Hanadi Gamal Saed El Jamara, 38, says sleep is all that can distract her children from the aching hunger gnawing at their bellies.

These days, the mother-of-seven finds herself begging for food on the mud-caked streets of Rafah, in southern Gaza.

She tries to feed her kids at least once a day, she says, while tending to her husband, a cancer and diabetes patient.

Over more than 100 days, Palestinians in Gaza have seen mass displacement, neighborhoods turned to ash and rubble, entire families erased by war, a surge in deadly disease and the medical system wrecked by bombardment. Now starvation and dehydration are major threats to their survival.

“We are dying slowly,” reflected El Jamara, the mother in Rafah. “I think it’s even better to die from the bombs, at least we will be martyrs. But now we are dying out of hunger and thirst.”

Israel’s strikes on Gaza since the October 7 Hamas attacks have killed at least 26,637 people and injured 65,387 others, according to the Hamas-run Ministry of Health. The Israeli military launched its campaign after the militant group killed more than 1,200 people in unprecedented attacks on Israel and says it is targeting Hamas.

People in northern Gaza ‘eat grass’ to survive

Mohammed Hamouda, a physical therapist displaced to Rafah, remembers the day his colleague, Odeh Al-Haw, was killed trying to get water for his family.

Al-Haw was queueing at a water station in Jabalya refugee camp, in northern Gaza, when he and dozens of others were struck by Israeli bombardment, Hamouda said.

Israel’s blockade and restrictions on aid deliveries mean stocks are desperately low, driving up prices and making food inaccessible to people across Gaza. Shortages are even worse in the northern parts of the strip, according to the UN, where Israel concentrated its military offensive in the early days of the war. Communication blackouts stifle efforts to report on starvation and dehydration in the region.

“People butchered a donkey to eat its meat,” Hamouda says friends in Jabalya told him earlier this month as shortages worsened.

In what could be a serious blow to humanitarian efforts, several Western countries have suspended funding to the main UN agency in Gaza, the United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) in recent days over explosive allegations by Israel that several of its staffers participated in the October 7 attacks. The UN fired several employees in the wake of the allegations.

Jordan’s foreign minister urged those countries suspending funding to reconsider, saying UNRWA was a “lifeline” for more than 2 million Palestinians in Gaza and that the agency shouldn’t be “collectively punished” over allegations against a dozen of its 13,000 staff.

‘No clean water’

Gihan El Baz cradles a toddler on her knee while comforting her children and grandchildren, who she says wake each day “screaming” for food.

“There are no drinks, no clean water, no clean bathrooms, the kid cries for a biscuit and we can’t even find any to give her.”

Displaced parents in Rafah, where OCHA reported more than 1.3 million residents of Gaza have been forced to flee, say the stress of being unable to protect their children from bombardment is compounded by their inability to provide enough food. Limited access to electricity makes perishable goods impossible to refrigerate. Living conditions are overcrowded and unsanitary.

“People are forced to cut down trees to get firewood for heating and preparing food. Smoke is everywhere and flies spread widely and transmit diseases,” said Hazem Saeed Al-Naizi, the director of an orphanage in Gaza City who fled south with the 40 people under his care – most of whom are children and infants living with disabilities.

Hamouda, the displaced health worker, used to feed his children – aged six, four and two – a mixture of fruits and vegetables, biscuits, fresh juices, meat and seafood. This year, he said, the family has barely eaten one meal a day, living on dried bread and canned meat or legumes.

“Children are being violent towards each other to get food and water,” said Hamouda, who works at Abu Youssef Al-Najjar Hospital and volunteers at a nearby shelter. “I can’t stop my tears from falling when I talk about these things, because it’s very hurtful seeing your kids and other kids hungry.”

All 350,000 children under the age of five in Gaza are especially vulnerable to severe malnutrition, UNICEF reported last month.

Increased risk of dying

The “scale and speed” of potential famine in Gaza will consign child survivors to a lifetime of health risks, said Rebecca Inglis, an intensive care doctor in Britain who regularly visits Gaza to teach medical students.

Malnourished children, especially those with severe acute malnutrition, are at greater risk of dying from illnesses like diarrhea and pneumonia, according to the World Health Organization. Cases of diarrhea in children under age five have increased about 2,000% since October 7, UNICEF said.

Hamouda said his own children have diarrhea, cold and flu symptoms. “The children’s bodies are dehydrated … their skin is dehydrated.”

Challenges to food distribution, blocked aid

Shadi Bleha, 20, is trying to feed a family of six. Twice a week, they receive two water bottles, three biscuits and “sometimes” two cans of food from UNRWA, he said.

In other cases, vendors purchase aid from merchants and trade at markets for inflated costs. Some people with cars travel further afield to get water, returning to displacement camps to resell water for hiked prices. Intensified strikes also raise prices. Three weeks ago, a 25-kilogram bag of flour cost $20 in Khan Younis, according to Al-Naizi, but after the IDF intensified attacks on the southern city, it became $34.

Others say they receive humanitarian parcels that have been opened, with items missing. Dates, olive oil and cooking oil found in aid packages are reportedly sold on the black market for more than double their value.

On January 21, Israel’s Coordinator of Government Activities in the Territories (COGAT), said 260 humanitarian trucks were “inspected and transferred to Gaza,” marking the highest number since the start of the war.

The WFP has called for new aid entry routes, more trucks to pass through daily border checks, fewer impediments to the movement of humanitarian workers, and guarantees for their safety. On January 5, the agency reported six bakeries in Deir al-Balah and Rafah had restarted operations, but three remained out of use. “Bread is the most requested food item, particularly as many families lack the basic means for cooking,” it said.

Meanwhile, Israel’s military offensive has razed at least 22% of Gaza’s agricultural land, according to OCHA. Livestock are starving and fresh produce is hard to come by.

“It’s absolute chaos and people are absolutely desperate, people are absolutely hungry,” added Touma. “The clock is indeed ticking for famine.”

“Sometimes families make a personal decision to sell WFP food in exchange for other household items that they might need. To be clear, any food distributed by the WFP is not for sale,” the agency said in a statement.

The war has also caused widescale loss of employment in Gaza, further draining residents’ purchasing power as prices rocket.

“We live almost in a jungle where war, murder, the greed of merchants, the injustice of institutions in distributing aid, and the absence of government lead to this deadly chaos,” al-Naizi said.