The world's leading authority on food crises officially declared on Friday that Gaza’s largest city is gripped by famine, and that it is likely to spread across the territory without a ceasefire and an end to restrictions on humanitarian aid.

The Integrated Food Security Phase Classification, or IPC, said famine is occurring in Gaza City, home to hundreds of thousands of Palestinians, and that it could spread south to Deir al-Balah and Khan Younis by the end of next month.

The IPC determination comes after months of warnings by aid groups that Israel's restrictions on food and other aid into Gaza, and its military offensive, were causing high levels of starvation among Palestinian civilians, particularly children.

Declaration comes amid occupation

The grim milestone — the first time the IPC has confirmed a famine in the Middle East — is sure to ramp up international pressure on Israel, which has been in a brutal war with Hamas since October 7, 2023.

Israel says it plans to soon escalate the war by seizing Gaza City and other Hamas strongholds, which experts say will exacerbate the hunger crisis.

The IPC said hunger has been driven by fighting and the blockade of aid, and magnified by widespread displacement and the collapse of food production in Gaza, pushing hunger to life-threatening levels across the entire territory after 22 months of war.

41,000-plus to suffer ‘severe’ malnutrition

More than half a million people in Gaza, about a quarter of the population, face catastrophic levels of hunger, and many are at risk of dying from malnutrition-related causes, the IPC report said.

It adds that 41,000 of these cases will suffer from "severe" malnutrition, twice the figure cited in the IPC’s May assessment, placing them at "heightened risk of death".

Last month, the IPC said the “worst-case scenario of famine” was unfolding in Gaza, but stopped short of an official determination.

Israel continues to deny accusations

Israeli Prime Minister Benjamin Netanyahu has denied there is hunger in Gaza, calling reports of starvation “lies” promoted by Hamas. After the publication of images of emaciated children in Gaza and reports of hunger-related deaths, Israel announced measures to let more humanitarian aid in. Yet the UN and Palestinians in Gaza say what is entering is far below what is needed.

The Israeli military agency in charge of transferring aid to the territory rejected the report Friday, calling it “false and biased".

The agency, known as COGAT, rejected the claim that there was famine in Gaza and said that significant steps had been taken to expand the amount of aid entering the strip in recent weeks.

Analysts: Famine is intentional

"A rapidly increasing number of people, especially young children, are dying preventable deaths from starvation and disease because Israel made starvation a core part of its campaign to control the strip," said Chris Newton, an analyst for the International Crisis Group.

Israel’s plan to escalate the war in Gaza City weeks after a warning that famine was beginning there demonstrates how “intentional the famine is and how Israel wields starvation,” he said.

Netanyahu says more military pressure is needed to achieve Israel’s goals of freeing the hostages held by Hamas and eliminating the militant group altogether.

How famine is determined

Formal famine determinations are rare. The IPC has previously determined famines in Somalia in 2011, South Sudan in 2017 and 2020, and parts of Sudan’s western Darfur region last year.

• The IPC says a famine exists in an area when all three of the following conditions are confirmed:

  1. At least 20 percent of households have an extreme lack of food, or are essentially starving.

  2. At least 30 percent of children six months to five years old suffer from acute malnutrition or wasting, meaning they’re too thin for their height.

  3. At least two people, or four children under five, per 10,000 are dying daily due to starvation or the interaction of malnutrition and disease.

Israel’s offensive and its restrictions on access to Gaza have made collecting data difficult.

Data shows clear evidence

The data analysed between 1 July and 15 August showed clear evidence that thresholds for starvation and acute malnutrition have been reached.

Gathering data for mortality has been harder, but the IPC said it is reasonable to conclude from the evidence that the necessary threshold has likely been reached.

The IPC warned that a third of Gaza’s population could face catastrophic levels of hunger by the end of September, and that this is probably an undercount.

Alex de Waal, author of Mass Starvation: The History and Future of Famine and executive director of the World Peace Foundation, said that had Israel allowed the IPC better access to collect data, a famine might have been determined months ago, which would have raised global awareness sooner.

“Sadly, it seems that it’s necessary for experts to shout ‘famine!’ before the world takes notice, by which time it is too late,” he said.

The UN humanitarian chief also stated that famine in Gaza was being "openly promoted" by Israel as a "weapon of war" and insisted it "could have [been] prevented if we had been allowed."

Israeli restrictions resume

Israel has restricted aid to varying degrees throughout the war. In March, it cut off the entry of all goods, including fuel, food and medicine, to pressure Hamas to free hostages.

Israel eased those restrictions in May and says there is currently no limit on how many aid trucks can enter Gaza. But it also pushed ahead with a new US-backed aid delivery system that requires Palestinians to travel long distances and pass through Israeli military lines to get aid.

The traditional, UN-led aid providers say deliveries have been hampered by Israeli military restrictions and incidents of looting, while criminals and hungry crowds overwhelm entering convoys.
Hospitals overwhelmed

Witnesses, health officials and the UN rights office say hundreds of people have been killed by Israeli forces while seeking aid from both providers, while Israel says it has only fired warning shots and that the toll is exaggerated.

Doctors and nurses in Gaza in recent weeks have seen rising numbers of visibly malnourished patients.

Kirsty Blacka, an Australian emergency nurse who worked in Gaza City's Al Quds hospital through June, said emaciated men with no pre-existing conditions were coming in looking like teenagers because they were starving.

She said the lack of food has been compounded by contaminated water causing diarrhoea and infections, and that diseases are harder to recover from when people are malnourished.

If Israel evacuates people from the city ahead of its new offensive, thousands will be too weak to leave, said Blacka.

“Because of the starvation it will put extra strain on already depleted bodies and will lead to the death of many of the Palestinians,” she said.

Children waste away

Families in Gaza City say they are watching their loved ones waste away. Yousef Sbeteh's two teenage children were injured by shrapnel during an Israeli air strike in June and have spent the last two months in the hospital.

While there, they have both lost weight because there has not been enough food, he said, adding that he cannot afford to buy more because prices at markets have soared. Doctors say the teenagers had no pre-existing conditions.

His 15-year-old daughter Aya lost nearly 20 kilograms (44 pounds), or about 30 per cent of her body weight, according to her doctors.

Her 17-year-old brother Ahmad has lost about 15 kilograms (33 pounds). The lack of nutritional supplements and healthy food is slowing their recovery, doctors say.

“Doctors say she needs protein, meat and fish," Sbeteh said while sitting beside his frail daughter. “But I cannot provide that now."