“No water, no gas in the house, humanitarian aid consists solely of canned food”: The growing humanitarian crisis in Gaza

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Tens of thousands of victims

The number of civilian casualties in Gaza remains a deeply divisive issue. According to the Gaza Health Ministry, which is controlled by Hamas, over 44,000 residents died between October 7, 2023, and early December 2024. However, this figure includes thousands of militants as well as people who passed away from unrelated illnesses or other causes not related to the Israeli military operation. Despite the ambiguities, international humanitarian organizations, including the WHO, often rely on these numbers. Israel, for its part, has not published its own data on civilian casualties.

Independent estimates suggest that war-related civilian deaths are at least as high as fatalities among militants. In March 2024, Israeli Prime Minister Benjamin Netanyahu stated that the Israel Defense Forces (IDF) had eliminated approximately 13,000 Hamas fighters, with a civilian-to-militant death ratio of one to one-and-a-half. By May, on the “Call Me Back” podcast, Netanyahu reported that about 16,000 militants had been killed, bringing the total death toll to approximately 30,000. At the time, Gaza’s Health Ministry reported 35,000 deaths. Western independent groups have raised concerns about the decreasing reliability of data from Gaza, warning that the actual death toll may be even higher. On October 7, 2024, the IDF estimated that 14,000 militants had been killed.

Amnesty International has referred to the situation as “genocide.” However, Amnesty Israel has clarified that the report does not establish “deliberate intent” to partially or fully destroy Palestinians in Gaza as a group. “The scale of killings and destruction caused by Israel in Gaza has reached catastrophic proportions and must cease immediately. However, our analysis does not confirm that Amnesty International's report meets the definition of genocide under the Convention on the Prevention and Punishment of the Crime of Genocide,” Amnesty Israel stated.

A source within Amnesty Israel explained to The Insider that when the IDF destroys a multi-story building while targeting a suspected terrorist, it cannot be conclusively proven — nor easily presumed — that the act is intended to exterminate the Palestinian population. But while the killing of dozens of civilians to eliminate a single terrorist may not meet the criteria for “genocide,” it does constitute a war crime. “This is especially true when the target is not a high-profile Hamas leader like Yahya Sinwar,” the source emphasized.

“Pharmacies sell only painkillers and weight-loss powders”

According to Gaza’s Hamas-controlled Health Ministry, more than 13,000 children have been among those killed. However, Israeli politicians and some media outlets believe the authorities in Gaza regularly underestimate the ages of the deceased. On September 16, Gaza’s Health Ministry published the names of 710 infants under the age of one who had died. Among them were eight-month-old Alia al-Souri and two-month-old George al-Souri. The Insider spoke with their uncle, Ramez al-Souri, who also lost his three children — 14-year-old Suhail, 12-year-old Julie, and 11-year-old Majed — in an Israel Defense Forces (IDF) bombing.

Before the war, Ramez lived with his wife and children in central Gaza City. The family was well-off. Ramez owned a large office building, renting out space to various companies. He was also an activist with the Gaza Youth Committee, an organization advocating for a peaceful resolution to the Israeli-Palestinian conflict and supporting collaboration with Israeli peace activists — despite repression from Hamas. In 2018, Ramez and other activists held a demonstration at the separation barrier, releasing 200 paper doves with messages of peace.

When the war began and the IDF called for evacuations, Ramez, his immediate family, and his cousins with their families moved south to the Zeitoun neighborhood, seeking refuge on the grounds of St. Porphyrius Church. Around 450 people sheltered in the expansive Greek Orthodox complex. On October 19, 2023, four Israeli rockets struck the church grounds, killing dozens. The IDF press office stated that the airstrike had targeted a Hamas headquarters located near the church, but the strike wiped out most of the al-Souri family: Ramez’s three children, as well as his cousins with their wives and children. Only Ramez and his wife survived.

In a conversation with The Insider, Ramez explained that he and his wife have remained on the grounds of St. Porphyrius Church because some of the buildings are still intact. They have been living there for the past year. The Zeitoun neighborhood is now considered relatively safe, and according to Ramez, many refugees from other parts of Gaza City have gathered there. However, the shortage of food and medical supplies is becoming increasingly severe.

International organizations, Ramez said, distribute humanitarian aid based on lists, but the help now consists solely of canned goods. “In pharmacies, you can only find painkillers and weight-loss powders. I know there are no medications for blood pressure regulation and not enough insulin for diabetics,” Ramez noted.

The Palestinian resident confirmed what humanitarian organizations have been reporting: since October, the humanitarian situation in the Gaza Strip has significantly worsened. This is primarily because, in October, Israel allowed much less humanitarian aid into Gaza than before. According to the Office of the Coordinator of Government Activities in the Territories (COGAT), only 37 tons of humanitarian cargo were delivered to Gaza in October, compared to 96 tons in August, 90 in September, and 55 in November. The October decrease was officially due to holidays and days of mourning, when most checkpoints were closed.

Around the same time, Israel decided to halt the entry into Gaza of goods intended for private-sector trade. COGAT explained that private traders in Gaza had been engaged in price-gouging and transferring goods to Hamas, and as a result, the products were not reaching those in need. Humanitarian organizations pointed out that, after measures were taken to combat the problem, the black market quickly filled the void left by private trade, leading to even higher prices and fewer goods reaching the people.

“There are no fruits in Gaza at all,” said Ramez. “Vegetables can be bought from market vendors, but not many people can afford them — tomatoes and peppers, for instance, cost several hundred shekels” (100 Israeli shekels is approximately $27.40).

Why aid doesn’t reach Gaza’s residents

COGAT oversees all coordination for the delivery of humanitarian aid to the Gaza Strip. This aid includes food, water, medicine, medical equipment, gas, fuel, and materials for building shelters for refugees. Over the 14 months of the war, 1.2 million tons of humanitarian aid have been delivered to Gaza.

The supply process works as follows: trucks arrive at border checkpoints, where they are inspected. Afterward, vehicles from Gaza come to collect the cargo. All drivers are Palestinians from Gaza who must first obtain clearance from Israeli intelligence services to perform this work. From the checkpoints, the aid is transported to UN distribution centers located near the border within Gaza.

In the summer, Israeli Brigadier General Elad Goren, head of COGAT’s humanitarian division, told journalists that hunger in Gaza is impossible — an average person needs 2,100 calories per day for normal nutrition, and according to COGAT’s calculations, humanitarian aid delivers 4,000 calories per person per day.

Israel does not take responsibility for what happens to humanitarian aid once it crosses the border. COGAT officials claim that tons of supplies remain at storage sites near the border for weeks, waiting for humanitarian organizations to collect them. However, staff from these organizations explained to The Insider that retrieving the aid from these storage areas and delivering it to the population is fraught with challenges.

“Cargo can only be collected on specific days and during specific hours, and only via designated routes. The roads the IDF has marked as safe for humanitarian purposes are simply in disrepair. It’s impossible to use other roads because they may be bombed,” a source from a humanitarian organization told The Insider. “Moreover, in recent months, especially in southern Gaza, armed gangs have been operating. They attack humanitarian convoys, either demanding payment for passage or simply seizing the cargo, which then ends up on the black market. There are very few drivers who have received permits from the IDF to transport goods, and I cannot send a driver to the border and promise that he’ll return alive.”

According to the source, the IDF does not interfere with the actions of these gangs because they are not affiliated with Hamas — or, at least, they do not display Hamas symbols — and COGAT claims it does not intervene in the distribution of humanitarian cargo unless Hamas attempts to seize it. Official COGAT representatives state that they are doing everything possible to facilitate humanitarian organizations’ access to aid — by, for example, repairing roads and extending the “windows” during which aid can be collected.

Transporting cargo from one part of Gaza to another is extremely difficult. The source explained that in recent months, goods destined for southern Gaza — which were previously delivered through the Kerem Shalom crossing, the southernmost crossing between Israel and Gaza — must now be transported through central Gaza. If COGAT grants permission, drivers collect the cargo at Kerem Shalom, then transport it through the Israeli-controlled buffer zone to Checkpoint 96 near Kibbutz Be’eri. Only there do they enter Gaza and attempt to deliver the goods to the southern regions.

“Of course, this is incredibly challenging and fraught with great risks. It’s important to remember that Hamas functioned as both the government and the civil administration in Gaza, so all local authorities and security structures were affiliated with Hamas. Israel has effectively destroyed these structures. But there are no alternative governing bodies in Gaza, which means that in areas without Hamas, gangs operate with complete impunity,” the source said.

IDF in Northern Gaza: Three districts cut off without humanitarian aid

Three IDF divisions remain active in Gaza, the Israel Defense Forces press service told The Insider. Fighting is concentrated in the Rafah area and north of Gaza City, near the northern border of the enclave. Since October 6, an operation to clear militants from three districts — Jabalia, Beit Lahia, and Beit Hanoun — has been ongoing. More than 30 IDF soldiers have died in these areas over the past month.

Between 65,000 and 75,000 residents of the affected districts have been trapped for three months. According to local residents and humanitarian organizations, the areas are under complete blockade, with no entry or exit allowed without special IDF permits or coordination with the Red Cross. The only operational hospital in Beit Lahia continually reports severe shortages of medicines, staff, and medical equipment. Permits for evacuating critically ill patients or importing medical supplies are reportedly granted very rarely, according to human rights organizations.

Even when patient evacuation permits are secured, Israel sometimes denies permission to deliver medical goods to the hospital, resulting in vehicles arriving empty to transport patients. COGAT explained to The Insider that the import of equipment and the evacuation of patients are separate missions requiring different permits, which are not always granted.

The UN Office for the Coordination of Humanitarian Affairs (OCHA) provides weekly updates on the situation in Gaza while also acting as a liaison between other organizations and the Israeli military authorities. According to an OCHA report dated December 3, humanitarian organizations attempted to deliver aid to Jabalia, Beit Lahia, and Beit Hanoun 53 times in November, but Israeli authorities rejected 48 of these requests. Although five requests were approved, the army later blocked the convoys on-site. (COGAT issues initial permissions for humanitarian convoys, but the IDF can override these decisions based on the situation, especially in active combat zones.) As a result, no food or medical supplies were delivered to these three districts throughout November. COGAT did not respond to The Insider’s inquiries regarding the situation in these areas.

“The windows in the house are shattered, there is no water or gas, and the prices on the black market are unaffordable”

In the central part of the Gaza Strip, the situation is not considered to be quite as catastrophic. However, humanitarian aid still reaches the area with great difficulty. In November, a woman and two girls, aged 17 and 13, were killed in a stampede while waiting in line at a bakery in the city of Deir al-Balah. The World Food Programme provides bread to the people of Gaza, and until recently, 19 bakeries operated in the territory under its auspices. But as of Dec. 9, only four bakeries remain — all of them in Gaza City. In the central and southern parts of the Gaza Strip, the price of a 25-kilogram bag of flour can reach up to 1,000 shekels ($274).

Five kilometers from Deir al-Balah, near the Netzarim corridor, lies the Nuseirat refugee camp. The Insider spoke with a resident of this settlement, Ilham (name changed at her request). Ilham has two daughters and three sons. Her youngest child is 8 years old, and her eldest is 20. One of her daughters suffers from a severe illness. Ilham is a chemist, holds a college degree, and speaks good English. At the start of the war, when the IDF ordered local residents to evacuate to the southern part of the Gaza Strip, Ilham, her husband, and the children moved to a displacement camp in Rafah. When the Israeli army took control of Rafah, the family returned to Nuseirat — to their partially destroyed and completely looted home.

Ilham says that with the arrival of cold weather life has become especially difficult, as all the windows in the house are shattered. The family does not have enough warm clothes, and buying winter wear is very expensive. As a result, they have to choose between insulation and food.

Three months ago, Ilham says, the situation worsened significantly. Bakeries have closed, and there is almost always no bread. In shops, there are no eggs, dairy products, meat, vegetables, or fruits. Prices on the black market are nearly unaffordable. There is no water in the house, so they have to carry containers from far away. There is no gas, so they cook over an open fire. Humanitarian aid comes in the form of a few canned goods.

According to Ilham, pharmacies are often unable to supply even basic painkillers. She has to obtain medication for her sick daughter on the black market — with great difficulty. She says that Israel does not allow the necessary medications into Gaza at all. The Insider inquired with COGAT about these medications, and the authorities deny that there is a prohibition on importing them into Gaza.

When asked who she blames for the situation, Ilham responds that both Hamas and Israel are at fault:

“I have never supported Hamas. Hamas completely disregards human life — both Israeli and ours. They made a mistake on October 7 and completely failed to consider that innocent people would pay for their stupidity. Israel, on the one hand, has always treated us, ordinary civilians, very unjustly. But on the other hand, we could work and receive medical care in Israel. We had at least some kind of life. Now, because of Hamas and Israel, it is over. We are constantly afraid for our lives because the approach of the Israeli army is always accompanied by heavy shelling. We are starving, freezing, getting sick, dying, and left without a roof over our heads.”

Ilham claims that she is not concerned about what will happen to Gaza after the war: “If the war ever ends, I will take my family out of here. We have no life here, and my children have no future here. I no longer care what happens to Gaza.”

Eiland, former head of the NSC: “Pointless death of our soldiers and Gaza's civilians”

In Israel, it is often said that the actions of the IDF in Jabaliya, Beit Lahiya, and Beit Hanoun are part of the so-called “generals' plan,” or the “Eiland plan.”

The purported architect of this supposed plan is Major General (in reserve) Giora Eiland, the former head of Israel's National Security Council. However, in a conversation with The Insider, Eiland denied that what is happening in northern Gaza is part of the plan he promoted. According to him, the “generals' plan” involved cutting off northern Gaza from humanitarian aid, but only while ensuring that all civilians had unrestricted access to humanitarian corridors, thereby allowing them to leave.

In his view, this would make it possible to encircle the terrorists “like the Germans at Stalingrad” and completely block their access to water and other essential supplies. According to this scenario, the terrorists would either surrender or die, and then the IDF would take control of an emptied northern Gaza and issue Hamas the ultimatum: land in exchange for hostages.

“Israel had three goals in the Gaza Strip: to destroy Hamas's military capabilities, to return the hostages, and to overthrow Hamas's rule. The first goal, after 14 months of war, was largely achieved, albeit at a huge cost. But no one has even attempted to return the hostages or overthrow Hamas’s rule, because military pressure cannot achieve that — the terrorists don’t value their own lives or the lives of civilians; they fear only the loss of territory. Therefore, in exchange for territory, they would have returned the hostages. What we have now is the completely pointless death of our soldiers and Gaza's civilians,” Eiland says.

According to the major general, the main problem with the IDF's actions in Gaza lies in the huge discrepancy between Israel's stated objectives and its hidden goals regarding the sector. If the real objective were to free the hostages and overthrow Hamas's rule, Israeli authorities would behave completely differently, Eiland believes. For example, they would have long ago sought to replace Hamas's rule and would understand that releasing hostages requires diplomatic efforts and concessions, not military pressure.

“We know for sure that two parties in the coalition — 'Religious Zionists' and 'Jewish Power' — aim to bring Jewish settlements back to Gaza. The same is true for half of Likud, and they openly declare this. I’m not in a position to judge what Netanyahu’s true goals are, but so far, what is clearly visible, for example, is the scope and complete clearing of the Netzarim corridor of local residents. The corridor that separates northern Gaza from the south, of course, must stretch from the Israeli border to the sea, but it does not need to be 7 kilometers wide. For dividing Gaza and creating humanitarian corridors, this is simply unnecessary,” says Eiland.

The area of the Netzarim corridor, where no Palestinians remain and all buildings have been demolished except for those adapted for IDF needs, is about 15% of the Gaza Strip’s territory.

How to free the hostages?

Over 14 months of war, only eight out of approximately 250 hostages have been freed as a result of military operations. Currently, 100 Israeli hostages remain in Gaza, though it is believed that several dozen of them are already dead. Negotiations for their release are ongoing, but Hamas is only willing to let them go in exchange for an end to the war, which the Israeli government considers unacceptable.

Both former Israeli Defense Minister Yoav Gallant and senior military officials have stated that they do not believe military pressure can lead to the release of Israeli hostages. Gallant and sources within the military command have also repeatedly stated that they do not believe Netanyahu’s refusal to leave the Philadelphi Corridor for the release of hostages is the right decision.

Israeli society is divided on the issue of the acceptable price to pay for the hostages' release, with the division occurring mainly along ideological lines. Supporters of Netanyahu’s government mostly believe that freeing the hostages is not the main objective in the “Iron Swords” war, while those arguing that the hostages must be returned at any cost are mostly opponents of the current government. According to a recent survey, 71% of Israelis support returning the hostages in exchange for an agreement to end the war against Hamas in Gaza.

Recently, Israel resumed negotiations for the release of hostages — likely due at least in part to pressure from U.S. president-elect Donald Trump. At the moment, discussions are underway about a partial “humanitarian” release of hostages in exchange for a temporary cessation of Israel’s military operations in Gaza, but Hamas remains willing to release all hostages only in exchange for the end of the war. The Israeli leadership continues to emphasize the need for military actions “until Hamas's complete destruction” — the specifics of which remain unclear.

Estimates from international organizations

According to a report by Human Rights Watch, as of October 2024 approximately 1.9 million people out of 2.2 million in the Gaza Strip have been forced to leave their homes. Human rights activists stress that Israel, as the occupying power, is obligated to provide livable conditions for Gaza’s residents and should resort to forced displacement only when absolutely necessary. Additionally, Israel must ensure the safety of displaced people and work to provide for their eventual return to their homes. The authors of the report argue that Israel is failing to meet these obligations, and that its actions are edging dangerously close to the definition of “ethnic cleansing.”

The latest report from the UN Office for the Coordination of Humanitarian Affairs describes the situation in Gaza as catastrophic. Due to widespread malnutrition and unsanitary conditions, the medical needs of the population are escalating, while hospitals’ ability to cope with this demand is rapidly dwindling. According to UNICEF, 100% of children aged 6 to 23 months, as well as pregnant and breastfeeding women in Gaza City, Deir al-Balah, and Khan Yunis, are not receiving the level of nutrition necessary for healthy development. Levels of violence, as well as female and child prostitution, are also on the rise. Half of Gaza’s hospitals are closed, and the remaining ones — such as “Kamal Adwan” — are severely lacking in electricity, medical equipment, and incubators.

In a conversation with The Insider, Israeli officials noted that IPC reports have been warning about the “danger of famine in Gaza” since at least the spring of 2024, but hunger has not yet set in. According to these sources, the fact that Gazans are not completely starving undermines the claims of widespread famine. However, human rights advocates argue that famine is already being seen in certain areas of Gaza, and that by the time it is officially declared throughout the sector, it will already be too late to reverse the situation.