Siege and Starvation: How Israel Obstructs Aid to Gaza

Executive Summary

The brutal October 7 Hamas attacks that killed more than 1,000 Israelis prompted a massive military response intended to root out Hamas in Gaza. The conduct of Israel’s ensuing military response has wrought disproportionate death and suffering among civilians in Gaza, generating famine-like conditions while obstructing and undermining the humanitarian response.

Despite its claims to be facilitating humanitarian aid, research and analysis by Refugees International shows that Israeli conduct has consistently and groundlessly impeded aid operations within Gaza, blocked legitimate relief operations, and resisted implementing measures that would genuinely enhance the flow of humanitarian aid into Gaza.

A Refugees International team traveled to Egypt, Jordan, and Israel in January 2024 where they interviewed key stakeholders in the aid response, displaced people inside Gaza, and people who had recently fled the conflict. Our research makes clear that conditions inside of Gaza are apocalyptic. After five months of war, Palestinians are struggling to find adequate food, water, shelter, and basic medicine. Famine-level hunger is already widespread and worsening.

Israeli policies and conduct are causing a man-made humanitarian crisis. Refugees International found routine and arbitrary denial of legitimate humanitarian goods from entering Gaza; a highly complicated Israeli inspection and approval process without clear or consistent instructions; frequent denials of humanitarian movements within Gaza; clear indications that Israel has failed to establish functional humanitarian deconfliction; and persistent attacks on Gaza’s humanitarian, health, food, power, and other critical infrastructure that have simultaneously debilitated the aid effort and escalated needs. 

Israel’s conduct of its attacks in Gaza calls into question its adherence to International Humanitarian Law (IHL), as well as both the propriety and legality of the United States continuing to supply it with arms. Now, two new mechanisms are forcing a closer look at the Israeli government’s conduct. The International Court of Justice (ICJ) issued legally binding provisional measures ordering Israel to facilitate the flow of aid and lessen humanitarian suffering in Gaza. In February, the Biden administration further issued a National Security Memorandum (NSM-20) requiring assurances that countries receiving U.S. security assistance will actively facilitate the delivery of humanitarian assistance, or risk suspension of U.S. security aid. While Israel was not specifically mentioned in NSM-20, it is required to comply with its terms.

The ICJ case and NSM-20 both define clear expectations for Israel’s conduct with regards to facilitating humanitarian action in Gaza. But Refugees International’s analysis finds that Israel is demonstrably failing to comply with both the ICJ provisional measures and the terms of NSM-20 as they relate to the delivery of humanitarian aid into Gaza. We issue the following urgent recommendations on the steps the parties to the conflict, aid agencies, and key member states should take to rectify the situation. 


To Warring Parties:

  • Immediately agree to a mutual ceasefire and release all hostages.
  • Adhere to international humanitarian law and refrain from any action that threatens the rights, safety, and dignity of both Palestinian and Israeli civilians. 
  • Cease all attacks on civilian infrastructure and allow UN and aid agencies access to populations-in-need.

To the Government of Israel:

  • Fully comply with the ICJ provisional measures.
  • End siege tactics, restore services, and guarantee humanitarian access for aid delivery to all parts of Gaza.
  • Establish clear, effective, and transparent deconfliction for aid delivery and humanitarian personnel in Gaza for the duration of hostilities.
  • Open all border crossings for aid and essential commercial access, including expanding permissions at Kerem Shalom and Rafah crossings.
  • Remove restrictions on items essential for humanitarian aid (including medical equipment, water filters, solar-powered medical storage units, and tents) and hand over inspection responsibility to a neutral party, following past precedents from Syria and Yemen. 
  • Refrain from a military offensive in Rafah, and other actions that could displace Palestinians further or otherwise worsen the humanitarian crisis.

To the United States Federal Government:

  • President Biden should express public support for a permanent mutual ceasefire and the immediate release of all hostages.
  • The Biden administration should elevate famine prevention as a central focus of its Gaza policy and prepare plans to address starvation risks through improved access and increased UN support. This must include lifting the freeze on funding to UNRWA. 
  • Given the widespread indications of systematic Israeli violations of International Humanitarian Law (which even the President has characterized as “indiscriminate” and “over the top”), the Biden administration should pause further offensive security assistance to Israel pending a thorough review of the credibility of Israel’s adherence to IHL, as mandated by NSM-20. 
  • The departments of State and Defense should actively canvas input from the humanitarian community active in Gaza when preparing their 90-day NSM-20 report to Congress.

To U.S. Members of Congress

  • Urge the Biden administration to quickly address Gaza’s food crisis to prevent famine. Congress should increase funding for aid agencies, including UNRWA, to resource the emergency response in Gaza. 
  • Conduct oversight hearings to assess Israel’s adherence to International Humanitarian Law.

To the Government of Egypt:

  • Strengthen UN agencies’ operations in Northern Sinai by allowing more UN and humanitarian personnel to deploy to Al-Arish.
  • Establish a UN operational center at the Rafah Crossing to manage truck crossings, including representatives from UNRWA and other key UN organizations. This center should coordinate with Egypt’s government task force in Arish to streamline aid and personnel movement to and from Gaza.

To the United Nations: 

  • Fully resource the office of the UN Senior Humanitarian and Reconstruction Coordinator (SHRC) for Gaza and use mandated briefings to the UN Security Council to provide public updates on the status of humanitarian aid and access.

Research Methodology

This report summarizes Refugees International’s findings regarding the challenges to aid delivery into Gaza since October 7, drawing on field research, firsthand interviews, and open source analysis. A Refugees International team conducted research in Egypt, Jordan, Jerusalem, and remotely in Gaza in January to assess the humanitarian response during the war. The field research portion was conducted prior to the issuance of the ICJ’s provisional measures and the Biden administration’s National Security Memorandum (NSM-20), but the team carried out additional follow-up interviews with stakeholders and accessed further documentation in February that underscored the further deterioration of conditions in Gaza and the borders. This included more than 35 interviews with government officials, humanitarian officials, and staff of international NGOs involved in the cross-border aid response for Gaza as well as people inside Gaza and some who were evacuated during the war. This report is further informed by ongoing research and advocacy that Refugees International has conducted since the onset of the conflict in October 2023 in coordination with international partners. 


Five months of war have left much of Gaza virtually uninhabitable. Global efforts to push Israel and Hamas to accept a ceasefire and release of hostages has, until now, failed to de-escalate the conflict or improve humanitarian conditions. Several UN Security Council resolutions calling for a ceasefire were vetoed by the United States, which has sought rather to use quiet diplomacy to push for a temporary pause in the conflict to create conditions suitable for scaling up a humanitarian response. U.S. officials, in coordination with Egypt and Qatar, are negotiating between Hamas and Israel to bring both parties to a mutual agreement for a hostage release in exchange for a temporary ceasefire. So far, these negotiations have not produced a way forward. 

In the absence of a ceasefire, Israeli forces continue their extensive air, sea, and land operations across Gaza, with little regard for civilian harm. So far:

  • Millions of people have been displaced. 
  • Hundreds of thousands are barely surviving in overcrowded, informal shelters. 
  • Hundreds of thousands are beyond the reach of aid workers and are starving in areas under Israeli control. 
  • Over 70,000 are wounded, 8,000 of whom need urgent medical evacuation from Gaza to survive. 
  • An estimated 30,000 are dead, and experts estimate that this number could soar by over 70,000 if the war continues amidst famine and disease. 

President Netanyahu told reporters he expects the war in Gaza to continue until 2025. Experts project that the worst mass casualty outcome is likely to occur by August 2024.

Israel faces extensive international scrutiny for its conduct during the war, in both the scale of civilian harm in Gaza, as well as serious accusations that it hinders the timely delivery of aid into Gaza. There is a growing call and efforts within the international community for accountability regarding these practices. South Africa’s case to the ICJ and the White House NSM-20 are the most recent and prominent mechanisms for questioning Israel’s humanitarian claims. 

South Africa’s Case to the ICJ

In January, South Africa formally accused Israel of committing genocide in Gaza at the International Court of Justice (ICJ). Israel’s defense argued to the ICJ that Israeli forces have taken noteworthy steps to facilitate the delivery of aid in Gaza and alleviate the suffering of Palestinians, including through coordination and prioritization of aid through the Israeli Defence Forces’ Unit for the Coordination of Government Activities in the Territories (COGAT), its reopening of the Kerem Shalom border crossing, support on medical evacuations, and the facilitation of key aid efforts. 

The Court decided that “at least some of the rights claimed by South Africa and for which it is seeking protection are plausible,” and ordered Israel to take immediate measures to ensure that it is not committing genocide, including—among other steps—taking “immediate and effective measures to enable the provision of urgently needed basic services and humanitarian assistance to address the adverse conditions of life faced by Palestinians.” 

Israel submitted a report on February 26 to the ICJ outlining how it is complying with these measures, including the provision of humanitarian aid. However, according to reporting, it will not be made publicly available. It is notable that the Israeli government seems unwilling to subject its response to public scrutiny. 

White House National Security Memorandum

Israel is obligated as a recipient of U.S. defense assistance to allow the transportation and delivery of U.S. humanitarian assistance under the U.S. Foreign Assistance Act (FAA) of 1961 (22 U.S.C. 2378-1). In January, several high ranking members of Congress accused Israel of blocking aid to Gaza and called on the Biden administration to pressure Israel to reverse these actions. These accusations are further echoed by UN agencies, humanitarian organizations, and human rights groups, who have called on President Biden to hold Israel accountable for its role in the catastrophic humanitarian crisis in Gaza. 

In February, the Biden administration issued a new National Security Memorandum (NSM-20) articulating a series of measures to be implemented in line with the Foreign Assistance Act to ensure U.S. defense partners and those receiving U.S. defense assistance comply with international humanitarian and human rights law and facilitate the provision of humanitarian assistance. 

The new directive will require that Israel provide written assurances within 45 days (late March 2024) to the Secretary of State that they refrain from using U.S. weapons to violate international law and that they will facilitate and not arbitrarily “deny, restrict, or otherwise impede, directly or indirectly, the transport or delivery of United States humanitarian assistance and United States Government-supported international efforts to provide humanitarian assistance.” Furthermore, the Department of State will then provide Congress within 90 days from the issuance of NSM-20 a comprehensive report analyzing whether Israel abided by the written assurances, including fully cooperating with U.S. government-led and supported efforts to provide aid in Gaza. This first report will cover not only 2024, but the entirety of 2023. 

Both Israel’s written assurances to the Secretary of State and the U.S. Department of State’s 90 day report to Congress will be critical moments for the U.S. Department of State to judiciously review the entirety of Israel’s actions and assess any patterns of aid denial and outright refusal to facilitate aid to Palestinians in Gaza since October 7. 

NSM-20 further requires that if a country’s assurances of adherence are not found to be credible, “the transfer of defense articles and, as applicable, defense services, shall be paused until the required assurances are obtained.” Thus Israel’s assurances, and the U.S. government’s assessment of their validity, are central to the continuation of U.S. support to Israel’s war effort. 

Has Israel Facilitated Humanitarian Aid?

Israeli authorities argued before the ICJ that Israel has facilitated aid to Gaza, including through facilitating bakeries, entry of trucks, access to water, medical supplies and evacuations, fuel delivery, and logistics. This distorts reality. While Israel has allowed a very limited flow of aid to enter the territory, this must be assessed in the full context of a clear pattern of wider obstruction of relief deliveries to Gaza, and its conduct of military operations that systematically obstruct effective humanitarian action within Gaza. This report outlines Refugees International’s conclusion that Israel has not complied with either the ICJ provisional measures nor has it fulfilled its similar responsibilities as required under NSM-20.

Israel’s Pattern of Aid Denials in Gaza

Israel’s obstruction of aid to Gaza since October 7 is an extension and expansion of a longstanding pattern of obstruction. Since the takeover of Hamas in 2007, Gaza has endured an Israeli blockade that has severely restricted the movements of people and goods and services into the territory, leaving 80 percent of Palestinians in Gaza reliant on humanitarian assistance.

During previous periods of intense escalations in fighting with Hamas – in May 2021, August 2022, and May 2023 – Israeli authorities imposed a blockade of Gaza by air, sea, and land, effectively enacting a total siege. They sealed off the borders, blocked access to humanitarian aid, medical referrals and supplies, and fuel critical for Gaza’s power generation. Furthermore, Israeli authorities have previously used the relaxation of the blockade as a bargaining tool in negotiations with Gaza, applying and lifting restrictions as a conditional strategy.

Even in times of peace, Israel applied extensive restrictions on Gaza, using a system it has now weaponized to obstruct adequate aid. Before October 7, Gaza received limited humanitarian aid and commercial goods, with about 500 trucks (excluding fuel) entering daily—the majority of which passed through the Kerem Shalom crossing. All shipments underwent thorough inspections and faced significant vetting imposed by Israeli authorities for so-called “dual use” items. To facilitate the inspection and delivery process, coordination mechanisms were established at key entry points into Gaza, involving collaboration between Jordan, Egypt, and Israel. Scanning equipment was installed at major border crossings, including Rafah, Kerem Shalom, and Erez, to expedite security checks. Approved trucking companies transported goods from Egypt, Jordan, and Israel directly into Gaza via designated routes. Once inside Gaza, the distribution of these goods was managed by the UN Relief and Works Agency for Palestine Refugees (UNRWA) and the Palestinian Red Crescent, ensuring aid reached those in need.

The Humanitarian Aftermath of October 7

Hamas’ brutal attack on October 7, 2023, killed estimates of more than 1,000 Israelis. Another 240 were taken hostage. Immediately following the incursion, Israeli authorities once again implemented a total blockade on Gaza. This blockade was publicly and unambiguously announced by senior Israeli officials, including the Defense Minister, who on October 9 said “I have ordered a complete siege on the Gaza Strip. There will be no electricity, no food, no fuel, everything is closed.” This statement constitutes a prima facie expression of intent to violate prohibitions on collective punishment under International Humanitarian Law.

Ensuing Israeli behavior has followed through on that intent. For the first two weeks of the war, Israel allowed in nothing at all. Palestinians in Gaza were cut off from critical services and any humanitarian aid until Egypt opened the Rafah border on October 21, facilitating the delivery of the first aid convoy. Blockade tactics have continued throughout the fighting, with Gaza cut off from access to critical supplies, including food, water, fuel, and basic necessities for its 2.2 million people. All but two border crossings remain closed to humanitarian traffic, and commercial traffic is even more limited. The Israeli air campaign has meanwhile decimated Gaza’s critical civilian infrastructure, resulting in a total blackout and drastically reduced access to clean water. The blockade has prompted a dramatic reduction in the operational capacity of the prewar aid mechanism. From a pre-war baseline average of 500 trucks per day – both aid and commercial – figures now range between 50 to 100 daily—a massive percent loss of capacity and nowhere near what is necessary to save lives. 

The conflict and obstruction of aid are producing devastating humanitarian consequences for people in Gaza.

Starvation and Malnutrition

Hunger is rampant as famine conditions are setting in. The Global Nutrition Cluster (GNC) – the leading multi-agency authority monitoring and responding to nutrition in conflict – reported in February a sharp escalation in the rates of malnutrition across Gaza, most acutely in the northern areas that remain largely cut off from aid. An estimated 90 percent of young children and pregnant and breastfeeding women face severe food poverty. An estimated 90 percent of children under five have at least one infectious disease. The spread of disease has been exacerbated by both overcrowded conditions and a lack of access to clean water. Nearly 82 percent of Palestinians lack safe and clean water, and the water available per person on average is less than one liter per day. This is far below the global average of 15 liters per person daily. These conditions are particularly acute in northern Gaza where one in six children are acutely malnourished, 3 percent of whom face the most severe form of wasting – a condition where a child is too thin for his or her height as a result of rapid weight loss or the failure to gain weight. 

New estimations by public health experts project that an escalation of hostilities in Gaza without any other improvements to the humanitarian response could result in an estimated 74,000 to 85,000 more civilian deaths beyond current casualty rates. 

Destruction of Food Systems

Palestinians told Refugees International that the destruction of Gaza’s food production systems has further complicated efforts to convert food ingredients into actual food products (e.g. baking flour into bread). In November 2023, Israel bombed Gaza’s largest wheat mill, knocking it out of production. Further IDF attacks left many of Gaza’s bakeries wholly destroyed or partially damaged, limiting the local capacity to convert what flour is delivered into actual bread. The effect of growing hunger is creating devastating consequences for the civilian populations. 

Destruction of Health Infrastructure

Gaza’s healthcare infrastructure is in rubble, and its hospitals – protected sites under international law – continue to be active battlegrounds for IDF soldiers. As of February, only 12 out of 36 hospitals in Gaza are partially functional as a result of Israeli attacks, as well as three partially functional field hospitals, one of which is managed by the Jordanian Armed Forces. Palestinians in Gaza told Refugees International that hospital staff, patients, and those sheltering in or nearby are often casualties in these attacks. The Al Shifa and Al Nasser hospitals – two of Gaza’s largest – have been systematically targeted (and occupied in the case of Al Shifa) and raided by Israeli forces, forcing tens of thousands of people sheltering in these hospitals to be forcibly displaced further south. This southward displacement of Palestinians from hospitals in northern and central Gaza to the remaining hospitals in the south has stretched them far beyond their capacity. 

Destruction of Housing and Shelter

As Israel’s operations have expanded southward toward Rafah, Palestinian civilians have been forcibly displaced to smaller and smaller areas in the south where many have few options for basic housing or shelter. This area faces massive overcrowding as new displaced Palestinians arrive daily, ballooning Rafah’s pre-war population of 280,000 to 1.5 million. As a result, shelter in Gaza is largely depleted. Israel’s military campaign destroyed more than 70,000 housing units and damaged an estimated 300,000 more—60 percent of Gaza’s housing. Virtually every available building has become an informal shelter—hospitals, schools, warehouses, businesses, etc. Humanitarian personnel told Refugees International that families are turning to tents, sheets, plastic tarp, and whatever other materials they can find. Even these materials have been difficult to source as a result of Israel’s ban on dual use items.

Arbitrary Denials, Restrictions, and Impediments

Israel’s conduct of the war and its use of blockade tactics have obstructed humanitarian action at every step of the aid delivery process both inside and outside of Gaza. Bottlenecks originate within Gaza itself, where Israel maintains de-facto approval over all aid operations and movements. Israel’s conduct of the war has greatly hampered aid operations inside the territory. It routinely denies movement requests for aid deliveries, particularly to the north, and has even struck relief convoys that it had approved for safe passage. It has repeatedly struck humanitarian facilities, including residences, offices, and warehouses. It has closed and at times struck the bakeries on which Gaza’s people depend for food. 

This means aid struggles to move – even when it can get into Gaza – creating cascading bottlenecks along the rest of the upstream logistics chain. If aid groups cannot safely move, aid cannot be distributed. Aid that cannot be distributed quickly fills up the warehouse space that has not yet been destroyed. When warehouse space is full, more aid cannot be imported. When aid cannot be imported, enormous lines of trucks wait for days at the border crossings. When trucks are tied up waiting at border crossings, their capacity is taken off line for other movements. The long lines of trucks waiting in Egypt – that COGAT spins as signs of UN logistical failures – are in actual fact a testament to Israel’s failure to allow an enabling environment for humanitarian response inside the territory.  

Israel’s obstruction of humanitarian action in Gaza, detailed below, contravenes both the letter and the spirit of the ICJ’s provisional measures on the facilitation of humanitarian assistance. It also contravenes the policy prohibitions in NSM-20 that defense partners should not “arbitrarily deny, restrict, or otherwise impede” the delivery of U.S. humanitarian assistance.

Obstruction of Humanitarian Action Within Gaza

Absence of Functioning Humanitarian Deconfliction

Deconfliction is the practice – common in wartime settings – of coordinating humanitarian sites and operations with conflict parties to ensure that humanitarians are not inadvertently attacked. The practice is crucial for delivering humanitarian assistance and has been successfully applied in challenging war zones, including in Syria, Ukraine, and Yemen. Effective deconfliction encompasses more than just alerting about imminent military strikes; it crucially involves measures to protect designated humanitarian workers and critical infrastructure, including hospitals, warehouses, shelters, ambulances, and safe houses. Furthermore, under international law, Israel is obligated to respect and protect humanitarian relief and medical personnel.  

In its defense to the ICJ, Israel stated that the IDF has employed pre-strike notifications. Noticeably absent were any such assurances for the protection of pre-approved humanitarian sites and personnel. According to Israeli officials, this notification system aims to forewarn of upcoming military actions, allowing individuals in the targeted areas to evacuate. Humanitarian operators and Palestinians interviewed by Refugees International report that this approach frequently fails, putting aid workers and beneficiaries at risk. 

Meanwhile, Refugees International also heard from Palestinians that, in some cases, they receive no advanced warning of strikes. One Palestinian woman told the team, “Before we used to receive what is called a warning missile sent by the Israelis so the people knew to evacuate. This time, they target the areas directly and without warning.” The team heard from another woman who lost more than 30 members of her extended family in a single airstrike that came without warning. 

Moreover, despite repeated appeals from the United States, UN, and various aid organizations, the IDF has not facilitated a working coordination system between the UN and other aid agencies and the appropriate Israeli military channels for the protection of humanitarian sites in Gaza. As one person with a humanitarian NGO team on the ground told Refugees International, at best, “deconfliction only means that you will be notified ahead of a strike.” And frequently that does not happen; other humanitarian workers told Refugees International that often no notifications come; or they come too late and thus provide no real window of opportunity for civilians to safely evacuate. UN and NGO staff told Refugees International of a number of cases where UN, humanitarian, and civilian infrastructure, including whole housing blocks, were hit without prior warning. These testimonies reinforce extensive public reporting of other such attacks by Israeli forces on humanitarian sites.

These conditions dramatically limit the ability of aid agencies to deliver assistance. UN and aid agencies provide a list of “protected” humanitarian sites to Israel’s COGAT, which includes staff safe houses, warehouses, medical clinics, hospitals, shelters, and more. In theory, this list provides Israel a clear “no strike” list. But in practice, Israeli strikes routinely target many of these areas. A number of those interviewed by Refugees International assessed that these attacks on protected sites submitted to COGAT happened with enough frequency that they may be deliberate. One NGO staff told Refugees International, “This is not a deconfliction list, it’s basically a strike list.” 

Whether intentional or inadvertent, Israel’s widespread failures to protect humanitarian staff and facilities from bombardment violate its obligations under international law. This creates a deeply unsafe environment both for aid providers and recipients. On February 21, Israeli forces attacked a clearly marked Médecins Sans Frontières (MSF) building sheltering MSF staff and their families during a military operation in Al-Mawasi, killing two and injuring six. General Director Meinie Nicolai’s response later observed: 

“These killings underscore the grim reality that nowhere in Gaza is safe, that promises of safe areas are empty and deconfliction mechanisms unreliable. The amount of force being used in densely populated urban environments is staggering, and targeting a building knowing it is full of humanitarian workers and their families is unconscionable.”

UN and NGO staff told Refugee International that they cannot do their job due to the severe security risks on the ground. One U.S. official told Refugees International, as a result of the security conditions, “…the risk and safety of humanitarian officials is untenable. People must be able to both deliver and receive assistance.” Another senior U.S. official also acknowledged Israeli authorities often provided them with no clear military justification for strikes on humanitarian infrastructure or for blocking UN movements to areas of critical need. 

The situation has not improved since the ICJ issued its provisional measures for Israel. Rather, the evidence of ongoing attacks on humanitarian sites and persons over the past month reasserts Israel has made no meaningful effort to improve its deconfliction. Humanitarian personnel continue to be attacked and killed while providing aid and while sheltering in clearly marked NGO sites—a point senior U.S. officials continue to flag as a problem.

The failure to address deficiencies in humanitarian deconfliction is a major indication of the Israeli government’s willful non-compliance with the ICJ provisional measures, the U.S. government’s NSM-20 requirements, and international law in general. The failure is not one of knowledge or capacity: Israel is fully familiar with standard deconfliction practices, having established such a system very effectively during its 2006 war in Lebanon. It is not due to tactical concerns: there is no plausible military rationale for failing to establish workable deconfliction. It would not impede battlefield objectives or create tactical disadvantages for Israeli forces. The failure is not one of awareness: UN and NGO officials have publicly and privately urged Israel to establish a working deconfliction system. Likewise U.S. government officials up to the senior-most levels have repeatedly raised the need for deconfliction with senior Israeli counterparts, to no avail. The lack of deconfliction is, however, consistent with a policy of blockading and depriving Gaza’s civilian population, as it materially impedes humanitarian operations throughout the territory. 

Obstructing Humanitarian Movements inside Gaza  

Under international humanitarian law, civilians in conflict have a right to receive humanitarian assistance. Humanitarian organizations have the right to deliver humanitarian assistance. And, the Israeli government has the legal obligation under IHL and the ICJ provisional measures to facilitate the delivery of such assistance to communities in need in areas under its control. U.S. policy under NSM-20 likewise requires that countries receiving U.S. security assistance work in good faith to facilitate the delivery of humanitarian assistance.

Israeli authorities have failed to meet these obligations. Across Gaza, Israeli authorities continue to deny UN and aid agencies the ability to deliver aid consistently across Gaza and, most specifically, to those in critical need in the north. These repeated denials, many of which have occurred since the ICJ ruling on January 26, are in direct violation of the imperative laid out by the ICJ and NSM-20 for Israel to facilitate and not hinder aid. 

Israeli authorities mandate that all movements of UN and aid agency personnel within Gaza must be reported to COGAT. This means that routine trips such as moving humanitarian staff from a safe house to a hospital require notification to Israeli authorities. In general, humanitarian actors lack uniform access across Gaza. Some areas are more accessible than others. For example, UN staff have told Refugees International that approvals for movements in Rafah, while challenging, do occur. However, with the impending threat of an invasion into Rafah, these are likely to be severely reduced. Meanwhile, accessing Northern Gaza is incredibly difficult and rare. UN and U.S. officials told Refugees International that any such access requires extensive diplomatic and political negotiation at senior UN and U.S. levels. These requests, they added, are routinely denied without any justification.  

Since January 1, 2024, Israeli authorities have only facilitated less than 20 percent of humanitarian missions aimed at delivering aid and assessing conditions in the north. Over half of all requests were outright rejected. The approved missions primarily focused on food distribution, while support for hospitals and sanitation facilities were overwhelmingly denied. 

In the rare instance that UN convoys are authorized by COGAT in Jerusalem, Israeli forces at checkpoints on the ground often restrict their entry. UN convoys frequently encounter hours-long delays at the Wadi Gaza checkpoint – the main route for aid delivery to the north – before being subsequently refused entry on COGAT-approved movements. In some instances, UN convoys facing protracted delays at the checkpoint have been raided by local communities urgently in need of food. In another case, Israeli forces fired on a UN convoy that was being held at an IDF checkpoint while transporting food to the north, destroying the supplies intended for those in need. Such incidents are not isolated and significantly heighten security risks for aid workers and recipients in the hardest-hit areas, especially in the north. The reasons for Israeli authorities’ denials are often unclear, and the unpredictable obstacles at checkpoints pose severe security threats to both aid workers and those in need.

On February 20, 2024, the World Food Program announced a pause in food deliveries to the north due to residual insecurity and due to the absence of an effective notification mechanism and the breakdown of civil order driven by the immense desperation of an estimated 300,000 people remaining in Northern Gaza. Meanwhile, Israel has provided little direct aid to these populations and continues to restrict their access to basic necessities. Despite calls from U.S. Secretary Blinken and other officials to open a direct corridor to the north to alleviate famine-like conditions, a senior U.S. official told Refugees International that Israeli authorities have categorically rejected such requests. 

The result of these arbitrary denials is the starvation of civilians, a violation of international humanitarian law. The Israeli government has not taken sufficient steps as required by the ICJ provisional measures to reverse the many aforementioned challenges. As a direct result of these denials, millions in Gaza are sinking deeper into catastrophic levels of humanitarian need.

Restrictions on Healthcare

Across Gaza, almost 70,000 injured Palestinians need some level of medical treatment. The most urgent of those in Gaza’s remaining hospitals are struggling to receive sufficient care. Hospitals are currently well over capacity. One doctor working at the European Hospital told Refugees International that the hospital, which has a normal capacity of 300 to 400 patients, was hosting 900 patients and sheltering an estimated 20,000 people. Palestinian medical staff also told Refugees International that there is a severe shortage of medical supplies because aid providers are unable to get them approved for delivery into Gaza. Meanwhile, they are facing extreme difficulty sourcing basic medicines available inside of Gaza. For patients, this often means undergoing extensive surgery without any form of anesthesia. 

Doctors and medical staff are also forced to provide care under unrealistic conditions without essential resources like water, electricity, or other basic supplies while facing bombardment. U.S. officials flagged that attacks on hospitals and the routes civilians use to access them remains a major concern. A senior U.S. official told Refugees International, “We made it clear [to the Israelis]…hospitals in the south must remain operational.” They underscored further that civilian access to these hospitals must also be properly protected. This included protecting the physical routes in and out of the hospitals to ensure civilians can reach lifesaving medical treatment. Some (not all) hospitals have seen reduced attacks within hospital compounds. However, NGOs continue to flag that military operations in the vicinity of the hospitals have blocked both the ability for staff to evacuate safely and access for victims to reach critical care.

Another 8,000 people – many of whom are children – are in critical need of emergency evacuation for their survival, but only 1,200 have been successfully moved to Egypt or beyond for critical care. Israeli authorities must individually approve all medical evacuees. UN officials told Refugees International that Israel’s criteria for approved evacuees, which as of January only approved patients under the age of 17 who are attended by a female guardian over the age of 55, automatically disqualified the vast majority of those flagged for emergency evacuation. In one baffling case shown to the team, a request for 50 names was provided to COGAT for review. Of the two who were approved, a ten year old boy made the list, but his parents – his primary caregivers – were not permitted to join. 

Challenges Delivering Aid into Gaza

Beyond Gaza’s borders, aid groups face major obstacles as well, primarily (though not entirely) related to obstructive practices by the Israeli government. The upstream logistical system is plagued by inefficiencies, including multiple layers of inspections, protracted wait times, and pervasive uncertainty. Unlike in Northwest Syria and Yemen, where an impartial UN monitoring mechanism was established for aid deliveries, such a system has not yet been established for Gaza. Typically, such mechanisms empower UN actors to streamline delivery processes and establish clear procedures to ensure efficient and prompt aid vetting and distribution. The UN Security Council appointed Sigrid Kaag as the SHRC and tasked her with establishing a cross-border mechanism, but has struggled to do so without political buy-in from Israel and Egypt. 

The absence of such a mechanism has left Israel with a veto over all aid deliveries into Gaza, and it exercises that veto capriciously and often arbitrarily. Israel, in its defense to the ICJ, argued that it has actively eliminated bottlenecks and improved the entrance and distribution of aid in Gaza, including by opening the Kerem Shalom crossing. Their defense further claimed that their efforts helped ease congestion at the Rafah crossing and helped facilitate greater amounts of aid entering Gaza. This argument is contradicted by facts on the ground.

Refugees International found instead that Israeli authorities have erected unnecessary hurdles, complicated logistical processes, and an unpredictable vetting system, rendering the inspection regime overwhelmingly burdensome with layers of bureaucracy and inspection and limited working hours. They have created a complex system with multiple potential choke points rather than a good-faith system optimized to maximize aid volumes. The Egyptian government as well bears partial responsibility, as it has required that all aid inflows be coordinated through the Egyptian Red Crescent, which is doing its best but has limited capacity and experience with large-scale aid logistics. But the reliance on Egypt is only necessary due to Israel’s refusal to open additional border crossings to regular humanitarian movements. 

Decrease in Aid Delivery

Despite Israel’s claims that it has facilitated an expanded capacity for aid delivery to Gaza, humanitarian actors continue to report extensive impediments to deliveries imposed at the borders, including arbitrary denials, refusal of entry, and arbitrary blocks of critical humanitarian items. This has resulted in a decrease in aid volumes since the ICJ issued its provisional orders.

Map of Gaza. Source: OCHA, 2024

Presently, humanitarian aid can only enter Gaza through the primary Rafah Crossing in Northern Sinai and the secondary Kerem Shalom crossing from Israel into southern Gaza. However, critical crossings like the northern Erez and Karni Crossing, vital for providing life-saving assistance to the estimated 300,000 Palestinians at risk of famine in Gaza’s north, remain closed despite persistent pleas from UN and U.S. officials to Israel for their reopening. 

A single truck has the capacity to provide lifesaving support for anywhere from 10,000 to 20,000 people. Since January 26, only a third of INGOs operating in Gaza have been able to successfully deliver goods by truck. On any given day, several hundred trucks are waiting in week-long queues to deliver their cargo into Gaza – delayed by upstream bottlenecks within Gaza, as outlined above. Some INGOs reported wait times lasting months at a time, and blamed Israel’s inspection mechanisms for the protracted delays. 

When trucks arrive to Kerem Shalom, the Nitzana inspection site, or Rafah crossings, there is no assurance that truck cargo will be permitted entry for delivery. This uncertainty arises from a lack of clarity regarding permitted items. Specifically, it remains ambiguous which items are approved or banned for entry into Gaza. According to UN personnel, if even a single item on a truck is rejected, the entire cargo faces rejection and must return to its origin.

Both Gaza crossings are also prone to random closures. Since January 2024, Kerem Shalom has closed on numerous occasions due to protests by local Israelis seeking to block trucks from delivering. In these cases, Israeli authorities were slow to clear protestors from the Kerem Shalom crossing and reopen the borders. Meanwhile, criminal gangs are reportedly looting truck shipments entering Gaza and traveling across the “no man’s land” from Kerem Shalom to Rafah. This has created a series of internal security concerns, which has posed a unique challenge for the safety of the drivers. 

The average number of trucks delivered in February since the January 26 ICJ provisional measures has fallen by 50 percent, according to UN data.

The graph above depicts truck deliveries from January 26 to February 26. Missing data for January 27 and Feburary 3. Source: OCHA

Logistical Impediments within Egypt

Egypt’s Rafah crossing with Gaza emerged initially as the last resort pathway for the delivery of aid. Israel’s initial closure of its own Gaza border crossings, Kerem Shalom (now open) and Erez, placed a heavy burden on Egypt to serve as Gaza’s primary access point for humanitarian aid. But the Rafah crossing, mainly intended for commercial deliveries, lacks the capacity to process the substantial amount of aid Gaza requires on its own. 

Aid route to Gaza from Egypt through Rafah. Source: Wall Street Journal

Limited capacity in northern Sinai, along with security and bureaucratic hurdles from COGAT and the Egyptian authorities, have significantly hindered the ability to scale the aid operation. Egyptian authorities have sought to deter a large-scale humanitarian response in the northern Sinai—a region largely used as a military zone and, until early 2023, a key site for counterterrorism efforts. Additionally, reports documenting Israel’s intentions to pressure Egypt to open its borders to Palestinian refugees heightened political strains between Israel and Egypt, inflaming concerns about the humanitarian crisis spilling over into northern Sinai. Egypt has responded to these dynamics by intensifying its oversight and regulation of access to the border area for UN and aid agencies, as well as its monitoring of entry and exit of individuals to and from Gaza. 

Egypt’s strict handling of the response has created some access constraints and cumbersome requirements for UN agencies and humanitarian organizations. NGO officials told Refugees International that impediments, ranging from inconsistency to coordination challenges to credible allegations of corruption, have hindered the ability to deliver aid. 

Egyptian authorities, for their part, could also improve the operating environment by expanding access, increasing transparency, and streamlining permissions for both humanitarian personnel and goods to northern Sinai. 

Infographic above depicts the process of cross border aid delivery to Gaza. Source: Refugees International.

Struggling to Scale a Jordan Corridor

The complications in Egypt pushed UN agencies and humanitarian organizations to look for other alternatives, including via Jordan. Prior to the current war, Jordan maintained a regular trucking route for commercial goods delivered to Gaza, which included a rigorous vetting and inspection process allowing for ease of delivery. This system could be scaled to expand the delivery of both UN humanitarian assistance and commercial deliveries to offset the crisis. However, aid provided from Jordan has also been subject to extensive uncertainty as a result of coordination challenges with COGAT. 

Today, the prewar aid and trucking corridor from Jordan to Gaza is completely unrecognizable. NGOs delivering aid to Gaza from Amman told Refugees International that COGAT officials have put in place “difficult obstacles” that did not exist before for the delivery of aid to Gaza. Like at Rafah, the Israeli COGAT have yet to provide clear standard operating procedures (SOPs) to Jordanian authorities. One UN official told Refugees International with the COGAT, “Nothing is systematized, regularized, or clarified.” 

The infographic depicts the Kerem Shalom Inspection process. Source: Refugees International.

New barriers, such as the addition of new inspection requirements by Israeli authorities, are creating impediments at both the Allenby Bridge Crossing into Israel and the border crossing at Kerem Shalom. Refugees International learned through interviews that truck scanners that previously enabled the rapid scanning of trucks at Kerem Shalom were no longer in operation, despite being in operation shortly before the conflict. No one could confirm whether these machines were broken or simply turned off. One NGO official told Refugees International that the trip used to take two hours before the war, but now it can take up to three days. 

To offset the time lag for the inspection process at Kerem Shalom, Jordanian officials are scaling up the capacity inside Jordan to mitigate potential hangups in the delivery process that may occur at any of the Israeli inspection points along the route. They set up truck scanners at the Allenby Bridge crossing for convoys moving from Jordan into Israel enroute to Kerem Shalom. They are building expanded warehousing to streamline the process, and are working closely with the UN to ensure a smoother process for both UN agencies and NGOs.  

The lack of transparency and predictability from Israel’s side has pushed Jordan to expand beyond the prewar corridor for additional delivery routes. In January, Jordan opened up a new corridor that involves moving trucks across the Red Sea by ferry to Egypt where they join hundreds of other trucks entering the complex Rafah inspection and approval process. 

For their part, the Jordanian Armed Forces have carried out more than 16 airdrops of aid directly into Gaza. 

The first image shows the land route. The second image shows the land & ferry route.

UN and NGO officials repeatedly point to a lack of clear instructions, procedures, and transparency from Israeli authorities as the root of many of these issues. Most stakeholders Refugees International interviewed attributed these obstacles to COGAT, but others recognize that the root of the problem lies with Israel’s political, military, and intelligence leadership. One senior humanitarian official speaking on anonymity told Refugees International, “The center of gravity with decision making is not with COGAT, it’s with the IDF and the intelligence services. COGAT is a go between.” 

One UN official told Refugees International, “Trucks or no trucks, properly palletized or not palletized, we know how to do that… You can only demystify so much if you don’t have clear instructions… This is a purely political crisis, it is not a technical crisis. It is not a problem of getting trucks in, it is a manifestation of bigger problems.”

Scaling aid from Jordan should be a priority to restore reliable capacity to Gaza, but this is not a silver bullet to solving access issues to Gaza. UN officials almost unanimously told Refugees International that they want “every potential avenue to scale to every extent possible.” 

Routine and Arbitrary Denial of Critical Humanitarian Items

Israeli authorities have also refused to provide clear criteria for the delivery of goods to Egyptian, Jordanian, or UN authorities, despite repeated requests. As humanitarian officials told Refugees International, In the absence of clear criteria, humanitarian actors have had to resort to informally crowdsourcing their own lists of approved and rejected items, accumulated based on the collective experiences of individual organizations. 

Prioritizing which items should be delivered to Gaza normally requires coordination among UN and humanitarian actors working inside Gaza, who then consult this list with the Egyptian Red Crescent, UN agencies, and COGAT outside of Gaza. There are multiple disconnects between the prioritized items and those actually delivered. The biggest challenge is Israel’s rejection of critical aid supplies that it considers to be “dual-use” items. Per Refugees International’s interview with aid officials, rejected items can range from water purification tabs to nail clippers to insulin pens to tent poles to green-colored sleeping bags to field hospital boxes to medical kits to water filters to generators and batteries to ultrasound devices to fire hoses to ventilators, and beyond. 

In addition, according to several humanitarian officials interviewed by Refugees International, the prioritization list is frequently altered by Egyptian authorities after submission by humanitarian organizations. These changes prioritize bilateral aid provided by friendly states such as the Qatar Red Crescent and the Emirati Red Crescent. Consequently, trucks entering Gaza do not consistently deliver the types of aid necessary to meet the specific needs identified by humanitarians in Gaza. 

In an effort to introduce more certainty, UN agencies and NGOs have established a UN-led pre-delivery mechanism managed by UN OCHA to streamline the approval process for goods entering Gaza directly with COGAT. While this has helped reduce some uncertainty, it does not fully substitute for an official list. The resulting ambiguity has discouraged some aid agencies from delivering essential items due to the likelihood of rejection.

Israel’s denial of certain items, such as tent poles, has further exacerbated the already severe shelter crisis. Palestinians are being asked to dig through rubble to find metal for tent shelters because Israel has banned the delivery of tent poles, as they could be “dual use” items. NGO officials told Refugees International that they were instead sending the remaining components for tent construction: tarps, duct tape, and rope. Meanwhile, the rejected items are piled up in a large warehouse, occupying scarce space. 

The shortage of medicine and medical supplies is another pressing issue. Humanitarians told Refugees International that there is no cold chain or cold warehouses in Gaza because they cannot deliver any form of cold storage. Medical organizations cannot even get in solar panel fridges and refrigerators because of dual use restrictions. These restrictions are unacceptable, especially given the rampant disease and sickness among the 1.5 million people forced to shelter in overcrowded conditions in Rafah. 

Meanwhile, the ongoing ban on heavy equipment means that aid workers and civil responders are unable to engage in rubble removal, clearing operations, or recovery operations for the thousands buried under rubble. 

Despite numerous opportunities to clarify border policies for UN aid and agencies, Israeli authorities have consistently failed to take effective action to improve aid delivery. Even with high-level interventions by U.S. and UN officials, this refusal reflects an unwillingness to facilitate aid delivery, echoing historical precedents of aid denials in Gaza [see section: “Israel’s Pattern of Aid Denials in Gaza”]. 

No UNRWA, No Response 

In January, the United States and other main donors stopped their funding to UNRWA because 12 of its employees were accused of being involved in the attacks on October 7. UNRWA quickly fired these employees, and the UN Secretary General launched an ongoing independent investigation into the issue. However, this pause in funding has put the agency’s activities in jeopardy. 

Israel’s political leaders are seizing on the UNRWA accusations to push the United States and other donors to permanently defund, dismantle, and replace UNRWA. On February 14, Israel’s Finance Minister blocked major shipments of flour, cooking oil, chickpeas, rice, and sugar from reaching UNRWA and suspended UN agency’s use of Ashdod port for receiving food deliveries. Further state retribution against UNRWA resulted in the removal of their tax benefits as a UN agency. 

The pause will create a significant capacity issue inside of Gaza to support the scale of aid piling up at the borders. UNRWA is the largest organization tasked with the movement and delivery of aid from the border crossings to the populations-in-need. As a result, they are the last mile mover of aid from the border to areas of distribution. Almost half of INGOs operating in Gaza directly rely on support from UNRWA to facilitate their operations.  

UNRWA is indispensable to Gaza’s aid infrastructure, delivering 80 percent of the aid and employing over 13,000 staff—3,000 of whom are dedicated to emergency relief. The closure of UNRWA would leave a vacuum no other agency is prepared to fill quickly, drastically increasing the risk of famine in Gaza.


Averting the worst humanitarian outcomes in Gaza requires decisive action. The impediments preventing aid and services into Gaza are entirely man-made. Refugees International’s findings indicate that Israeli authorities have failed to implement measures that would genuinely enhance the flow of humanitarian aid into Gaza. This has severely impeded U.S. government efforts and U.S.-supported international efforts to provide humanitarian assistance to Gaza. Despite Israeli government assertions of facilitating aid deliveries, evidence since October 7—and in previous conflicts—suggests they are doing the opposite by imposing unpredictable and increasingly complex conditions on humanitarian efforts. 

Since January 26, Israel continues to show by its actions that it is either unwilling or unable to meet its humanitarian obligations laid out under the ICJ provisional measures and NSM-20. Rather than make efforts to alleviate impediments to humanitarian aid, Israel has continued to obstruct the delivery of assistance to Gaza. It has further threatened to escalate the conflict against Hamas by invading Rafah, where 1.5 million Palestinians are currently displaced. These mechanisms are a helpful start in documenting Israel’s IHL violations, but they must be followed by real actions to hold Israel’s leaders accountable.

The Biden administration must lead accountability measures to prevent a worse crisis and avert an impending famine. President Biden’s latest warnings to Prime Minister Netanyahu around a ground offensive into Rafah will only matter if they come with consequences. If Israel moves forward with its ground offensive, the Biden administration must review all accountability options on the table, including the immediate suspension of further arms transfers to Israel. 

Featured Image: Palestinians hold out empty containers to be filled with food since they are unable to obtain basic food supplies in Rafah, Gaza on February 25, 2024. (Photo by Abed Zagout/Anadolu via Getty Images)