Gaza’s Intensifying Humanitarian Catastrophe

At a recent event, Carnegie nonresident fellow Katherine Wilkens spoke with three experts about the ongoing humanitarian crisis in Gaza. Scott Anderson is the United Nations Relief and Works Agency (UNRWA) deputy humanitarian coordinator and director of UNRWA affairs in Gaza. Jeremy Konyndyk is president of Refugees International. Ambassador David Satterfield is the former White House special envoy for Middle East humanitarian issues. An excerpt from their conversation, which has been edited for clarity, is below.

Katherine Wilkens: Two weeks ago, Refugees International released its new report, Untangling the Reality of Famine in Gaza, which closely examines the trajectory of hunger and the factors influencing Gaza’s hunger crisis from January until May of this year. Jeremy, can you review the findings of your report?

Jeremy Konyndyk: One of the key questions we wanted to explore is what happened following the March projections of imminent famine. We broke it down into four phases.

The first phase set the table for famine, from the immediate aftermath of October 7 through about the end of the year. This phase started off with a complete cutoff of all food, fuel, and other forms of aid and commercial activity into Gaza. That was incrementally relaxed bit by bit over the next few months—modest concessions over several months by the Israeli government, which continued to greatly restrict the flow of both aid and commercial activity into Gaza.

By the time we got to late December, the first [Integrated Food Security Phase Classification (IPC)] projections identified a risk of famine, and that was built on the food deficit that had built up in Gaza over that period. At one point in November, the World Food Programme had assessed that only about 10 percent of Gaza’s total food consumption needs were actually entering the territory during that period. And for a territory that produces very little of its own food and is heavily dependent on imports to feed itself, that was a critical situation.

Normally, when you see the IPC put out a report projecting possible famine, there is then an immediate international reaction. We would expect to see food aid ramp up, concerted diplomacy around access. Instead, what we saw going into January and February was very little change, and in fact some further deterioration in access. It got so bad during that period, particularly in northern Gaza, that Samantha Power, the [U.S. Agency for International Development] administrator, went out in late February, stood on the border with Gaza, and called on the Israeli government to do more to open more crossings and facilitate more aid inflows.

There was a lot of activity behind the scenes at this time . . . but the Israeli government was not doing nearly enough to respond to that. During this period, conditions in the north deteriorated markedly—the Israeli government would not open the border crossings directly into northern Gaza, and it was nearly impossible to move aid from southern and middle Gaza up into northern Gaza because of the Israeli line of control across the center.

By the time you get to March, the situation in northern Gaza is critical. We heard firsthand accounts from Palestinians of telltale famine indicators, things like people selling off all of their assets in order to scrape together a little bit of money to try and purchase food, women selling sex, substituting things that are not food for food—eating animal feed and local weeds and grasses.

What’s then really important to look at is a period of about two weeks in the second half of March. First, the IPC report came out. Not long after that, [there’s the International Court of Justice (ICJ)] order calling on the Israeli government to do much more to facilitate humanitarian aid. Then you have the now infamous strike on World Central Kitchen that killed seven aid workers and prompted a really furious global reaction.

I think the confluence of those events puts a huge amount of pressure on the Israeli government. There is a phone call between President [Joe] Biden and Prime Minister [Benjamin] Netanyahu in the aftermath of that strike, which is probably the most forceful, at least reportedly, that Biden was with Netanyahu. Immediately after that phone call, there is opening of the northern border crossings, and food begins to flow into the north. There is also a period then of a couple months up to the Rafah invasion where more is getting into southern and middle Gaza as well. And the situation kind of levels out.

Katherine Wilkens: I’m going to quote from UNICEF executive director Catherine Russell, who said recently, “Simply put - we do not have the necessary conditions in the Gaza Strip for a robust humanitarian response. The flow of aid must be unimpeded and access must be regular and safe.” Can you talk about the changes that we need?

Scott Anderson: We had done much better in April bringing food in and trucks. We were bringing 300 a day, and it made a difference. In March, I was in the north at Kamal Adwan Hospital, which is a pediatric hospital, and I saw two-month-old babies that were starving to death because we weren’t getting enough [food into Gaza]. The mothers didn’t have enough food to lactate. [Then] we were doing better in April, but then Rafah started May 6, when the ceasefire talks fell through, and that changed everything quite significantly.

It created an environment where law and order basically didn’t exist and you had essentially crime families controlling territory in Rafah. They shot at trucks, they shot at truck drivers, they stole anything of value and tried to resell it, and it made everything come to a screeching halt for aid. What was supposed to be a two-week operation in Rafah and is still ongoing, we’ve seen a continued deterioration of the law and order environment and of our access.

And for us, what that means is we have limited entry points for aid. We’re not able to distribute aid where everyone is, because some places require coordination with the forces on the ground, and that has not been an easy process. There’s been some very catastrophic failures—World Central Kitchen and a couple of UN convoys that have come under fire, and we have lost international staff as well as over 200 UN workers throughout this conflict.

It is a difficult situation, and for us it’s quite frustrating, because logistically this is very simple.

We have the capacity, and we [can move supplies]. We have 100,000 metric tons of food ready to come in—more than enough for the entire population for three months. Now [approaching] the second winter, we’re very concerned about people’s immune systems and their ability to withstand the cold, as well as not only our inability to bring in food, but our inability to bring in tents and shelter repair kits and these kinds of things that will help in the winter. I think we find ourselves on the precipice of either doing much better or a man-made disaster in Gaza.

Katherine Wilkens: What about general access—humanitarian trucks or commercial trucks?

Scott Anderson: We’ve seen also a reduction starting [at the end of September]. The number of commercial trucks that are being allowed to enter Gaza was around 200 a day, but now it’s down to fifty. The cabinet in Israel was meeting [September 30] to make a decision on whether to completely stop access for commercial trucks. That’s something that we need even if we’re bringing aid in. The commercial sector and the humanitarian sector need to work hand in hand.

Two big things would help: one is we would welcome the [Israel Defense Forces (IDF)] in providing security in the Rafah area so we can move trucks in at scale. I think they’re the only ones that can provide security for the humanitarian convoys. We would also welcome additional crossings—other options to bring aid in at scale.

Katherine Wilkens: From your experience, what should be done next?

David Satterfield: What is to be done today is exactly the same thing that needed to be done in that first, second, and third week of October last year. When Biden came to Israel on October 18, he told Netanyahu and the security cabinet, publicly and privately, that two things needed to be done. First, the military campaign needed to be prosecuted with utmost vigor. The United States had Israel’s back on this. The other message was that the first task will take considerable time and space. We didn’t know just how much time and space would be required. We didn’t understand the extent to which Hamas had dedicated sixteen years in diverting humanitarian assistance, commercial assistance, into the tunnel network, into building a terrorist military, 30,000-plus strong. The president said that Israel must prosecute a humanitarian campaign with the same vigor, the same attention, and the same effectiveness as the kinetic campaign. That has never happened.

I disagree fundamentally with any assessment, whether ICJ or other, that there is a deliberate Israeli policy attempt to starve the people of Gaza. I do not believe the evidence supports such an assertion. What I do believe is that the October-to-May narrative indicates that it is not intent. It is lack of effort, which is difficult in a hyperkinetic environment. We all understand that.

This is an extraordinarily complex campaign because of the entanglement deliberately by Hamas of civilian population, civilian infrastructure, humanitarian infrastructure. But Israel has not undertaken the necessary measures even given or particularly because of this complex context, to assure that assistance can be distributed throughout Gaza.

Katherine Wilkens: The first round of the polio campaign happened . . . somehow the message got through for that. Why can’t the message get through for food and water and humanitarian trucks?

David Satterfield: It got through for two reasons. The specter of an outbreak of polio carries a message around the world, which would have redounded negatively upon Israel—point one. Point two: the sewage flows from Gaza, moves north up the coast to Ashdod, to Ashkelon, and eventually to the Tel Aviv beaches. Israel has a significant non- or inadequately vaccinated population—the ultra-Orthodox. Israel recognized it was not just a reputational threat, it was a genuine health threat to Israel and Israelis, and they showed they could do it.

Katherine Wilkens: So what you’re saying is: where there’s a will, there’s a way?

David Satterfield: Absolutely.

Katherine Wilkens: How do we encourage the will?

David Satterfield: The will has never been present.

Jeremy Konyndyk: I think the crude reality underscored by the polio campaign is that when the IDF and the Israeli government want aid to get through, want an operation to occur, want aid groups to have access, that can be done. Within the course of a few weeks, World Health Organization and its partner teams were able to reach, I think, Scott—it was 87 percent of kids under ten in Gaza?

Scott Anderson: Yes.

Jeremy Konyndyk: And if you can reach them with a shot, you can reach them with food [and] other services. And from talking to some of the people who were involved in that operation, they did see a markedly more supportive facilitation by the IDF forces on the ground than they were used to seeing. And that is really what it comes down to, as David said: the will has been lacking.

I think the question of deliberate intent with respect to the outcome of, are they intending to achieve a famine or not? I think that is a muddy question and it’s hard to prove. What’s not hard to prove is that they’re not doing everything that is manifestly within their capacity to facilitate a much more substantial aid operation than we’ve seen over the past year.

Katherine Wilkens: On the issue of the role of the UN on the ground and the relationship with some of the leadership in Israel, how can we crack that nut, when there seems to be such animosity and distrust and anger? I’m sorry, David, to lean on you, but after over four decades, you know the answers.

David Satterfield: It’s not a radical new answer I’m going to give you. Focus solely on the logistical capacities, vehicles, drivers, loaders, warehouse managers, the people who work the delivery and distribution of assistance on the ground in Gaza and certain other specific undertakings—fueling of wells, sewage pickup, waste pickup. Focus just on that and recognize right now and in the immediate future, there is no magical solution or alternative to what UNRWA has and can do on the ground. In the future, who knows? But for right now, it has to be UNRWA in significant measure.

You cannot, if you are Israel, simultaneously undertake a meaningful humanitarian effort while conducting this campaign against all aspects of UNRWA functioning, which includes the ability of UNRWA staff to receive goods from the Jordanian army trucks in the north. You can’t selectively hold what remains of the legs of a table out from under it while conducting a humanitarian and kinetic campaign. It’s too many things all at once. It makes all of it fail.

Scott Anderson: I think that we’ve talked about all the solutions, but the most urgent thing that is needed, and we hope happens soon, is the ceasefire. The hostages need to go home. It’s been almost a year they’ve been away from their families, and then people in Gaza can begin to meaningfully rebuild their lives. Until then, we’ll be here every day doing our best to get aid to people and making sure we’re meeting their basic necessities.

Watch the video of the event below, or read the full transcript here.