Famine is imminent and likely to occur by May in northern Gaza and could spread across the enclave by July, a UN-backed report said on Monday, after more than five months of war which have shattered the Palestinian territory and cut off supplies.
Malnutrition and food insecurity have probably exceeded famine levels in Gaza's north, and hunger-linked death rates were likely to do so soon, the report by the Integrated Food Security Phase Classification (IPC) said.
The assessment - a scale used by UN agencies, regional bodies and aid groups that sets the global standard on measuring food crises - comes amid global pressure on Israel to allow more humanitarian aid into the enclave of 2.3 million people.
Some 300,000 have been cut off by fighting in the north.
The European Union accused Israel on Monday of provoking famine and using starvation as a weapon of war - claims that Israel rejects, saying it does not target civilians and is only interested in eliminating the Hamas movement.
The IPC uses a complex set of technical criteria. Its most extreme warning is Phase 5, which has two levels, catastrophe and famine.
Famine is assessed as at least 20% of the population suffering extreme food shortages, with one in three children acutely malnourished and two people out of every 10,000 dying daily from starvation or from malnutrition and disease.
In northern Gaza, "the upward trend in non-trauma mortality is also expected to accelerate, resulting in all famine thresholds likely to be passed imminently," the IPC said.
"The window is shutting, and it is shutting very, very fast," Arif Husain, chief economist of the World Food Program, told Reuters.
The study said the number of people projected to experience "catastrophic hunger" across the besieged enclave between now and mid-July had nearly doubled to more than 1.1 million, or about half the population, since the IPC last reported in December, when there was already record hunger.
Under a worst case scenario, central and southern Gaza also face a risk of famine by July, the IPC said.
Skipping meals
Famine has been declared just twice in the past 13 years: in parts of Somalia in 2011 and in parts of South Sudan in 2017.
Some humanitarians voice frustration with the criteria, since assessing famine thresholds can be particularly difficult in a war zone due to a lack of access and reliable data.
Gaza health authorities have reported children dying of malnutrition or dehydration, but UN officials say the health system has basically collapsed and the situation is hard to monitor.
"It's impossible to find the data to meet their criteria in northern Gaza as people aren't dying in hospital so it's unrecorded," said one aid worker who asked not to be named.
The IPC said that because of a lack of aid, almost all households were skipping meals every day and adults were reducing their meals so children could eat.
In northern Gaza, in nearly two thirds of households, people went entire days and nights without eating at least 10 times in the last 30 days, it added. In southern areas, that applied to one third of the households.
The IPC analysis said famine could still be avoided if Israel and Hamas stop fighting and aid organizations gain increased access.
Israel has said it plans to assault Rafah, the southern Gaza city bordering Egypt, to root out Hamas fighters, but it is also involved in mediation talks about a possible truce.
"We must act and we must act now," said Husain. "When famine happens, people have already starved, children are already wasted, and many, many, many lives are already lost."
