Half of Gazans are experiencing "catastrophic" hunger, with famine projected to hit the north of the territory by May unless there is urgent intervention, a United Nations-backed food security assessment warned Monday.
"People in Gaza are starving to death right now. The speed at which this man-made hunger and malnutrition crisis has ripped through Gaza is terrifying," said Cindy McCain, head of the UN's World Food Programme (WFP).
The Integrated Food Security Phase Classification (IPC) partnership on Monday estimated that 1.1 million people - half the population of Gaza, on UN estimates - were facing catastrophic conditions.
"To have 50 percent of an entire population in catastrophic, near-famine levels, is unprecedented," Beth Bechdol, deputy director general of the UN's Food and Agriculture Organization (FAO), told AFP.
The WFP confirmed this was the "highest number of people ever recorded as facing catastrophic hunger" under the IPC system, originally developed in 2004.
The situation is particularly dire in the north of the besieged Palestinian territory, where the UN says there are about 300,000 people, with aid agencies reporting huge difficulties in gaining access.
"Famine is imminent in the northern governorates and projected to occur anytime between mid-March and May 2024," said the IPC, made up of UN agencies, NGOs and regional bodies.
Martin Griffiths, the UN's humanitarian chief, said there was "no time to lose", calling for Israel to allow unfettered access for aid.
"The international community should hang its head in shame for failing to stop this," he said.
The bloodiest-ever Gaza war broke out after Hamas launched an unprecedented attack on Israel on 7 October that killed 1,200 people according to Israeli figures.
Israel responded with a relentless and indiscriminate bombing campaign and ground offensive in the Palestinian territory that has so far killed at least 31,726 people according to Gaza's health authorities.
The UN has warned for weeks of the risk of famine in Gaza.
The IPC said Monday that while the technical criteria for famine had not yet been met, "all evidence points towards a major acceleration of deaths and malnutrition".
"Waiting for a retrospective famine classification before acting is indefensible," it said.
"Hunger is a slow and painful death," said Hiba Tibi, country director for the CARE international aid group, who reported aid workers seeing children "who can barely talk and walk" for lack of food.
A famine is declared when 20 percent of households face an extreme food shortage - which is the case in Gaza, the UN says.
Other criteria are that one in three children are acutely malnourished, and that at least two in every 10,000 people die every day of starvation or malnutrition.
According to the WFP, "one in three children below the age of two is now acutely malnourished, or 'wasted'", meaning they are dangerously thin.
Arif Husain, WFP's chief economist, warned that meeting the final criteria for declaring a famine - the mortality rate - would "happen any time from now until the end of May".
Bechdol, of the FAO, said that challenges of data collection and analysis meant it was "possible that famine is already occurring in the north".
Gazans are "turning to alternative sources" for food, including animal feed and "inedible items, purely out of desperation", she told AFP.
Donors have turned to deliveries by air or sea, but air and sea missions are not viable alternatives to land deliveries, UN agencies say.
Aid charity Oxfam on Monday accused Israel of continuing to "systematically and deliberately block and undermine" the delivery of aid into Gaza, in violation of international humanitarian law.
WFP said meeting basic food needs would require at least 300 trucks to enter Gaza every day, especially in the north.
The agency has managed to get only nine convoys into the north since January, the latest on Sunday night involving 18 truckloads of food supplies delivered to Gaza City.
"The convoy, the second to use a coordinated route into Gaza City and the north, delivered some 274 metric tons of wheat flour, food parcels and ready-to-eat rations," the WFP said.
"This route needs to be made available for daily convoys and safe access to the north," it said.
The WFP's Husain said: "Our hope is we can still avert a full-fledged famine. But the window is shutting and it is shutting very, very fast."