordinator with UNICEF.

Israel has restricted deliveries of fuel, alleging it will be stolen by Hamas to power its rockets, and has defended the inspection process as necessary to prevent the smuggling of illicit goods. Israeli officials have also accused the United Nations, without evidence, of turning a blind eye to large-scale diversion of aid by Hamas. U.N. officials have denied the claims.

A senior U.S. official, speaking on the condition of anonymity to discuss sensitive matters, told The Post: “The Israeli government has not brought to the attention of the U.S. government … any specific evidence of Hamas theft or diversion of assistance provided via the U.N. and its agencies. Full stop.”

Under U.S. pressure, Israel opened a second crossing in December, at Kerem Shalom, where the inspection process moves faster. The World Food Program has also begun sending convoys from Jordan to Gaza via the West Bank and Israel.

“That is some good news, but it’s important to recognize that it’s not a permanent solution,” said Steve Taravella, a senior WFP spokesman. “We need the opening of all border crossings for faster aid delivery.”

Nine in 10 Gazans are eating less than one meal a day, the U.N. agency says. And winter cold is setting in.

More than a million people displaced by Israel’s offensive are crammed into a tiny strip of land along the southern border with Egypt, most without adequate shelter. Hundreds of thousands of people are estimated to be stuck in the north. In the first two weeks of January, humanitarian agencies were able to carry out only seven of 29 planned missions to the north; permissions for the rest were denied by Israeli authorities, said the U.N. Office for the Coordination of Humanitarian Affairs.

Videos posted on social media in recent days show crowds in Gaza City rushing toward aid trucks, then fleeing as shots ring out. The Post verified the location of the videos but could not confirm when they were filmed.

“People are hungry and quite desperate, so we have to have police escorts for all our convoys, which limits when we can move, how many [vehicles] we can put in a convoy,” said Scott Anderson, deputy director for Gaza at the U.N. Relief and Works Agency (UNRWA).

Humanitarian officials emphasize that the war itself remains the greatest obstacle to aid deliveries. Israeli airstrikes and street battles make it impossible for workers to safely provide supplies to the people who most need them, they say, and have hastened the collapse of Gaza’s medical system.

“We are running out of hospitals,” said Michel-Olivier Lacharité, head of emergency operations at Doctors Without Borders. “If you want to save lives, patients need to have access to the hospital. Supplies need to reach the hospital.”

Channels to deconflict with Israeli forces are unreliable, aid workers told The Post, adding that they cannot guarantee the safety of staff or their families. To date, 152 U.N. staff members have been killed in Gaza, according to Guterres, “the largest single loss of life in the history of our organization.”

This month, an Israeli munition killed the 5-year-old daughter of an employee of Doctors Without Borders at what was supposed to be a safe house, the group said.

Asked about the incident, the Israel Defense Forces told The Post: “In stark contrast to Hamas’s intentional attacks on Israeli men, women and children, the IDF follows international law and takes feasible precautions to mitigate civilian harm.”

Allegations that Israel is deliberately hampering the flow of food and basic supplies into Gaza lie at the heart of South Africa’s high-profile genocide case against Israel at the International Court of Justice. Israel has fiercely denied what it calls “false and baseless claims.”

But in the face of growing international outrage, the Israeli agency in charge of liaising with aid organizations – known as Coordination of Government Activities in the Territories, or COGAT – unveiled a new website in English and Arabic this week detailing the humanitarian assistance and field hospitals it has enabled to enter Gaza.

COGAT has also stepped up its criticism of U.N. agencies, which Israel blames for the slow pace of aid distribution.

“We’re not perfect or infallible,” said Anderson, of UNRWA. “But the crossings only open so many hours a day. … And on days when [Israeli officials] promise to send more trucks, they don’t.”

U.N. agencies are calling on Israel to open the Erez crossing and other routes into Gaza and to speed inspections. But if the war continues, humanitarian aid alone will not be enough to stave off starvation, officials warn.

“Most of all,” said Lucia Elmi, a UNICEF special representative, “what is really needed is a cease-fire.”

Heba Farouk Mahfouz in Cairo, Imogen Piper in London, Karen DeYoung in Washington and John Hudson in Tel Aviv contributed to this report.