At the end of April, David Satterfield, the Biden Administration’s envoy for humanitarian aid in the Middle East, announced that the flow of food and medicine into Gaza had been improving. Satterfield’s comments came after months of requests from President Biden—who has been supporting the Israeli government militarily and diplomatically—for Israel to allow additional aid into the territory. More than thirty-four thousand Gazans have already been killed in Israel’s military campaign, and the enclave remains at serious risk of famine—a risk that Satterfield acknowledged. (Several weeks ago, Save the Children, a humanitarian group, reported that twenty-seven Gazan children have died from starvation and health conditions related to malnourishment.) The situation is especially dire in the northern part of Gaza, where around three hundred thousand people still live. The majority of the population is now in the south.
Almost eight months into the war, I wanted to understand how much aid is actually reaching Gazans. I recently spoke by phone with Arif Husain, the chief economist of the United Nations World Food Programme, which both collects data on where people are in need of food and helps to provide food to needy populations. Our conversation, edited for length and clarity, is below.
How much aid is currently reaching Gaza right now, as we begin May?
For me, the most important data in terms of accuracy is our own data. I know that in February we were able to bring only about twenty-seven trucks into northern Gaza. And then, in March, we were able to bring forty-seven trucks into northern Gaza. In April, we saw the real improvement. By April 29th, about a hundred and seventy-two trucks that were able to come in, enough to feed about five hundred and sixteen thousand people. Ninety-one of those trucks came through the Erez Crossing, and another eighty-one were able to reach the north from inside Gaza, which is crucial. A single truck, on average, carries about fifteen tons of basic food commodities, which is enough to feed about three thousand people for ten days. This means that, for northern Gaza alone, we need three hundred trucks with food per month.
It is definitely true that there has been an uptick in terms of what is coming in. Over all, the World Food Programme sent nine hundred and ninety-one trucks into Gaza through April 29th, compared with eight hundred and sixty-six trucks in March, and seven hundred and four in February. Is it enough? No. We need a lot more. Think about all the displacement, lack of shelter, think about congestion, think about the lack of food, lack of water, lack of medicine, all of that, and what it means for these people whose immune systems are extremely weak. They’re highly susceptible to disease outbreaks. We need to make sure that they get the nourishment they need. And that cannot be for one day or two days or for a week. That has to be every single day for the foreseeable future. And if we can do that, we can essentially minimize the pain. We can reverse famine.
The U.N. has said that more trucks are getting in, but the average was a hundred and sixty per day in March and it rose to more than a hundred and ninety per day in April. That’s throughout the whole territory. Those numbers are still pretty low considering that experts say at least five hundred trucks need to come in per day. Correct?
Yeah. It is low. All we have is an uptick. It is something positive. But we are not at a level by any means where we can say, O.K., this is great, this is enough.
I know that there’s been some talk about more aid being brought in by boat. The United Arab Emirates has been trying to bring in aid that way, and the Biden Administration is in the process of constructing a floating pier. Has there been any success with non-truck routes?
Well, look, at the end of the day, what is important is to get enough nourishment, enough sustenance, into the Gaza Strip. The best way to do that is through roads and through the Port of Ashdod, where it can be inspected before going in through Kerem Shalom crossing. That’s what worked before. Whatever is arriving on top of that is obviously welcome. If it comes through the pier, it’s welcome; if it comes through air drops, it’s welcome. But, at the end of the day, the most cost-effective, fastest way is through roads and ports.
Do you understand why there’s been an uptick in your food deliveries, however insufficient?
All I can say is that there is a definite change in terms of what is coming into the Gaza Strip. Now, for what reason? I really don’t care. I’m just happy that it is moving. From Day One we were basically saying that if you’re going to stop this famine, three things must happen. One, enough food, water, medicine, and essential commodities need to come into the Gaza Strip. Two, people who are bringing in this stuff, such as humanitarian workers, people from the commercial sector, they must feel safe. Three, people who are receiving this stuff must also be safe to receive it.
Right. There has been a lot of concern that—because of lawlessness in Gaza, because aid workers have been killed, as we saw with the I.D.F. strike on the World Central Kitchen convoy—some of the aid that got in was not able to be delivered. Do you have some confidence that your trucks are reaching the intended recipients?
I think they are reaching their intended recipients. And we are collecting data. So what we are seeing is that prices of commodities in the markets are coming down. They’ve come down in the south but also in the north. We are seeing that there is an improvement in people’s food consumption. Does that mean that there is no risk of famine? No—there is absolutely a risk of famine. Why? Because the population is at such an elevated risk. In March, seventy per cent of the population in northern Gaza was in Phase 5 of the Integrated Food Security Phase Classification (I.P.C.).
What do those terms mean?
When we try to determine whether there is famine or a risk of famine in a particular place, we are essentially analyzing three things. First, at least twenty per cent of the population must be experiencing extreme hunger—essentially, starving. At least thirty per cent of the children must be wasted, meaning they’re too thin for their height. And the daily mortality rate, meaning death rate, must be double the global benchmark: for adults, that means from one to two per ten thousand, and, for children, from two to four per ten thousand. When these three conditions come together in one place, we call it a famine.
In Gaza’s case, especially in the north, the first condition was met. Why? Because seventy per cent of the population was starving. The second condition was met. Why? Because more than thirty per cent of the children were wasted. And then the third condition was not verified. Why? Because it’s kind of a lag condition and the mechanisms are not there to really verify if non-trauma mortality has doubled or not. This is why we said that, in northern Gaza, famine was imminent by mid-May.
The World Food Programme, in conjunction with other groups, released a report in March projecting that famine was imminent for the three hundred thousand Palestinian civilians in northern Gaza.
At the time the report was done, not enough nourishment was coming in, and the assumption was that if things continued in the same way, a famine would occur by mid-May. Now, for one reason or another, aid has picked up—not enough, but it has still picked up—which means that people are starting to get more nourishment than they were getting before. In the month of April, we have seen the number of people who are experiencing extreme levels of food insecurity, extreme hunger, start to drop. We are planning on compiling another report at the end of May to see what the data is telling us.
The report was not conducted by one agency. Eighteen different entities, both U.N. and non-U.N., came together to produce it. And then analysts looked at all the data that was available for the Gaza Strip, and, on the basis of that data, they came up with certain conclusions in terms of imminent famine. After that, there was something that’s called the Famine Review Committee, which is composed essentially of five experts in food security, nutrition, disease, and mortality who are brought in to look at the data and the methods. And their conclusion, obviously, was that in the north there would be an imminent famine if things remained the way they were.
I’ve read some stories indicating that, especially for children, the long-term health consequences of starvation are really serious. And again, as you said, food aid needs to be consistent for a long period of time to get them out of the woods.
For a child under the age of two, or from conception to the second birthday—those are the most important days for health. If during that time the mother doesn’t get enough nourishment, and if during that time the child doesn’t get enough nourishment, chances are that they will never reach their full potential in life. So is this going to have an impact? Of course it is going to have an impact. There’s also an impact on the older or slightly older kids who are experiencing all of this trauma. Obviously that is going to have an impact as well.
Right now, we are just talking about saving lives, but tomorrow there are going to be many, many other issues that are going to come out of this for the people who have experienced it. I was just doing the numbers, and injured people and those who have died in the conflict make up about five per cent of the population now.
You seem to be saying that the biggest fears in terms of food are focussed on northern Gaza. Can you explain a little bit why that is and what the difference is between the north of Gaza and the rest of Gaza?
After October 7th, when the war started, the focus was on the north. The big displacements were out of the north, with people going toward the south, basically. But there were about three hundred thousand people who were stuck in the north. And they have remained stuck for a very long time, more than two hundred days. For a long time, they were not getting anything in terms of either commercial supplies or humanitarian aid. Why? Because it was a war zone, and difficult to get in.
Many of the people who were displaced moved down, went closer to Egypt, into Rafah. That’s why you have about 1.4 million people in Rafah, which covers about twenty per cent of the area of the whole Gaza Strip. This was also closest to the crossings, whether through Egypt or through Jordan. So there was more supply in Rafah than up north. The next big problem is what happens if Rafah is attacked. It will have two consequences. One, the 1.4 million people who are already exhausted, living in such congested space, will be hugely vulnerable. They will have to be displaced elsewhere. And then, also, remember that Rafah is where our supply chains are—from Jordan and from Egypt—and that would create an additional disruption for the distribution mechanism. I just hope that they find another way and that these people don’t have to experience one more catastrophe.
What’s the situation in the rest of Gaza? If we turn away from the north, how worried are you about issues like hunger and starvation?
Issues of hunger and starvation are everywhere, but they are worse in the north. If you’re in the south, you’re doing a little bit better than people in the north, but if you’re in the middle, you likely don’t have enough food. It’s kind of like on a gradient scale, right? The I.P.C. famine numbers clarify this. In the north, seventy per cent of the population was in I.P.C. Phase 5, meaning catastrophe, and thirty per cent was in emergency, or I.P.C. Phase 4. When you look at the middle, meaning Deir al-Balah and Khan Younis, half the population was in I.P.C. Phase 5 and half was in I.P.C. Phase 4. And, when you look at Rafah, forty-five per cent of the population was in I.P.C. Phase 5, thirty-five per cent was in I.P.C. Phase 4, and twenty per cent was in I.P.C. Phase 3, which is in crisis. But again, with a big incursion, people in the south will have to move out and go away, toward the middle.
You said that one of the ways you determine whether or not there’s a famine is by looking at how many children are dying and whether that’s more than the normal rate. I’ve had trouble looking into how many children have already died from famine or starvation in Gaza in the past few months, and you said you couldn’t verify the rate. Do you have any sense of how many children have already been lost?
Look, I mean, I don’t have a number. What I know is that we do these surveys, and we do about five hundred households per month. And one of the questions is whether the households have lost a child because of starvation. All I can say is that we have seen an uptick in that number, but I don’t have an exact figure that I can use to say exactly how many children have died because of hunger-related causes. This is one of the things that’s missing in the analysis. But we are seeing that the percentage of households that are reporting this has been increasing during the past few months. ♦
