Gaza is now facing its fiercest fight: absolute hunger.

There’s no food to buy even if you could afford it, people there have told Al Jazeera.

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The widespread hunger has been imposed by the Israeli military as it restricted the entry of aid for months and enforced a food distribution system where people get shot almost daily.

“It’s one of the most … barbaric ways to kill,” Dr James Smith, an emergency doctor who has volunteered twice in Gaza, told Al Jazeera. “Starvation is always something that is done by one person to another. It’s intended to be protracted and to maximise suffering.”

On July 29, the United Nations-backed Integrated Food Security Phase Classification (IPC) issued its gravest warning yet: that “worst-case scenario of famine is currently playing out in the Gaza Strip”.

Mounting evidence shows a rise in hunger-related deaths. Famine thresholds for food consumption have been reached in most of Gaza, and for acute malnutrition in Gaza City.

According to the Health Ministry in Gaza, so far, at least 180 people have died of starvation, half of them children, underscoring the devastating toll of hunger on Gaza’s young.

According to the IPC, more than 20,000 children have been admitted for treatment for acute malnutrition between April and mid-July – more than 3,000 of them severely affected.

As it begins to starve after being deprived of food for days, the body begins to break down its own muscle and other tissues.

Metabolism slows, kidney function is impaired and the immune system falters, reducing the body’s ability to heal.

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Essential organs like the heart and lungs become less effective. Muscles shrink, and people feel weak. Eventually, its protein stores ravaged, the body breaks down its tissues as death nears.

The aid allowed into Gaza

Despite the suffering, Israel allowed just 36 aid trucks into Gaza on Saturday, even as 22,000 loaded trucks remain at the crossings, waiting to enter, according to the Government Media Office in Gaza.

Before October 2023, around 500 aid trucks entered Gaza daily – a number that not been reached since.

In March, Israel completely blocked all exits and aid, only opening up for a tiny fraction of the needed aid in the past two months.

Once food is offloaded at the border holding areas, agencies must request permission for convoys to enter and distribute in Gaza.

But approvals are inconsistent. According to the UN’s World Food Programme (WFP), only 76 out of 138 convoy requests were approved between July 19 and 25.

After approval, convoys often idle for hours, waiting up to 46 hours for final clearance to move, during which time hungry civilians gather along expected routes, hoping to intercept food.

Once on the road, the journey is slow and dangerous – it can take up to 12 hours to complete a delivery due to checkpoints, security threats, and rerouting.

Convoys and civilians alike face Israeli sniper fire, drone surveillance, and bombing. Only 60 drivers are approved to operate inside Gaza – far too few to meet the need.

Trucks are attacked by people who are desperate for aid, creating a complicated and often violent situation for the drivers and aid seekers.

On May 27, the Israeli- and US-backed Gaza Humanitarian Foundation (GHF) started working, with the plan being that it would replace all UN operations in Gaza.

However, it replaced a network of some 400 distribution points operated by the UN Relief and Works Agency for Palestine Refugees (UNRWA), with four “mega-sites” in heavily militarised zones just next to open combat zones.

Civilians who walk long distances, spend nights in the open, and run a gauntlet of random shooting, find themselves fighting for scraps of food, if they’re lucky.

Vulnerable groups – children, the elderly, the injured, and pregnant women – are also forced to make the treacherous GHF journey.

A former GHF guard, US veteran Anthony Aguilar, has told Al Jazeera how a little boy who he gave aid to was caught as “pepper spray, tear gas, stun grenades and bullets” were shot at the feet of the crowd of aid seekers, killing the boy.

Israeli soldiers have reportedly opened fire on Palestinians gathering at GHF sites on a near-daily basis.

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As of August 5, at least 1,487 people have been killed and 10,578 injured trying to collect aid from the GHF.

Israel insists that the GHF is needed to prevent Hamas from stealing aid entering Gaza.

However, internal analysis by the US Agency for International Development found no evidence of widespread aid diversion by Hamas.

Israeli military officials similarly told The New York Times last week that they had no evidence that Hamas was systemically stealing aid.

Airdrops

Since the announcement of tactical pauses, countries like France, Jordan and the United Arab Emirates have tried airdropping aid into Gaza. Much of it falls into unsafe or inaccessible areas and, in some tragic cases, people have been injured or killed trying to retrieve it.

In some cases, the aid falls into the sea and becomes damaged by the saltwater. In addition, several videos posted by people in Gaza show airdropped aid that has been contaminated by mould.

UN agencies say airdrops are dangerous as well as insufficient and that Israel must allow far more aid in overland and allow access to Gaza to prevent its 2.2 million people from starving.

Palestinians killed and starved for over 660 days

Since October 7, 2023, Israel has killed nearly 61,000 people, including at least 18,430 children, in its war on Gaza.

In February 2025, The Lancet medical journal estimated the death toll in Gaza from October 2023 to June 2024 was 40 percent higher than figures provided by the Palestinian Health Ministry, citing the fact that many people die outside hospitals and are never registered.