Gaza is on the brink of a mass starvation crisis, and once it starts, it will be difficult if not impossible to stop.

The Palestinian population of the Gaza Strip has faced various levels of food insecurity throughout the war that Israel has waged on the territory since Hamas’s October 7, 2023, attack, fluctuating with the amount of aid Israel has allowed to enter the enclave via checkpoints it controls.

In March 2024, the Integrated Food Security Phase Classification (IPC) — the primary organization tracking food insecurity worldwide — issued a warning that every resident of Gaza was at risk of crisis levels of food insecurity, and half were at risk of famine. (Crisis levels are reached when a population has “food consumption gaps alongside acute malnutrition” or is “only just able to meet their food needs, resorting to crisis coping strategies like selling off essential livelihood assets.” Famine is the most serious form of hunger, involving a complete lack of access to food and resulting starvation and death.) A famine was never officially declared, and food access peaked during the negotiated ceasefire reached in January.

In March, Israel cut off all shipments into the Gaza Strip, including food aid, when the ceasefire expired. Israel justified it as a tactical strategy to get Hamas to release more Israeli hostages as part of continuing negotiations.

The flow of humanitarian aid has since slowed to a trickle under the purview of the Gaza Humanitarian Foundation, a private group backed by the US and Israeli governments. It began operating in May, and is the sole entity that has been allowed to deliver food. Almost one-third of the 2.1 million people remaining in Gaza are not eating for multiple days in a row, according to the United Nations World Food Programme.

Israel has also made it treacherous for hungry Gazans to even access food from the GHF. The UN estimates that the Israeli military has killed more than 1,000 Palestinians trying to get aid in Gaza since May. There are four GHF distribution centers throughout Gaza, three of which are in areas where the Israeli military has issued evacuation orders, and they are often only open for short periods of time, sometimes spurring crowds to rush to get provisions.

After enduring more than 21 months in a war zone with inadequate nutrition, the population of Gaza is worn down, and humanitarian groups say that imminent famine will likely cause many to die — not just from hunger, but also from preventable disease that their bodies can no longer fight off.

To understand how Gaza got to this point and what happens next, I spoke with Jeremy Konyndyk, president of Refugees International, an organization that advocates for humanitarian assistance and protection for displaced people. Our conversation below has been edited for length and clarity.

How has access to food in Gaza changed throughout the course of the war?

What happened from really almost the start of the war through all of last year was a population that was hovering right at the edge of a starvation emergency, but never quite dipping fully into it.

The Israeli government had been hugely restricting aid through January and February of 2024. The warning of potential famine came out in early March [2024], and then they subsequently allowed a great deal more aid in in April, and the situation improved. Some of the concessions that the Israelis then made in late March into April, and somewhat beyond that, really did make a meaningful difference. And then the Rafah offensive started in May, and things worsened again after that.

The period of the ceasefire [beginning in January 2025] was the best period for aid access since the war began. For six weeks, hundreds of aid trucks were coming in every day. There was relative freedom of movement and freedom of operation for aid organizations who previously had been heavily, heavily constricted by [Israel Defense Forces] operations and permission structures.

There was always just enough that would be allowed in to prevent the kind of full-blown famine outcomes that I think we’re now beginning to see.

Why is the population of Gaza now on the brink of starvation?

If you fully cut someone off [from food] when they are otherwise in good health, it’s going to take longer for them to deteriorate. If they have spent a year-plus being one step removed from starvation, then they’re much more vulnerable. Another shock to their system has the risk to be much, much more damaging.

I think that’s what we’re now seeing, when Israel withdrew from the ceasefire in March and imposed a total, complete, hermetic blockade on Gaza.

There was, for a while, enough residual aid that had been brought in during the ceasefire.The population could stretch that out and and make do for a while before the deprivation really started to bite again.

I would argue what we’re seeing is still effectively an extension of that blockade, because the primary aid that Israel has been allowing in is through this Gaza Humanitarian Foundation, which is not a meaningful factor in terms of the hunger situation in Gaza. The amounts they’ve been letting in are vanishingly small.

This Gaza Humanitarian Foundation is distributing modest amounts of very poor quality aid to, as far as we can tell, a pretty limited number of people: the ones who happen to be able to get to their sites, which is not most of the population. The cost of a bag of flour has gone up from 50 shekels during the ceasefire earlier this year to over 1,700 now.

What happens if famine sets in now?

When you have a population that is that stressed, whose health has deteriorated that much, or is [already] in such an advanced state of population-level food deprivation and malnutrition, then things can turn bad very rapidly, because there is nothing to stand in the way of starvation.

We have seen this kind of a trajectory in other settings before. Once people’s coping mechanisms are exhausted, once their food and financial reserves are exhausted, once their bodies are in a very weakened state due to sustained malnutrition over a long period of time, then it doesn’t take much to kill someone.

It is very hard for your body to fight off disease or survive an injury, or even just survive. In most famines, we see mortality coming from a mix of both outright starvation and opportunistic infections. So people’s bodies are greatly weakened, and they can’t fight off diseases that would otherwise be very survivable.

There is nothing coming on the horizon to improve that situation unless the Israeli government allows the mainstream professional humanitarian community to actually do their fucking jobs, and that is the one thing they will not allow.

Famines have a momentum, and the longer that they are allowed to deepen, the harder they are to reverse. You need your standard food aid package distributed at scale. But you also need specialized, fortified food products, because people are in such an advanced state of malnutrition. You need advanced therapeutic malnutrition treatment, because a lot more people are now going to be coming into an advanced state of malnutrition that requires inpatient malnutrition treatment.

You need clean water because the food that’s being distributed has to be prepared with water. You need fuel so that people can cook the foods. You need medical treatment because many people who die in a famine die of disease, rather than outright starvation. And you need to improve sanitation, because if people do not have good sanitation, that’s what allows the spread of waterborne diseases.

None of that’s possible right now.

Why in your view has the Gaza Humanitarian Foundation been so ineffective?

A core principle of humanitarian aid delivery is you want to get the aid as close to where the population is as possible.

Gaza Humanitarian Foundation inverts that: They make the people come to the aid, rather than bringing the aid to the people. And they make people come to the aid through a deeply insecure territory, past IDF forces, who have been consistently trigger-happy anytime they see a crowd of Palestinians nearby.

I and others warned very early on that this was likely to produce massacres, that this model was a recipe for disaster.

Another core principle of humanitarian aid is that you must not provide aid in a way that increases the risk to the population. There’s a very strongly ingrained ethos of “do no harm.” This is a “do harm” ethos, if anything. You’re creating a situation where, in order to access aid, you compel people to cross a military perimeter where they are routinely shot at. That is not humanitarianism.

Some advocates have suggested that Israel is using starvation as a weapon of war. Do you agree with that?

That’s indisputable. It’s explicit. They want Hamas to relent, and they see the starvation of the population as a pressure point there.

Do you think the US is complicit in that?

I think the US is certainly complicit in that. I think even the Biden administration bears a degree of complicity in that, because they put somewhat more pressure on the Israeli government than the Trump administration has. But fundamentally, they tolerated the situation that brought Gaza to this point.

They tolerated a year-plus of starvation tactics being used, deprivation and illegal blockade tactics being used, and obstruction of aid, including aid provided by the US government. Rather than taking that on with the Netanyahu government, they did gimmick after gimmick. They did air drops. They did that ridiculous pier operation.

It wasn’t until nearly the very end of the administration that they sent the formal letter to the Israeli government demanding concrete progress. And then, of course, there was no meaningful progress.

I don’t think that solely falls on the Trump administration. Obviously, it is currently the Trump administration’s complicity.