Humanitarian organisations are warning that the aid response in the Gaza Strip is near collapse, with the fragile system thrown into disarray by Israel’s invasion of Rafah, more than two months ago.
Israeli Prime Minister Benjamin Netanyahu said at the end of June that the war in Gaza would soon enter a new phase characterised by less intensive combat. But there are no signs yet of the Israeli military campaign slowing down or of any new phase creating an opening for aid agencies to mount a meaningful response to the staggering level of need.
Instead, the situation for civilians is worsening, and the aid system has been “shot through the knees” after the invasion of Rafah, Georgios Petropoulos, head of the Gaza sub-office for the UN’s emergency aid coordination body, OCHA, told The New Humanitarian.
Across Gaza, at least 1.9 million people – out of a population of around 2.1 million – are forcibly displaced, most more than once. The medical system is barely functioning. And with continued restrictions on food aid, UN experts say famine has spread throughout Gaza, pointing to the deaths of children from malnutrition as an indicator, although a famine has not been officially declared.
The recorded death toll from Israel’s military campaign is nearing 40,000, according to health authorities in Gaza, including at least 503 Palestinians killed between 11 and 18 July – one of the deadliest periods since the war began.
As the situation has deteriorated sharply since the Rafah invasion, aid workers say they have been forced to abandon critical infrastructure and supply lines that took months to establish, and to try to rebuild elsewhere in Gaza – all while facing movement restrictions and frequent Israeli military strikes, including near aid distribution sites, UN shelters, and in areas the military has unilaterally identified as safe.
Aid workers also described a dramatic breakdown in security around the main border crossing in the south of Gaza and increased looting, which has worsened along with the desperate conditions.
Until May, Rafah, the southernmost city in Gaza, was the logistics hub for aid agencies and the last place where they had been able to operate with any degree of safety; they had warned for months that an offensive would devastate humanitarian efforts.
More than two months on, the aid system faces enormous challenges. “Everything has to go perfectly in order to be able to do the most basic of tasks – and that's not realistic in Gaza,” explained Alexandra Saieh, head of humanitarian policy and advocacy with Save the Children.
Israeli officials have repeatedly promised to expand aid access – but any changes have been “largely cosmetic”, said Saieh.
The core issues that have prevented effective aid delivery throughout the now more than nine-month-long war – the lack of open crossing points, and the extreme danger to aid operations and aid workers (unpredictability on all fronts) – have not been solved, she added.
The situation has grown beyond what aid workers can be expected to control, according to Petropoulos.
“UN personnel are truckers, nutritionists, project managers,” he said. “We are not riot police. We are not the military. We are not mayors. It's a bunch of nerds. We need someone to create an enabling environment, and not hold us accountable for a megalopolis of 2.2 million people where civil order and the rule of law have been allowed to collapse.”
Limited gains
Aid workers say it has been impossible to deploy an adequate response since the beginning of the war, when Israeli Defence Minister Yoav Gallant announced a “complete siege” of Gaza in response to the 7 October Hamas attacks on Israel.
Since Israeli authorities began allowing a limited amount of aid into Gaza at the end of October, they have imposed what aid workers describe as arbitrary and unpredictable restrictions on imports and movement. At least 261 aid workers have been killed in Gaza, according to the Aid Worker Security Database, with more killed in just three months in 2023 than in the deadliest year ever recorded globally.
But by late spring, humanitarians had managed to carve out a path to deliver some aid, largely in southern Gaza near the border crossings at Rafah and Kerem Shalom (known as Karem Abu Salem in Arabic), where aid infrastructure – and the majority of Gaza’s forcibly displaced population – was concentrated.
Access to northern Gaza, blockaded by the Israeli military for much of the war, has remained drastically limited.
The system was tenuous, and far from able to meet needs, numerous aid workers The New Humanitarian spoke to explained. It relied on humanitarians – primarily Palestinian local staff – continuing to work in the face of unprecedented risk, all while Israeli military strikes constantly reduced the supply of warehouses, water and sanitation facilities, and other irreplaceable infrastructure.
Life for civilians in Gaza remained appalling. “No matter what we do, there’s always more and more and more need,” said Petropoulos.
In the week before the Rafah offensive, UN figures show a daily average of 229 aid trucks entering Gaza – less than half the 600 aid and commercial trucks experts say are needed to support Gaza’s population, but an increase from earlier in the war.
Humanitarians were able to make some gains over the spring, including breaking through to bring some food, water, and treatment for starving children to the besieged north. That increase in food and other aid likely helped to avoid the full-on famine that the UN-backed Integrated Food Security Phase Classification (IPC) task force had predicted for northern Gaza in March, the group said in June.
Efforts upended
The invasion of Rafah completely upended those efforts, aid workers told The New Humanitarian.
Both southern crossings shut down after the offensive started, which also displaced over one million people from Rafah. Israeli troops occupied the Rafah crossing with Egypt, which was burned down during the offensive and remains closed.
Kerem Shalom has since reopened; two other crossings – Erez West, in the north, and Gate 96, in the centre – have also been open intermittently. Aid groups told the New Humanitarian that Israeli authorities rarely authorise use of Gate 96, and OCHA data shows almost no traffic through it since May.
Even with these border crossings open, aid deliveries plummeted to an average of 76 trucks per day in June, OCHA reported, and about 1,500 NGO trucks are in Egypt waiting to be screened by Israeli authorities.
A temporary US aid pier, which began operating on Gaza’s coast shortly after the beginning of the Rafah offensive, also failed to deliver a meaningful amount of aid before being permanently shut down last week.
Aid groups have noted that truck numbers entering Gaza are an imperfect metric that doesn’t account for the extreme challenges of delivering aid inside the enclave.
The Israeli military tightly controls access between northern and southern Gaza, meaning aid entering one part of the enclave is unlikely to reach the other. Since the Rafah invasion, picking up aid from Kerem Shalom requires travelling through an active combat zone. And trucks and fuel are in short supply – just a quarter of the fuel needed for humanitarian operations entered Gaza in the first two weeks of July.
“Even if the supplies are allowed to go through Kerem Shalom, there's no guarantee that the conditions are going to be safe. On the other side, there are no guarantees that we will have fuel to send the trucks to go pick them up. There's no guarantee that the route out of Kerem Shalom is going to be safe,” explained Saieh, with Save the Children.
“Israel's obligations as the occupying power don't end when items are dropped off at the border,” Saieh said. “As the occupying power, they're responsible for ensuring that aid actually gets to the people in need.”
In a statement to The New Humanitarian, a spokesperson for COGAT, the Israeli government agency responsible for coordinating with aid groups, insisted that authorities are facilitating aid.
“The scope of aid transferred has not been reduced,” the spokesperson wrote, blaming Egypt for the closure of the Rafah crossing – which Egypt denies.
Effect on medical system
For more than two months after the Rafah offensive began, aid bound for Médecins Sans Frontières (MSF) was held up waiting to enter Gaza.
The organisation had 75 tonnes of medical supplies ready, including two 100-bed field hospitals – but nothing was getting through; “not even paracetamol”, said Dounia Dekhili, MSF’s emergency coordinator for Gaza. MSF finally received seven trucks in mid-July, she added.
The delay has forced medical staff to ration: Instead of changing a wounded patient’s dressings every other day, for example, they are now stretching to every three or four days, which is causing an increase in infections.
Medical Aid for Palestinians (MAP) and Save the Children also reported that medicine and supplies have become even more scarce since the Rafah invasion.
Dekhili said the medical system is bracing as Israeli evacuation orders target hundreds of thousands of people still in northern Gaza, which has experienced months of starvation and bombardment. “It will put even more pressure on the really poor, fragile system,” she said.
“They can’t even die in a bed. The families come to get their kids, and the kids are dead on the floor. And you know where the beds are? They’re in Egypt.”
In just one week in early July, evacuation orders forced patients and medical personnel to evacuate two hospitals in the north of Gaza and one in the city of Khan Younis. Fleeing medical staff had to leave behind medical equipment, with no hope of replacing it.
Aid workers say Israeli authorities appear to be prioritising commercial goods entering Gaza, which are often sold at “sky-high” prices. The profitability of commercial convoys, and their willingness to pay protection money to prevent looting, has allowed traders to increasingly edge out aid agencies for access to trucks and fuel.
In its statement, COGAT denied that commercial goods are prioritised over aid. “In view of the difficulty experienced by the international community in transporting goods from the crossings, and the logistical shortfalls in the distribution of the aid, it has been decided to turn to the private sector [to supplement aid delivery],” the spokesperson wrote.
If goods can’t get in, people also can’t get out, Dekhili added. The already infrequent evacuations of severely wounded patients stopped when the Rafah invasion began in May. At the time, there were at least 9,000 patients on the evacuation list. Around 20 patients, all children, were evacuated at the end of June, along with some family members.
Just 15 of the 36 hospitals in Gaza were operating as of 17 July. With supplies short, and staff exhausted and often under fire, conditions are “beyond comprehension”, Mohammed Aghaalkurdi, medical programme lead at MAP, wrote in a WhatsApp message relayed by a spokesperson.
He was at Nasser Hospital on 13 July as casualties arrived after an Israeli airstrike killed at least 90 people in an Israeli-declared ‘safe’ area in al-Mawasi. The Israeli military said it was targeting a senior Hamas commander, Mohammed Deif – one of the planners of the group’s 7 October attacks.
“Ambulances streamed in relentlessly for over two hours. The emergency [department] overflowed with patients on beds, floors, and corridors. Some of them have had their amputated limbs beside them. Blood stained the ground. The smell of burnt flesh was overwhelming,” Aghaalkurdi wrote.
Petropoulos, with OCHA, described witnessing similar scenes at the al-Aqsa Hospital in Deir al-Balah, where underequipped and overwhelmed medical teams received some of more than 270 Palestinians killed – and hundreds more wounded – during the Israeli raid on the Nuseirat refugee camp that freed four Israeli hostages on 8 June.
“There was blood halfway up the walls. There were kids dying, bleeding out on the floor,” he said. “They can’t even die in a bed. The families come to get their kids, and the kids are dead on the floor. And you know where the beds are? They’re in Egypt.”
Movement increasingly difficult
Israeli officials promised to improve communication with aid groups after an Israeli military airstrike killed seven World Central Kitchen workers on 1 April. Instead, due to the increase in military activity in Rafah, aid groups say coordination has become even more complicated.
On 21 July, Israeli forces hit one vehicle with at least five bullets as they fired on a UN convoy waiting near a military checkpoint at the edge of northern Gaza, UNRWA head Philippe Lazzarini reported. The convoy was clearly marked and its route had been coordinated with Israeli authorities, he said.
By restricting aid efforts to a bare minimum, Israeli authorities have prevented the establishment of a more robust response, leaving a vulnerable system with little ability to absorb shocks.
COGAT officials also appear to be overwhelmed by the increase in fighting, and are denying coordination requests more frequently, one aid worker said. “There is nothing systematic or predictable,” they added. They asked for anonymity to avoid compromising ongoing discussions with Israeli authorities.
COGAT said: “Despite the active warfare in the south, tactical coordination takes place dozens of times daily in the Gaza Strip.”
With Gaza’s civilian police largely absent after being repeatedly targeted by Israeli strikes, the security vacuum and dire conditions in Gaza are also driving an increase in looting, which aid workers say appears to be increasingly organised and has made movement around Kerem Shalom even more unsafe.
Aid convoy drivers have been attacked and threatened, and are frequently targeted both by desperate civilians and organised looters. Smugglers are charging some commercial convoys protection fees of up to 30% of their cargo, explained Petropoulos.
At the same time, Israeli authorities have denied the UN’s requests to scout out alternative routes to bypass the most dangerous areas, he added.
With such unstable supply lines, limited warehousing capacity, and needs eclipsing the availability of aid, the effect of a single day’s interruption or reduction is felt immediately. If there are vegetables in the market today, they came in yesterday, one aid worker explained.
Those problems are symptomatic of a larger issue that several aid workers described in conversations with The New Humanitarian: By restricting aid efforts to a bare minimum, Israeli authorities have prevented the establishment of a more robust response, leaving a vulnerable system with little ability to absorb shocks.
“We have been communicating about the challenges for nine months,” Saieh added. “I don't know what more we could be doing or saying. We ask governments to use their diplomatic capital to get the conditions we need in place. But unfortunately, that hasn't happened,” she said.
“That's where we need governments to focus their efforts. It's holding those responsible accountable for their obligations under international law, and creating an enabling environment that allows us to do our job.”
Edited by Eric Reidy.
