(LONDON) — Israel’s decision to halt all humanitarian aid from crossing into Gaza is entering its third month.
The Israeli government said the blockade is to pressure Hamas to release the remaining 59 hostages, including the remains of those who have died, and to accept a new proposal to extend phase one of the ceasefire deal, which ended on March 18.
Israel’s Coordination of Government Activities in the Territories (COGAT) wrote in a post on X in late April that humanitarian personnel have been allowed to enter and exit Gaza to support humanitarian efforts in the strip.
But multiple doctors and international aid workers told ABC News that water, food, medicine and medical supplies are running low, and in some cases running out completely.
Children are becoming malnourished, diseases are at risk of spreading and those who are injured cannot be treated properly, the workers said.
“If nothing is done, if food is not brought in, if water is not brought in, if vaccines are not brought in at scale — we’re already in a catastrophe, and we’re going to have way more children dying [from] preventable causes,” Jonathan Crickx, chief of communication for UNICEF Palestine, told ABC News.
A Trump administration official told ABC News there is a no-yet-finalized plan to administer the delivery of humanitarian aid in Gaza, starting with fewer than half a dozen distribution sites set up throughout the enclave.
The Israel Defense Forces did not immediately return ABC News’ request for comment.
Children becoming malnourished
The lack of food entering Gaza is one of the most severe problems the strip is facing, according to aid workers.
Osama As, the lead for quality, evidence and learning with the Mercy Corps Gaza Emergency Response Program, said the situation “is getting worse day after day, especially in relation to food” because most people in Gaza depend on humanitarian aid and community kitchens for food.
He said most families survive on one meal a day, and that most food available is canned food and bread.
“I never imagined that we would reach this point. Most people cannot afford the remaining items, which are either like canned foods and few quantities of vegetables which are produced locally here in Gaza,” As, who is based in Gaza, said. “The prices are very high, so I think most people cannot afford these kinds of items to buy from the local market.”
Dr. Ahmed Alfar, head of the pediatrics department at Nasser Hospital in Khan Younis, in southern Gaza, said he has seen many examples of malnourished children over the past two months.
One example he gave is a baby girl named Siwar, who was born four months ago. At birth, she weighed 2.5 kilograms, or 5.5 pounds.
Four months later, she should be weighing about 5 kilograms, or 11 pounds. Instead, she is only about 6 pounds, according to Alfar.
Alfar said the mother is unable to lactate and the family does not have much money, so they have been unable to feed Siwar milk, just sweetened water.
“That means in four months she gained just 200 grams, and this is unbelievable,” he told ABC News in Arabic. “She was a full-term baby. She was delivered vaginally. Her health was completely normal. … We called it one of the most severe [cases of] malnutrition. Now Siwar is facing a severe, critical situation.”
Similarly, Crickx, from UNICEF Palestine, who is currently in Al Mawasi, in southern Gaza, said he visited Nasser Hospital this week and met a 4-year-old boy named Osama.
Crickx said Osama should weigh 15 to 16 kilograms, about 33 to 35 pounds. Instead, he weighs 8 kilograms, or 17.5 pounds, Crickx said.
He said UNICEF and its partners have a small number of ready-to-use therapeutic foods to treat malnutrition, but they are running out. UNICEF has already run out of food meant to address the first signs of malnutrition.
“[Osama] has, really, the skin on the bones, and he was healthy before the beginning of this terrible war,” Crickx said. “So, we are now in a situation where children are hungry, they are little by little being affected more and more by acute malnutrition, acute severe malnutrition. And if nothing is done, we fear that the worst will happen to them.”
Community kitchen workers told ABC News if the border crossings remain closed, markets will close, and ingredients will run out. Some food relief organizations have already closed.
In late April, the United Nations’ World Food Programme said it had delivered its last remaining food stocks to hot meal kitchens in Gaza, and it expected to fully run out of food in the coming days. Additionally, the nonprofit group World Central Kitchen (WCK) announced on Wednesday that it had run out of supplies and ingredients needed to cook meals or bake bread in Gaza.
WCK said it has trucks loaded with food and cooking fuel that have been ready to enter Gaza since early March as well as additional food and equipment ready to be shipped from Jordan and Egypt.
“In recent weeks, our teams stretched every remaining ingredient and fuel source using creativity and determination. We turned to alternative fuels like wood pallets and olive husk pellets and pivoted away from rice recipes that require more fuel in favor of stews with bread,” WCK said. “But we have now reached the limits of what is possible.”
Risk of spreading disease
The blockade has also had an impact on the spread of disease in Gaza, aid workers said.
Overcrowding in tent camps — along with a lack of clean water, hygiene products and poor sanitation — puts Gazans at risk of contracting infectious diseases, they said.
Limited supplies of soap and hygienic products “will continue to lead to escalation in skin manifestations of diseases like scabies,” Dr. Aqsa Durrani, a pediatrician who was recently on assignment in Gaza with Médecins Sans Frontières (MSF), or Doctors Without Borders, told ABC News.
It’s unclear how many infections have been diagnosed over the past two months but a study from April 2024 estimated 55,400 cases of scabies and lice outbreaks among children under age five who were displaced.
Limited clean drinking water and overcrowded camps has also led to a rise in diarrheal diseases. A report from the Institute for Palestine Studies estimates at least half of cases recorded as of Jan. 2024 have been among children under 5 years old.
Crickx said a majority of children are affected by chronic watery diarrhea, which can lead to serious complications for babies and toddlers.
There has also been a rise in vaccine-preventable diseases in Gaza including hepatitis A, chickenpox, measles and polio.
Aid workers say the blockade imposed by Israel has halted the delivery of vaccines, such as the oral polio vaccine to Gaza, leaving residents vulnerable to diseases.
“Even in these terrible conditions, we have pregnant women and babies still being born in this community and population of 2 million people,” Durrani said. “And so, we need more vaccinations as well vaccines.”
Hospitals running out of supplies to treat injured
Since Hamas launched its surprise terrorist attack in Israel on Oct. 7, 2023, and Israel responded by declaring war, thousands have reportedly been killed or injured. Israel has said its goal is to destroy Hamas and that it attempts to minimize civilian casualties as often as possible.
More than 15 months into the conflict, Hamas and Israel reached a ceasefire deal. The ceasefire saw the withdrawal of some Israeli forces to allow more aid to get in and the release of some of the hostages.
However, resumption of hostilities in mid-March led to an increase in injuries, Crickx said. UNICEF estimates that more than 500 children have been killed since March 18 and more than 1.250 children have been injured.
Durrani — who worked as medical activity manager for MSF at a field hospital in Deir al Balah in central Gaza from the end of February until the end of April — said she saw injuries caused by air strikes, fires after air strikes and from large cooking fires.
“Because there’s no cooking gas, people are burning household items and trying to cook over large open flames,’ she said. “So, we also saw children with burns due to those flames, as well as scald burns from children who had been waiting in food distribution lines, and the jostling of the food items would then lead to them being injured from hot food.”
What’s more, burn victims or those who are injured can take longer to heal due to malnourishment. They can also be at risk of infections or skin graft failure.
Durrani explained that poor wound healing can be associated with poor nutrition, which resulted in some pediatric burn patients developing infections.
“Not only was our staff hungry, but we also had no food for our patients, including our pediatric patients,” Durrani said. “Other than just being harrowing from a human perspective, it’s also, from a medical perspective, really impacts the way that people can heal from these injuries, and these types of burns.”
“Not even being clear that we will have enough antibiotics to treat the infection if the patients develop infections,” she continued. “In the face of also not having enough surgical materials or concern that we may run critically low on anesthesia supplies if they need to go back to the [operating room].”
In conversations with doctors this week, Crickx said hospitals are experiencing shortages of anesthetics and anticoagulants. There is also a lack of medical supplies to fix bones when they suffer fractures, he said.
Durrani said her team was forced to ration medications, including painkillers, antibiotics and critical surgery supplies. They often had to perform painful procedures and wound dressing changes without any pain control.
She said she didn’t want to cause pain by removing dressings without proper pain control, but if the dressings aren’t removed, then it could lead to infections for patients.
“We’re being forced to make impossible decisions like that, which is unconscionable, given that just miles away there are trucks and trucks full of food and supplies and medications and nutritional sources,” she said. “For me personally, this is the first time that I had to look patients in the eye and say I didn’t have something that I know is just miles away.”
ABC News’ Shannon Kingston and Diaa Ostaz contributed to this report.
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