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People in Gaza are dying of starvation due to a monthslong Israeli blockade and shambolic program to feed Palestinians. The enclave’s health ministry recently reported that 33 people, including 12 children, died of malnutrition in a 48-hour window. The World Food Program states that a third of the population in Gaza is “not eating for multiple days in a row.” Since March 3, when Israel’s defense minister announced that “no humanitarian aid will enter Gaza,” the famine there has gotten significantly worse, while those who do line up for hours for food risk getting shot by the Israel Defense Force. The United Nations claims that 1,000 Palestinians have been killed since May trying to access food from Israeli aid sites.

Earlier this week, 115 international aid groups, including Doctors Without Borders and Save the Children, wrote an open letter warning that Israel’s “total siege” is creating “chaos, starvation, and death.” I spoke with Rachael Cummings, Save the Children’s humanitarian lead in Gaza, about what she and her team are seeing in recent weeks from their headquarters in Deir al-Balah, a small city in central Gaza that was attacked by Israeli forces last week.

**From what you’ve seen in recent weeks, how is the famine getting worse?**This week is significant. It feels like we’ve reached a tipping point in Gaza. In Deir al-Balah, there has been no food in the markets. There’s literally nothing in the market. Normally they’re very basic market stalls, people crowding around, vegetables — not at large scale, but this week there was nothing. Visibly, everybody is thin.

We run child-protection education services in communities, which are basically tents in the communities. And we’ve had our staff fainting. It’s very, very hot here, but they’re fainting because they haven’t eaten for days actually. There are over 220 Palestinians that work for Save the Children in Gaza. There are only five internationals here with me. Our team is Palestinian.

With my team who work in the office, I’ve been watching for weeks, if not months, the women getting thinner and thinner. After the weekend on Sunday when people came back to work, it was a stark difference. They haven’t eaten.

**How has the situation deteriorated in recent weeks?**People went from three meals a day to two meals a day. A month ago, they started to go from two meals a day to one meal a day. And now many people are not eating every day. This is the tipping point and these coping mechanisms that people employ in their households and their families are generally to protect children. So women will always eat last, which is why you see women who become thin quicker than you see men. But children are protected in that environment. Now we’re seeing an increased rate of children coming to our clinics and our nutrition centers who are malnourished. I’ve seen children rummaging through rubbish. And there’s banks of rubbish in Gaza because there’s no real waste management. They are looking for food, looking for something to eat.

That’s got to be the alarm bell because adults are already malnourished, children are now malnourished, and we see it. We’re also seeing a high proportion of pregnant women and breastfeeding women who are now malnourished. And that’s really, really concerning.

**What about water?**The majority of people are relying on water trucking. The availability of water coming is much more scarce. Water, distributing water, is very reliant on fuel, and fuel is very restricted in terms of how much is coming into Gaza. The result is that more and more people have less and less water. From our data, nearly 40 percent of all non-trauma illness is related to diarrhea. That’s related to the poor quality of the water. And we also see a very high rate of skin disease, which is related to water. The quantity and quality of water is very, very poor.

How have things changed since the American-led **Gaza Humanitarian Foundation took over aid distribution in May?**Nearly 1,000 people have been killed in and around the vicinity of the GHF. We’ve lost count of the number of mass-casualty incidents. That has been because of the GHF, thousands of people have been injured, taken to the hospitals in and around. It’s important to remember that three of the GHF are in Rafah, which is a militarized zone.

Before the GHF, there were over 400 food-distribution points in Gaza. They’re now operating with three or four. It is wholly inadequate and extremely dangerous. There’s nothing safe or dignified about the GHF, and it’s literally killing people. And of course, because of the availability of food in the market, this is the impossible decision people have to make. They stay at home with their children who are crying because they haven’t eaten or they go to the GHF and literally risk their lives for a bag of pasta.

**Is this or the blockade the primary reason for the famine worsening?**The GHF is a distraction. The reason for the state of the nutritional status for people in Gaza is because there isn’t enough food to feed over 2 million people. It’s the availability of food that’s driving the starvation of children. That’s been sustained since the blockade was put on Gaza.

There were 600 trucks a day entering Gaza, both humanitarian and commercial, and that was adequate to meet the basic needs in Gaza. That stopped on March 2 and since mid-May, it’s been a drip feed of humanitarian supplies, including flour, food, and other essential life-sustaining supplies.

**What do you see or hear of parents telling children why this is happening?**What we’ve understood, having spoken to thousands of caregivers, mainly mothers, is that they are so focused on survival for their children. They’re focused on collecting water, firewood, food, that those moments of connection are secondary.

At our facilities, we provide them with — the language we use is a safe space, — but there is nowhere safe in Gaza. But that space to be one-to-one with their child or two-to-one with their children, and to reconnect and to share emotions and experiences and to hug, to physically hug is one of the exercises we do. And children and parents say, ‘We don’t do this at home.’ It has a big impact. Parents are terrified that they will lose their children. Parents have lost their children, children have lost their siblings. And it’s desperate. It’s desperate. What children are sharing with us now and what children have witnessed should never be witnessed by any child.

**What will happen if this situation continues to deteriorate?**Now that this tipping point has been reached, people will start to die very quickly. We’re already seeing a doubling of the number of children in our clinics. We’re seeing that also with pregnant and breastfeeding women. There is no food for people.

At Save Our Children, we have around five or six weeks left of supplies, essential supplies.

We need a definitive cease-fire. We need member states to use all the legal tricks that they have in their toolbox to create the definitive cease-fire that’s required. We need to stop bombing children. We need humanitarian supplies to enter, at scale.

**Sorry, what does “quickly” mean in this context?**Weeks. This is my opinion.

**Is the word “exponential” appropriate to describe how this will happen?**Yes, it’s correct. We will see an exponential rise.

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