AMMAN, Jordan — As the Israeli military moves to displace the entire population of Gaza City, aid organizations are warning that the military offensive and new Israeli restrictions on aid groups due to be implemented next week will create an even bigger catastrophe in a territory already wracked with famine.
As part of its planned takeover of Gaza City, Israel has told residents to move south or risk being killed. But the International Committee of the Red Cross and others are warning that there is no safety, food, water or shelter in places where Israel is warning them to go.
It calls the evacuation warnings for Gaza's hundreds of thousands of civilians "incomprehensible."
After almost two years of war, aid providers say the health care system has collapsed, even as the number of injured, ill and starving Palestinians continues to rise sharply. The most prominent U.N.-backed global panel on hunger last month declared that conditions in Gaza City and the north had reached the level of famine and that it would spread to central and south Gaza by the end of this month if nothing is done.
This as aid groups say Israel continues to sharply restrict food and medicine going into Gaza.
"Not only is there not enough aid entering but there's more and more people who are wounded and sick and suffering from malnutrition," says Amande Bazerolle, Gaza emergency director for Doctors Without Borders. "Not only that but the number of patients is exponential at the moment."
Israel this week said it was halting all aid going to Gaza City as it escalates attacks there in what it says is its fight against the militant group Hamas.
Bazerolle says adding to the difficulties posed by Israeli restrictions on bringing in medical supplies, Israel's attack in July on a warehouse of the U.N.'s World Health Organization in Gaza further depleted supplies.
"That's put a big stretch on the health system that is already beyond the verge of collapse. We are in the collapse at the moment," she says.
The WHO says it lost most of its stock in the strike, including surgical and trauma supplies, medication, and treatment for malnourished children.
Israel said at the time, without providing evidence, it was responding to a militant threat when it hit the warehouse.
Aid groups say the famine was hastened by Israel's halt to all aid going to the Gaza strip for almost three months this year, starting in March.
When aid resumed again, it sidelined the U.N. with a controversial U.S.-backed Israeli distribution system overseen by armed military contractors.
A medical system "on the brink"
The WHO says 94% of all hospitals in the Gaza Strip have been either damaged or destroyed in Israeli airstrikes. There are no hospitals operating in Rafah, the city near the Egyptian border destroyed by Israel where Israeli officials have said Palestinians forced from Gaza City would be concentrated.
Gaza health authorities say some 160,000 Palestinians, many of them women and children, have been wounded in Israeli attacks since the beginning of the war almost two years ago. They say more than 63,000 have been killed. Israel says nearly 1,200 Israelis and others were killed in the Hamas-led attack in October 2023.
The biggest looming threat is Israel's demand that aid groups operating in Gaza re-register under new rules. The rules include providing personal data on all local and international staff and their families — a requirement most groups have rejected. The move leaves aid organizations that do not comply by Israel's Sept. 9 deadline at risk of being shut down next week.
"Gaza's health system is already on the brink," WHO said in a written response to NPR questions. "If the lifesaving support of NGOs and emergency medical teams is compromised, health care services will be severely reduced and more lives put at risk."
It said the NGOs — nongovernmental organizations — were the "backbone" of health care, keeping hospitals running and providing critical treatment.
Bazerolle, of Doctors Without Borders, says with so many health care workers killed by Israel, organizations are afraid that Israel could use the personal details to target staff.
"We have never been asked this kind of information in any other country," she says, adding they are waiting for an explanation from Israel as to how it will use the data.
"We are hoping that they will understand and will explain," she says. "What is said is that if we are not registered, we have 60 days to end all operations."
The United Nations has also said the new regulations could be used to reject any groups that criticize Israeli policy from providing aid.
Israel accused NGOs that refuse to provide details of staff and their families of possibly being tied to Hamas.
The WHO said Israel in July rejected requests by 29 NGOs it said were not authorized to send humanitarian supplies to Gaza, preventing delivery of lifesaving aid. It said the move had the greatest effect on women, children, the elderly and people with disabilities.
Israel has argued that restrictions are aimed at stopping from Hamas seizing food and medicine. But aid groups and an internal U.S. government assessment have said there is no evidence of widespread looting by the group.
Aid groups say that flooding Gaza with aid is not just the only way to avoid more preventable deaths but would also cut down on aid being sold on the black market as food prices would fall substantially.
"Palestinians in Gaza urgently need a consistent flow of humanitarian aid, but NGOs are being denied authorization by Israel meant to block the impartial distribution of aid by trusted organizations," said Cindy McCain, head of the U.N.'s World Food Program. She called on Israel to allow WFP to restart its 200 food distribution points across the Gaza Strip along with community kitchens and bakeries. WFP, which has operated for six decades, is the world's biggest humanitarian aid organization.
Israel's replacement for the U.N., the Gaza Humanitarian Foundation (GHF), operates just three distribution sites in Gaza, a six-hour walk from major population centers. The group behind the famine report said it found that GHF aid distribution lasted on average just 23 minutes per day.
New customs fees for aid trucks
In Jordan, just a few hours' drive from the border with Gaza and traditionally a major aid corridor, government officials say Israel has made it more difficult to send the aid convoys that are needed.
Jordanian communications minister Mohammad Al-Momani told NPR that Israel had recently begun imposing customs fees of between $300 and $400 per truck for aid transiting through Israel to Gaza.
He said between what seemed to be Israel's arbitrary delays and rejection of some shipments, and attacks by Israeli settlers trying to prevent food from getting to Gaza, what should be a three-hour drive had turned into an up to 36-hour ordeal for some convoys.
"They throw rocks on them and sharp objects under the wheels of the trucks," he said of the settlers' attacks.
Bazerolle said the uncertainty and restrictions had sharply increased the difficulty and the cost of getting aid into Gaza, most of it donated by foreign governments and private donors. She says Israel last month also began requiring NGO aid convoys on the main route to Gaza to use Israeli military escorts to ensure that nothing is added to the shipments after Israeli-compliant inspections in Jordan, a requirement rejected by most groups.
Another aid official with knowledge of logistics speaking on condition of anonymity because they were not authorized to speak publicly confirmed the new requirement.
"Now we all have things stuck in Jordan," says Bazerolle. "So we're thinking, 'OK, we need to send the things from Jordan to somewhere else' because there's no direct flight from Jordan to Israel."
She said one possibility was sending goods waiting in Jordan to the United Arab Emirates and then from Dubai to Israel. "That's how crazy it is at the moment," she says.
She added that Doctors Without Borders is facing a situation where they will need to position three times the amount of stock they normally would because they cannot count on routes being accessible. And she says the heat shortens the shelf life of shipments held up often near borders.
Israel did not respond to requests for comment on the customs charges and the military escorts.
Also at issue is what aid groups say is an opaque list of equipment and supplies that Israel rejects as having the potential to be used by militants.
It often includes almost anything with metal, including tent poles or wheelchairs, according to U.N. officials. Israel refused to provide NPR with a current list of banned items.
Bazerolle says her organization was struggling to bring in an operating table as well as desperately need external fixators for setting bones, autoclaves, sterilization supplies and water desalination equipment.
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