In Focus

Inside Israel’s blockade on Gaza – where the UN and EU warn of man-made famine

As cases of people starving to death are reported by Palestinian health ministry officials in Gaza, Bel Trew speaks to a dozen aid agency workers, UN officials and medics about aid into the territory being impeded or outright blocked, an accusation Israel denies

Thursday 14 March 2024 16:10 GMT
Palestinian children wait to receive food cooked by a charity kitchen amid shortages of supplies in Rafah
Palestinian children wait to receive food cooked by a charity kitchen amid shortages of supplies in Rafah (Mohammed Salem/Reuters)

In Jordan, workers diligently pack aid from across the country – and the world – onto pallets they hope will be delivered to Gaza by land and air.

There are a total of 10 warehouses, crammed with food and medical supplies, clean water and hygiene kits as well as shelters, blankets and clothes. The stickers show the aid comes from countries across the world, as well as the biggest aid agencies and charities.

The need in the tiny besieged enclave, particularly in the war-ravaged north, is unprecedented according to the UN – which has warned a quarter of the 2.3 million strong population are one step from famine. Children are now dying from hunger and disease, not just Israel’s bombardment.

This aid – about 90 miles (150km) from north Gaza – could save lives. If all of it could get there.

COGAT, the Israeli defence ministry unit tasked with coordinating with the Palestinians, has told The Independent that Israel is “actively engaged in significant endeavours to facilitate the delivery of humanitarian aid”. COGAT frequently posts on X/Twitter, that “there are no limits to the amount of humanitarian aid that can enter Gaza”.

But UN agencies, human rights and aid organisations, as well private charitable initiatives, speaking to The Independent, have accused Israel, which controls everything that goes into and through Gaza, of strangling – and in some cases blocking – assistance with a “Kafka-esque system” that is having a devastating effect. One UN official says that looming famine in the besieged strip “is man-made and primarily caused by restricted access”.

“We have warehouses that are completely full that are just sitting waiting to dispatch to Gaza in different ways,” says one senior humanitarian aid official on the ground in Jordan, who asked not to be named over concerns of backlash.

“One of the main things that is making an obstacle is Israel’s procedures of inspections that they are following on the borders. They never gave us a clear list of what items are allowed or not allowed to enter Gaza – it is a ghost list”.

A Palestinian woman waits to receive aid from a UNRWA distribution in Rafah
A Palestinian woman waits to receive aid from a UNRWA distribution in Rafah (Reuters)

“Sometimes we get approval to cross into Israel, and when we get to the [crossing] we get a no,” he adds.

The aid official says it has had a devastating effect on Gaza. “During the war they were afraid to die of shelling. Now they are dying because of lack of water, food and medicines.”

Israel launched its heaviest-ever bombardment of Gaza and a “total siege” in retaliation against the bloody Hamas militant attack on southern Israel on 7 October, Around 1,200 people were killed in that attack, with another 250 taken hostage, including toddlers. Up to 136 of the hostages remain in Gaza, an unknown number are still alive.

Israel’s bombardment has killed more than 30,000 Palestinians, the vast majority women and children, according to Palestinian health officials in the Hamas-run strip. At least 60 per cent of Gaza’s homes and buildings have reportedly been destroyed or damaged. More than three-quarters of the strip’s population are displaced.

This has led to an “unprecedented” humanitarian crisis according to the UN. As conditions have worsened, the International Court of Justice (ICJ) has ordered Israel to take all measures within its power to prevent genocidal acts, including ensuring aid reaches Palestinians under siege.

The European Union’s top diplomat, Josep Borrell, told the UN Security Council on Tuesday that this crisis was “not a natural disaster… It is man-made.”

First boat carrying aid for Gaza leaves Cyprus port

“Starvation is being used as a weapon of war,” he added, an accusation also made by Human Rights Watch that said this constitutes a war crime. Israel denies this.

Hundreds of thousands of people are now just one step from famine, and disease is rife according to aid agencies. Particularly in the north of the strip, where only a trickle of aid is getting in. There, the World Health Organisation (WHO) has said that due to food, hygiene and clean water shortages a sixth of children under two years old are now acutely malnourished and 3 per cent suffer from severe muscle wastage. Palestinian health ministry officials have said at least 25 people have died from malnutrition and dehydration. Dr Mohammed Salha, in Al-Awda hospital in north Gaza, stated that pregnant women were now miscarrying, as they were so malnourished.

This should not be happening, UN officials say, as Gaza – which is only 42km long and in some places just 10km wide – should be accessible for aid deliveries.

There are at least half a dozen land crossing points along its borders with Israel and Egypt but most were closed after the 7 October attacks. None are open in the north, where 300,000 people are living in an area that is experiencing one the most acute humanitarian catastrophes in the world right now.

“This looming famine is man-made and primarily caused by the very slow and restricted access of food to the Gaza Strip, especially in the north,” says Tamara Alrifai from the United Nations’s Palestinian refugee agency UNRWA – the biggest UN agency operating in Gaza.

Palestinians carry bags of flour from an aid truck in Gaza City last month
Palestinians carry bags of flour from an aid truck in Gaza City last month (Reuters)

“Now, the entire population in Gaza almost exclusively rely on a trickle of humanitarian assistance, especially since the commercial supply line remains largely interrupted,” Alrifai says.

UNRWA told The Independent that in February an average of 99 trucks of humanitarian assistance went into the Gaza Strip every day, nearly half the amount making the same trip in January. Both fell well below the target of 500 trucks of supplies (commercial and humanitarian) that used to cross into Gaza every day before the conflict.

COGAT has rejected the claim that there has been a decrease in authorised aid trucks. Prior to the war, COGAT said that approximately 70 trucks carrying food were permitted to enter Gaza on a daily basis – now the average is around 102, a 45 per cent increase according to its own statistics. However these numbers do not take into account the commercial supply of food, which has been interrupted, and the huge surge in reliance on aid from the outside.

The UN’s food and agriculture agency (FAO) said two weeks ago that Gaza’s food production pre-war allowed self-sufficiency in most fruits and vegetables but the conflict has “severely disrupted this”. According to FAO, 42 per cent of Gaza’s cropland has been damaged. By the end of January, all broiler poultry are assumed to have been slaughtered or died due to lack of water and fodder, while approximately 70 per cent of beef cattle are estimated to be dead. Fishing has come to a standstill and bakeries have been bombed. Aid is the only way for many to eat.

Aid convoys that do get into Gaza say they have come under Israeli fire. On 5 February, UNRWA reported that one of its convoys was hit by an Israeli tank shell. The Israeli military has yet to publicly comment but said it is looking into the incident. On Wednesday, the UNRWA said an Israeli strike on one of its aid distribution centres in Rafah killed a UN staffer and wounded 22 others. The Israeli military said the strike killed a Hamas operative. The WHO has also said convoys have come “under fire and threat”.

Trucks containing humanitarian aid from the World Food Programme in northern Gaza
Trucks containing humanitarian aid from the World Food Programme in northern Gaza (Reuters)

If the shipments, which are approved to enter Gaza via the southern border crossings, try to head to the north, they are often stopped by Israeli military checkpoints or are not approved to continue their journey, according to multiple UN agency officials who were interviewed.

UNRWA said more than half of its requests to bring much-needed water, food and medical supplies to the north have been rejected by Israel since the start of the war in October. The organisation has not been able to access the northern part of the besieged areas since 23 January, despite repeated requests.

The World Food Programme (WFP) delivered food to northern Gaza on Tuesday for the first time in three weeks. Prior to that, they had only managed to get seven convoys to the north since the beginning of the year. They said their last attempt on 5 March was turned around by an Israeli checkpoint and rerouted.

The WHO said only three out of 16 missions to north Gaza in January were facilitated by Israel and none were allowed in February. Their first approved trip to Al-Awda and Kamal Adwan hospitals since the war began was on 1 March.

“If the system would work you could talk about 10 to 15 missions to the north each day – it’s not happening right now,” said Richard Peeperkorn, the WHO representative for the occupied Palestinian Territory.

In response to questions by The Independent on why the Israeli military had restricted access to the north, it said “The IDF carries out humanitarian operations and will continue to do so. The decisions on the locations and timings of them are based on assessments of the situation.” Facing mounting pressure after the attack on UNRWA’s aid centre, the military said on Thursday it continues to “expand its efforts” to enable aid into Gaza – most recently facilitating the delivery of a shipload of aid from Cyprus. Israel wants UNRWA to be disbanded after repeatedly accusing them of supporting Hamas, which the organisation has vehemently denied.

On board an aid drop flight over devastated northern Gaza

COGAT, meanwhile, denied restricting access to the north, adding that some shipments north were not carried out because of “intensive fighting” in the area. It said in the last two weeks it “has approved and coordinated more than 250 truckloads of humanitarian aid for the northern Gaza Strip”.

COGAT did not specify which aid groups were responsible for the trucks or where they were delivered to.

However, aid organisations say that months of strangulation of supplies and a lack of adequate security for the convoys has not only led to unprecedented levels of hunger but to a breakdown in law and order. The WPF said they had to briefly suspend convoys last month – among the reasons given was that they were overwhelmed by starving people in the hardest hit areas.

The WHO say that the situation is chaotic, nothing is properly facilitated and the fighting has destroyed much of the area’s roads. It can take a fuel truck two days to do what would have been a half-hour drive before the war. That is if the trucks can secure the permissions in the first place.

“There is absolutely no need for these convoys to be so insecure… hazardous and dangerous,” said the WHO’s Peeperkorn. “There needs to be a deconfliction mechanism that works, so that the humanitarians can work safely. We have had convoys that were shot at and threatened.”

Some countries including Jordan, the US, UK and Egypt have resorted to air-dropping aid to the least accessible areas, even though humanitarians – including the WFP – say it is woefully inefficient, costly and even dangerous, and to be thought of as “the last resort”. On 8 March, five Palestinians were reportedly killed when a pallet of food supplies crashed into a building because its parachute failed to deploy. There are no guarantees that the food, which literally falls out of the sky, gets to the most vulnerable like the wounded, disabled or infirm. International medics working in Gaza have told The Independent they are concerned that the kind of food in these deliveries – like rice, biscuits and canned goods – may not be properly administered to acutely malnourished people and therefore could be life-threatening as their bodies are not used to it.

Head of Israel’s COGAT, Colonel Elad Goren, speaks from the Kerem Shalom crossing into Gaza
Head of Israel’s COGAT, Colonel Elad Goren, speaks from the Kerem Shalom crossing into Gaza (Reuters)

A sea route to north Gaza from Cyprus was also opened this week. A pilot mission coordinated by the Cypriots, funded by the UAE and run by US-based charity World Central Kitchen and Spanish group Open Arms saw a barge containing 200 tonnes of food aid set sail for Gaza on Tuesday. Separately the United States, which gives Israel billions of dollars of military assistance every year, is building a sea pier in north Gaza, to enable aid to be delivered via this new maritime route.

UN humanitarian office spokesperson Jens Laerke welcomed any additional delivery of aid but said that sea and air routes cannot be a “substitute for the overland transport of food”.

WHO’s Peeperkorn, agrees, saying that the UN was ready. “We need more land entry points into Gaza in the north, and also more entry points within Gaza.”

UNRWA’s Alrifai added that under international law, Israel must allow sufficient aid access as it is the occupying power. “Opening and using more border land crossings is the most effective, efficient and economical way to send much-needed supplies in,” she said. “Israel must comply with international humanitarian law and allow sufficient food, medical supplies and other items into the strip. This is also what the ICJ order requested.”

But another barrier is not just access inside Gaza but what items are allowed to enter in the first place. According to a dozen interviews with UN agencies, Palestinian, international and Israeli charities, as well as individuals manning private initiations and British MPs who have submitted Freedom of Information (FOI) requests in the UK, Israel is “arbitrarily denying” entry of a slew of life-saving goods because they are labelled at risk of “dual use” for war by the militants. The dual-use items often include elements within a larger item, like a specific gas needed for a CT machine, or a battery for solar panels.

Gathered from interviews with The Independent, items that have been intermittently or permanently prevented from entering include: some shipments of dates because they had stones in them, metal tent poles, anaesthetic machines and medicines, portable X-rays, both ultrasound and MRI machines and/or their spare parts, solar panels, generators, batteries, ultrasound devices, insulin pens, ventilators, pencils (but not pens), morphine and water purification tablets.

UNRWA food supplies in Rafah, where an aid centre was recently hit by Israeli forces
UNRWA food supplies in Rafah, where an aid centre was recently hit by Israeli forces (Reuters)

UNRWA chief Philippe Lazzarini said this week that a truckload of aid was turned back because it contained scissors used in children’s medical kits. He added that the “dual-use” banned items UNRWA had logged also included anaesthetics, oxygen cylinders, cancer medicines and maternity kits.

British-donated aid has also been restricted. Labour MP Dr Rosena Allin-Khan said that the Israeli aid unit COGAT has prevented 1,350 water filters and 2,560 solar lights supplied by the UK from entering Gaza. Dr Allin-Khan submitted an FOI request to the Foreign Office, and shared the government response on her social media accounts.

She said that nothing was being done to address the issue of “supposedly” dual-use items being turned away, “leading to truckloads of life-saving aid arbitrarily being denied access”.

“I have heard harrowing reports of children eating weeds to fight off the pain of hunger. There are accounts of newborn babies passing away because they are so malnourished. Meanwhile, Israeli authorities are obstructing and turning away vital aid at the border.”

Dr Allin-Khan added that the UK must pressure Israel “to end unreasonable barriers to aid and prevent the looming humanitarian catastrophe” including insisting on a ceasefire.

COGAT said it “vehemently condemns the false accusations” that it strangles aid. In a statement sent over the weekend COGAT said according to its statistics 1,543 trucks have entered Gaza since October containing 18,500 tons of medical equipment – as well as 2,347 trucks loaded with 33,820 tonnes of shelter supplies. In those shipments, COGAT claims items have included some X-ray machines, CT machines, oxygen generators and anaesthetics for hospitals. The Independent has asked for clarification on how many of the machines were permitted to enter Gaza, as Palestinian health officials have said that not enough is getting in, and is awaiting a reply.

Citizens queue for food that is cooked in large pots and distributed for free in Rafah, southern Gaza
Citizens queue for food that is cooked in large pots and distributed for free in Rafah, southern Gaza (Getty)

COGAT said it had posted its dual-use list in 2008 which it claimed was clear and accessible to the general public. It said that these items are not “sweepingly denied entry into Gaza” but rather “subject to security evaluation”.

But aid officials and charity workers say the 2008 list is effectively obsolete – as, in reality, the process is unpredictable and erratic, with new confusing rules that are not laid out.

One senior aid official in Jordan said there is no standard operating procedure so no one knows what is or is not permitted or how many trucks will be allowed in on which day. He said they were forced to work by trial and error: “If an item is denied then we take it off future lists, even if it may not be formally banned.”

For example, The Independent was told by two senior aid officials a shipment of dates was barred because the dates contained stones inside them but other shipments got through. COGAT’s response was that 500 tonnes of dates had been authorised for entry since the commencement of the war.

Another aid worker for a major international charity who asked not to be named, said that sometimes they had lobbied hard to allow one previously banned item in, leading to it eventually being allowed.

The WHO’s Peeperkorn says even if they do get an item in “it takes an enormous process, a lengthy bureaucratic process”. Another UN official said that the requirements on how to submit the requests keep changing and there is no set date. “Sometimes you don’t hear anything, you don’t hear a yes, or you don’t hear no.” The Independent has also been shown documentation to that effect.

Palestinians rush to get humanitarian aid dropped by the US Air Force into Gaza City
Palestinians rush to get humanitarian aid dropped by the US Air Force into Gaza City (AP)

The Israeli rights group Gisha has submitted several FOI requests to COGAT concerning this. Miriam Marmur, Gisha’s director of public advocacy said that Israel’s definition of dual use “far exceeds the internationally recognised standard”. She said this is not necessarily new. Gaza has been subject to a 17-year-long blockade by Egypt and Israel imposed after Hamas, which is a designated terrorist organisation in the US, violently swept into control of the Strip.

“At the same time, many of the items that are reportedly being blocked don’t appear to be on Israel’s dual-use lists. There is very little transparency about Israel’s policy but what’s clear is that vital items for the humanitarian response are being blocked,” she said.

Marmur says the uncertainty regarding Israel’s current policy “follows years of obfuscation on what exactly qualifies as dual use”.

In the interim convoys have to wait at Egypt’s border with Gaza, sometimes for weeks – often after going through multiple checks at different checkpoints slowing the process down. “There are thousands of trucks with food lined up along the route. Some trucks have taken two months to get through,” said Amed Khan, an American philanthropist and humanitarian who has a network facilitating aid into Gaza via the Rafah crossing, and has faced significant delays to his convoys.

“It should take two hours [to do the checks] and it can sometimes take two weeks waiting for all the security checkpoints, the stops, the unloading, reloading,” he adds.

He questioned why Israel was permitted to control the entire process. “Are there no other trusted authorities in the world that can oversee the delivery of humanitarian goods to prevent the death of thousands of innocent human beings?”

This is having a direct impact on Gaza where people are starving to death. Dr Salha, who mans the maternity unit that is barely working Al-Awda Hospital in north Gaza, described desperate scenes where even the doctors, alongside their patients, were forced to consume animal feed to survive and caesareans were being performed with limited anaesthetic.

“We are getting more and more cases of malnutrition every day. The aid dropped from aircrafts is not enough and only the young fit people can collect it, we need more coming to the north of Gaza,” he said.

“This situation is critical. Please bring everything into Gaza, into the north as there are few signs of life left.”

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