Intended for healthcare professionals


The meagre flow of aid into Gaza is creating a deadly health crisis for Palestinians

BMJ 2024; 385 doi: (Published 21 June 2024) Cite this as: BMJ 2024;385:q1390
  1. Jamil Sawalmeh, country director, ActionAid Palestine

Unless more aid and fuel gets into Gaza, many more people will die from malnutrition, dehydration, and disease, writes Jamil Sawalmeh

For months, delivering aid to the people who need it in Gaza has been an enormous challenge. But since the Israeli military launched its ground invasion of Rafah in early May, it has become even more difficult, greatly exacerbating the already dire health situation for Gaza’s 2.2 million strong population.

One of the two main entry points for aid into Gaza—the Rafah crossing with Egypt—has been closed since the Israeli military seized it on 7 May. The other—Karm Abu Salem (Kerem Shalom)—has reopened, but active combat around the crossing and the prioritisation of commercial goods trucks often makes it too difficult for humanitarian workers inside Gaza to access. As a result, the amount of aid getting into Gaza has dropped precipitously: data from the United Nations (UN) show the total number of trucks entering the south fell from 5671 in April to 1656 in May.1 Less than 400 trucks entered between 6 May, the day the ground invasion of Rafah began, and the end of the month1—a pitiful figure considering that Gaza normally requires at least 500 trucks of aid a day to meet people’s most basic needs, owing to the blockade imposed by Israeli authorities since 2007.

Even when aid does make it into the territory, the near constant bombardment and destruction of roads makes distributing essential supplies extremely dangerous, while permission to do so is not always granted. According to the UN Office for the Coordination of Humanitarian Affairs, less than half of all humanitarian assistance missions to northern Gaza were facilitated by the Israeli authorities between 1 June and 18 June; the rest were either refused access, cancelled, or impeded.2 People trying to access aid have also been attacked: at least 112 people were killed while waiting to collect flour in early March after Israeli troops reportedly opened fire on them.3

With very little aid able to reach people, and food either unavailable to buy or unaffordable, Gaza’s hunger crisis is spiralling—and children are bearing the brunt. Nine out of 10 children in the Gaza strip are experiencing severe food poverty and eating just two or fewer food groups a day, according to Unicef.4 Another survey found that 85% of children had gone a whole day without eating at least once in the previous three days before the data were collected.5 The UN has reported that 32 people, mostly children, have already died as a result of malnutrition, and the director of the World Health Organization (WHO), Tedros Adhanom Ghebreyesus, warned earlier this month that “a significant proportion of Gaza’s population is now facing catastrophic hunger and famine-like conditions.”6

For Gaza’s pregnant women—95% of whom face severe food poverty—the lack of food is having a disastrous effect.7 Staff at a hospital in central Gaza, run by ActionAid’s partner Al-Awda, told us that miscarriages were becoming more common as a direct consequence of women being malnourished. Most children are born underweight, and their mothers are struggling to produce milk in order to breastfeed them, doctors at the hospital said.

Gaza is also experiencing a critical shortage of water because of the lack of fuel needed to operate key facilities like desalination plants.8 This is particularly dangerous considering the hotter temperatures that will continue to sweep over the territory in the next few months, turning tents into greenhouses. Two children have already died from the heat since the start of summer, according to the UN Relief and Works Agency for Palestine Refugees (Unrwa).9

Breeding ground for disease

Rapidly worsening living conditions in Gaza and repeated forced displacements are increasing the risks to people’s health. Since the ground invasion forced almost a million people to flee Rafah, almost two thirds of the population of Gaza are now believed to be living in an area measuring one fifth of the strip.10 There is such overcrowding that in one location, Oxfam estimates there is one toilet for every 4000 people.10 Without fuel, sewage treatment facilities and waste collection services are unable to operate, resulting in untreated sewage flowing between tents and rubbish piling up.

Amid such inhumane conditions, diseases are spreading. A rise in infectious diseases such as diarrhea illness and hepatitis A has been reported,11 while Unrwa has warned that cholera may become prevalent.12 At the same time, Gaza’s health system is on its knees, with only 17 hospitals in the entire strip partially functioning, and those that are increasingly overwhelmed with casualties.13 Al-Aqsa hospital in Deir Al-Balah, for example, is currently caring for five times its usual number of patients, many with critical injuries.13

Hospitals are desperately short of medical supplies and in particular fuel, which is vital to keep lifesaving equipment such as oxygen stations running. In Rafah, there are no functioning hospitals at all, leaving around 90 000 people remaining there with no access to healthcare, the WHO reports.14 An estimated 14 000 patients require urgent treatment abroad, but since the Rafah crossing with Egypt was closed last month, medical evacuations have been completely halted.14

It is appalling but inevitable that unless more food, water, medicine, and fuel enters Gaza immediately, more people will die from malnutrition, dehydration, and disease. We are demanding that all land border crossings are opened immediately, aid is permitted to enter Gaza unhindered, and the safe passage of humanitarian relief is guaranteed.

Ultimately, however, there is only so much that aid agencies can do while people are being bombed and killed. A permanent ceasefire is needed now to stop the atrocious death toll from this crisis climbing any higher. Only when the hostilities stop, completely, will it truly be safe and possible to deliver aid on the scale required to support Gaza’s desperate and traumatised population.


  • Competing interests: None declared.

  • Provenance: Commissioned; not peer reviewed.