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Gaza aid in-depth: Response leaders warn of extreme obstacles, even with a ceasefire

‘I’ve never seen anything where there was such a lethal combination of factors going on to create the humanitarian situation, but also prevent it from being addressed.’

A view of the destruction caused by Israeli attacks after the Israeli army withdrew from parts of Gaza City and North Gaza governorate for the first time since it started its ground offensive on Oct. 27, in Gaza City, Gaza on February 01, 2024. Abdulqader Sabbah/Anadolu
A view of the destruction left by Israel's military campaign after ground forces withdrew from parts of Gaza City and North Gaza on 1 February 2024.

Aid efforts are utterly failing to meet the basic needs of the population in the Gaza Strip due to ongoing hostilities and logistical barriers, while the prospects of starvation and deadly disease outbreaks are growing by the day, international and local officials leading relief efforts warn.

The near-total destruction of much of Gaza after months of Israeli bombardment will also make it nearly impossible to mount an adequate aid response even if the fighting stops, officials at seven UN agencies and international and local NGOs told The New Humanitarian.

“This is on a scale that you very rarely see,” said Jamie McGoldrick, interim humanitarian coordinator for the Palestinian territories for the UN’s emergency aid body, OCHA, describing the extent of the needs in Gaza.

  • At a glance: What aid officials say about the Gaza response

  • Aid efforts are utterly failing to meet the basic needs of the population due to ongoing hostilities and logistical barriers, as the population faces the prospect of famine and widespread disease outbreaks.
  • Even if the fighting stops, the near-total destruction of much of Gaza after months of Israeli bombardment will make mounting an adequate response nearly impossible. 
  • Inside Gaza, ongoing hostilities, communication blackouts, the absence of security guarantees from Israel, and the widespread destruction of roads and other infrastructure make it exceedingly difficult to distribute aid.
  • Aid organisations have barely been able to access the north of Gaza in 2024 as Israel has repeatedly denied access to UN aid missions. 
  • In southern Gaza, aid agencies are finding it increasingly difficult to work because of the enormous number of people – more than half the population – who have been forced into the area.
  • Time-consuming and often arbitrary Israeli security inspection processes are slowing the entry of assistance to Gaza.

Nearly four months into the war, the vast majority of Gaza’s 2.3 million people have been forcibly displaced from their homes by an Israeli bombing campaign that experts say is the most destructive in recent history, and a ground invasion is increasingly squeezing the desperate population into an overcrowded, shrinking sliver in the south of the enclave. 

“Every man, woman, and child needs help. There's active fighting; no deconfliction mechanism; [and] significant hurdles to getting aid inside the country,” said Kate Phillips-Barrasso, vice-president for global policy and advocacy with Mercy Corps.

“I’ve never seen anything where there was such a lethal combination of factors going on to create the humanitarian situation, but also prevent it from being addressed,” Phillips-Barrasso added. “You're trying to deliver aid on a scale that almost never exists.”

The Israeli military campaign began following a deadly attack into Israel on 7 October by Hamas – the Palestinian political and militant group that governs Gaza – which left around 1,140 people dead in Israel. Hamas and other Palestinian militant groups also took around 240 hostages back to Gaza. An estimated 136 remain in captivity.

Shortly after 7 October, Israel imposed a complete siege on Gaza, cutting off water and electricity, and blocking the entry of food, fuel, medical supplies, and other essentials. Since then, Israel has allowed some humanitarian aid to enter, first through the Rafah border crossing with Egypt, and more recently through Kerem Shalom, between Gaza and Israel. 


But time-consuming and often arbitrary Israeli inspection processes have slowed the entry of assistance, and ongoing hostilities, communication blackouts, the absence of security guarantees from Israel, and the widespread destruction of roads and other infrastructure have made it exceedingly difficult for UN agencies and NGOs to distribute it once it's inside Gaza. 

In the meantime, every single resident of Gaza is hungry, and more than 500,000 people are facing catastrophic levels of food insecurity, according to UN officials, who believe famine is already taking place in parts of the enclave. 

Without a fundamental change, the UN and aid groups are warning that the death toll from starvation and disease could surpass the number of people killed in Israeli airstrikes and hostilities, which currently stands at more than 27,000, according to local health officials.

The allegation that Israel has deliberately created a humanitarian catastrophe (bolstered by public statements from some Israeli officials) that is threatening to destroy Palestinian life in Gaza is central to the case being brought by South Africa to the International Court of Justice (ICJ), the UN’s top court, accusing Israel of genocide. 

In an interim ruling on 26 January, the ICJ found “at least some” of South Africa’s allegations to be “plausible” and ordered Israel to take “immediate and effective measures to enable the provision of urgently needed basic services and humanitarian assistance”. The ICJ required Israel to report back by 26 February on how it has implemented the order.

Israeli Prime Minister Benjamin Netanyahu described the genocide accusation as “outrageous” and said the military offensive will continue. 

On the same day as the ruling, Israel accused 12 employees from UNRWA, the UN’s agency for Palestine refugees – the largest aid organisation in Gaza – of being involved in the 7 October attacks. In response, at least nine of UNRWA’s top donors – including the United States, Germany, Switzerland, and Canada – suspended funding for the agency, plunging the future of aid operations in Gaza into disarray. 

UNRWA says it may be forced to end services in Gaza as early as the end of February if donors continue to withhold funding. 

“It would be tragic and unbelievable if… exactly when the International Court of Justice says humanitarian aid must be provided, that donors, by cutting funding, prevent Israel from implementing that part of the ruling,” Lex Takkenberg, a former UNRWA administrator who worked with the agency for 30 years, told The New Humanitarian in a recent interview.

Aid agencies say a lasting ceasefire is a prerequisite for beginning to address the catastrophic humanitarian situation. Hamas leaders are reportedly considering an Israeli proposal for a longer-term ceasefire – pushed for by the United States.

But even if a deal is struck soon – and implemented by Israel – aid officials say significant changes would still be needed in terms of access and logistics for them to even be able to provide those in Gaza with basic necessities.

Little progress on barriers slowing aid into Gaza

Since the ICJ ruling, there has been little sign of change on the ground in Gaza. UN agencies say Israel continues to block and delay their efforts to access northern and central Gaza – cut off from the south by Israel’s ground invasion – and that intense Israeli bombing has continued, threatening the safety of aid workers and humanitarian supplies. 

Israeli officials blame the inadequate aid response on the UN, saying they are allowing enough aid into Gaza but that the UN hasn’t deployed enough trucks or workers to distribute it. They have also alleged – without providing evidence – that Hamas is stealing aid on a large scale; a claim UN officials have repeatedly denied

Members of the Israeli government’s war cabinet have suggested cutting the amount of aid allowed into Gaza, Israeli media reported on 1 February.

Protesters, meanwhile, supported by some members of Netanyahu’s government – have been calling on the Israeli government and the United States to block aid from entering Gaza. 

Despite repeated statements from Israeli officials that they are not obstructing aid operations, UN agencies and NGOs who spoke with The New Humanitarian said there has been no significant change since last year to reduce the barriers blocking food, water, medical supplies, and other critical items from getting into Gaza.

Palestinians, who left their homes and took refuge in Rafah city under hard conditions, carry the flour they received at the area where UNRWA (The United Nations Relief and Works Agency for Palestine Refugees) distributes flour to families.
Abed Zagout/Anadolu
Forcibly displaced Palestinians collect aid from UNRWA, the UN's agency for Palestine refugees, in the southern city of Rafah in Gaza.

All of the organisations described an erratic inspection process, with shifting rules imposed by Israel on all aid entering Gaza being a major impediment. 

“Before the conflict, we had 500 trucks a day going in. Now, we have less than 200,” explained Ricardo Pires, a UNICEF spokesperson. “It’s not because the trucks are not available. They are available. It’s because they can't move in fast enough – and that has to do with slow inspection processes, unpredictable inspection processes, [and] protracted layers of inspection.”

“Children are running out of time, and the life-saving humanitarian aid they so desperately need is right there across the border, stranded between insufficient access corridors and protracted layers of inspection and processes,” Pires said. 

COGAT, the Israeli government agency responsible for coordinating with aid organisations, did not respond to a request for comment in time for publication.

Israeli authorities have also said that aid delivery is delayed because of problems on the Egyptian side of the border – a claim Egyptian authorities have denied.

Ahmed, a truck driver working on the Egyptian side of the border who asked to be identified only by his first name, told the New Humanitarian the Israeli inspection process at the Nitzana border crossing between Egypt and Israel can can take hours for a single truck, and that he has seen entire loads of food or medical supplies turned away for unclear reasons. 

“Often, they ask us to unload the load on the ground, and they confiscate some of the goods or leave them on the ground and destroy them,” said Ahmed, who spoke with The New Humanitarian by phone. “There are no clear standards regarding what they allow to enter or not,” he said. “The matter is subject to the mood of the soldiers supervising the inspection process, and there are no clear regulations.”

UN officials have expressed similar concerns, with UN emergency aid chief Martin Griffiths saying Israeli officials often deny critical items for “unclear, inconsistent and often unspecified reasons”. 

Israel provides a list of banned “dual-use” items – those it argues could have a military use – but items not on the list are also often turned back, aid workers told the New Humanitarian. Critical items like scalpels, oxygen tanks, and solar panels have also been blocked

Equipment for hospitals – X-ray machines, generators, and fuel – has also been blocked by the Israeli authorities, who say they could be used by militants.

“The reason is security, which of course doesn’t make any sense because everybody knows that at MSF, we use our generators for ourselves,” said Leo Cans, Médecins Sans Frontières’ (MSF) head of mission in Gaza.

MSF is in constant communication with Israeli authorities about equipment blocked at the border, but little has changed since the beginning of the current hostilities, according to Cans. “Aid is coming in, but now it’s maybe 1 or 2% of what is needed. It’s not enough,” he said. 

“It’s completely forbidden under international law to block humanitarian aid to the population,” he added. “The number of laws that have been completely disrespected and disregarded by the Israeli government is shocking.” 

Aid agencies fear bottleneck in Egypt

Even if the inspection process is simplified and the number of trucks ramped up, aid agencies worry that the Rafah border crossing into Gaza from Egypt – a pedestrian crossing not intended for high volumes of truck traffic – will become a bottleneck.

“If we’re going to have to serve a population of two million people in need, we can’t do it through that one door – we have to find other ways,” said OCHA’s McGoldrick. 

In December, after negotiations with the UN and the United States, the Israeli government began allowing aid trucks to pass through the Kerem Shalom crossing from Israel, but it has refused to open additional crossings. US and European officials have also been pressuring Israel to allow aid to be delivered by sea through the Israeli port of Ashdod to provide an alternative to Rafah, and some aid has been delivered overland from Jordan to the Kerem Shalom crossing.

“If we’re going to have to serve a population of two million people in need, we can’t do it through that one door – we have to find other ways.”

But Kerem Shalom has been repeatedly blocked by Israeli protesters, who stopped trucks loaded with flour, food, hygiene items, and tents for nearly a week in late January.

The protesters – including family members of Israeli hostages held in Gaza and of Israeli soldiers fighting in the enclave – have said Israel should block aid until the hostages are released, with some calling on Netanyahu to allow “not a single drop of water” into Gaza. 

After the ICJ ordered Israel to improve aid delivery, the government cleared the protests from the Kerem Shalom crossing, declaring the area a closed military zone and sending police to arrest protesters, who have tried to continue their blockade. The protesters’ efforts have now shifted to Ashdod, where they have blocked trucks carrying aid from leaving the port. 

Barriers inside Gaza

In southern Gaza, aid agencies are finding it increasingly difficult to work because of the enormous number of people who have been forced into the area. An estimated 1.7 million people have been displaced in Gaza, and more than one million of them are packed into the southern region of Rafah, which previously had a population of just 280,000. 

People and shelters are spilling over onto the roads, forcing aid convoys to move “at a snail’s pace”, McGoldrick said.

Some people are starting to spread out towards the coast into a muddy, isolated Israeli-designated ‘safe zone’ that has repeatedly been shelled by the Israeli military. Aid remains scarce in the area, and OCHA is now assessing how to scale up water and food delivery and set up sanitation facilities, McGoldrick said.

“We almost died, or some of us were injured, while we were trying to deliver aid, and other times the needy attacked the vehicles loaded with aid.”

But UN agencies and aid organisations say security continues to be the main problem slowing aid delivery – worsened by frequent communication blackouts that make it nearly impossible to coordinate movement and allow staff to work with some degree of safety.

“The army opened fire on us repeatedly,” said Kamel Abdul Hadi, who works in Gaza with UNRWA’s aid distribution team. “We almost died, or some of us were injured, while we were trying to deliver aid, and other times the needy attacked the vehicles loaded with aid.”

OCHA doesn’t have a reliable, direct line of communication to Israel Defense Forces’ (IDF) units operating in Gaza, McGoldrick explained. Time-sensitive messages about security and route-planning have to be relayed through COGAT.

This system of broken telephone often results in aid convoys waiting at checkpoints, held up by military activity, or directed down unsafe or blocked routes, McGoldrick explained: “Where you may get the green light somewhere, you get the red light somewhere else, and you get held back.”

Adding to the confusion are constant cell network outages – the result of infrastructure damage and Israeli interference, according to internet advocacy group Access Now. These make it impossible for NGO staff to reliably communicate.

OCHA teams inside Gaza have access to only about 20 satellite phones, McGoldrick said, adding that more phones and internet terminals have been held up at the border by Israeli authorities. OCHA is lobbying the Israeli government at a high level for the devices to be allowed through but has been told the issue is “under consideration”, McGoldrick added. “Meanwhile, we're waiting. We're putting people in harm's way.” 

Northern Gaza cut off 

Among the most desperate and hard-to-reach Palestinians are those remaining in northern Gaza, which is under Israeli military control. Aid organisations have barely been able to access the north in 2024. Out of 51 planned UN missions to deliver aid there between 1 and 25 January, only eight were given access by the Israeli military while 29 were denied permission, according to OCHA. 

Israeli authorities have also denied repeated UN requests to open military checkpoints inside Gaza earlier in the day, which the UN says would improve humanitarian access to the north. 

Of the eight convoys allowed to proceed, most were carrying food, while most of those loaded with water and hospital supplies were blocked, OCHA said. A convoy bringing fuel to al-Shifa Hospital on 22 January was the first to reach the north in almost two weeks. 

For residents trapped in northern Gaza, each day revolves around staying alive while searching for basic necessities.

Speaking by phone, Sahar Ismail, who is living with 13 family members in the rubble of a mostly flattened UNRWA school in the south of Gaza City, said she struggles to find firewood to stay warm. 

Ibrahim Dawwas said he often waits for more than 10 hours at an aid distribution point – set up by locals who use donations from abroad to buy the limited amount of basic goods still available in Gaza – to get about a pound of flour mixed with ground animal feed.

Israeli strikes have killed and injured civilians as they wait for aid, including one strike on 25 January that killed 20 people and injured another 150 who were lined up for food aid near Gaza City, according to the Gaza health ministry. 

More than 60% of the homes in Gaza have been damaged or destroyed by Israeli bombardment, with the most intense devastation concentrated in the north.

McGoldrick said critical infrastructure, including water, sewage systems, and roads have been devastated, while the area is also likely littered with unexploded ordnance, which will complicate humanitarian work even after a ceasefire. 

He said OCHA is looking at setting up aid distribution points throughout the north, aiming to flood aid into the area as soon as it becomes safe to do so, then see where it can be further scaled up. It’s unclear when that will be possible, and it remains difficult to make solid plans until staff can get into the area and assess the extent of the damage and the situation they’ll be walking into, he added.

The lack of basic goods also creates opportunities for looting by people who are desperate, as well as extortion – something that can only be remedied with a massive increase in the amount of aid available, McGoldrick said.

Wael Balousha, who escaped Gaza to Egypt about a month into the war and is the director of the Coalition for Accountability and Integrity, the local affiliate of Transparency International, said his office has seen tents re-sold at inflated prices to desperate civilians – a result of the lack of basic goods and an overall breakdown in order. 

Scaling up efforts

Israel’s military campaign has crippled Gaza’s healthcare system, with only 14 of the 36 hospitals in the enclave still running, and those are only partially or minimally functional – and operating at far above their normal capacity due to the number of casualties. 

If Israeli attacks on healthcare facilities stopped, security could be guaranteed, and if fuel and generators were allowed in, the healthcare system could be up and running relatively quickly, Cans said. 

“What’s blocking us now is security, supply, and access to the hospitals,” Cans said. “If these three obstacles are taken away, we will be able to scale up our operations. Right now, as MSF, we’re doing 1% of what we could do.”

Still, the number of severely wounded people – many of whom need multiple, complex surgeries – will continue to push healthcare providers far beyond their capacity, he added.

“It is virtually impossible to scale up an aid effort of any level of seriousness without a sustained ceasefire,” said Phillips-Barrasso, from Mercy Corps. 

“Something serious is going to have to change. I hope the serious thing that changes is stopping the violence – that would be a major hurdle cleared, but it’s not the only problem or challenge that we’re facing,” she said. “People need to recognise that the amount of damage that has been inflicted there is tantamount to a lot of places where war has been going on for years and years and years.” 

Riley Sparks reported from Paris; Hajar Harb reported from London; And a Palestinian journalist, whose name is being withheld due to security concerns, contributed reporting from Cairo, Egypt. Edited by Eric Reidy.

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