It has been more than 100 days since Israel launched its war on Gaza, and conditions have grown even more dire in the Gaza Strip. Since writing my first article on this topic for The Nation in October, warning about the brewing public health crisis, more than 24,000 Palestinians have been killed, of whom more than 10,000 were children. That’s about 250 Palestinians a day, according to Oxfam. According to the World Food Programme, Palestinians in Gaza are at risk of famine; four out of five people in the world who are facing extreme hunger are in Gaza. Meanwhile, more than 1,000 children have had limbs amputated—at an average of more than 10 children a day—and many of them without anesthesia, according to UNICEF. Out of 36 hospitals that are in Gaza, only 15 are operational and only three are not damaged. Those that are running are operating at a capacity of 200 percent. The WHO says 70 percent of healthcare workers have left. These statistics alone should stop the world in its tracks, but the killing continues.

As the death toll mounts, the urgent need for humanitarian aid has become a talking point that supposedly everyone can agree on. The Biden administration, for instance, continues to reject calls for an absolute and indefinite cease-fire, but does, at least rhetorically, agrees that more aid needs to get to Gazans. After tense negotiations, the United States abstained from, rather than vetoed, a Security Council resolution demanding safe and immediate delivery of aid and to accelerate aid deliveries. So why isn’t aid getting through—why are Palestinians still starving? That is because the delivery of aid cannot be separated from the military assault and occupation. The conditions of the latter make the former impossible.

Let’s start at the Rafah crossing, where Gaza shares a border with Egypt. Two US senators, Chris Van Hollen and Jeff Merkley, recently returned from the crossing and issued a statement in which they reported that aid workers are being restricted from doing their jobs and that the Netanyahu government has “erected a variety of barriers that are preventing the delivery of sufficient life-sustaining goods.” Van Hollen expanded on what he saw in an interview with The New Yorker, saying that trucks filled with things like medical kits, water filters, and solar-powered desalinization units, among other things, would be rejected by Israeli authorities for arbitrary reasons like “having metal poles.” Van Hollen added that if one item on the truck is rejected, the entire truck has to return the beginning of the inspection process. This process, which can take up to 20 days, requires going through one or potentially two Israeli border inspection facilities before crossing at Rafah. Both inspection facilities have limited hours. The trucks are loaded and unloaded multiple times. The drivers transporting the goods must be “sterile” after the inspection, not coming into contact with anybody. One driver was turned away because he got a cup of coffee after an inspection. Today, only 100–200 trucks per day are entering Gaza; that may sound significant, but that is actually a decrease from the 500 before the war.

To Palestinians and anyone paying attention to Gaza in recent years, the current restrictions on aid do not come as a surprise, in fact, they are the extreme extension of the siege that Gaza has been under for years. Israel has imposed a total blockade and restricted the movement of goods and people in and out of Gaza for the past 17 years. Many of the goods that cannot come in at all are classified as dual use, using the pretext of preventing the manufacturing of weapons; key construction materials are prevented from entering the strip—affecting health, education, and sanitation projects, according to UNICEF. In 2012, it was revealed that Israeli officials had calculated the minimum amount of calories Gazans needed to avoid malnutrition when determining just how many trucks to allow into the strip. The restriction of goods also has an impact on Gaza’s economy as locally produced goods cannot be easily exported, resulting in Gaza’s having high rates of poverty and unemployment. The blockade even impacts people’s ability to access medical care, as Palestinians need permission from Israel to leave Gaza to access it.

According to the World Health Organization, since 2007, 30 percent of people who applied to leave Gaza for medical care were denied, amounting to about 70,000 people. Looking at the period between 2015 and 2017, a study found that cancer patients who were denied or delayed permits for radiotherapy or chemotherapy were 1.5 times less likely to survive over the next few months and years. The WHO report also cites the siege as a factor in limiting development and maintenance of Gaza’s healthcare infrastructure—in 2021, for instance, 69 percent of requests for spare parts for X-ray and CT machines were denied. The WHO concluded the report by calling for the blockade on Gaza to end. 

The rationale given by Israeli authorities for restricting basic humanitarian aid and equipment is that it will ultimately be diverted to Hamas. This is an accusation that is rejected even by US officials, albeit privately, saying off the record that Israel has not pointed to any evidence of these claims. What we do know is that as limited food aid arrives into Gaza, scenes of mayhem play out as people desperately try to get food for their families. As the trucks roll through the streets of Gaza, people climb on top of them, desperate to get any food they can get for their families. It has also been alleged that people have been shot while waiting for food deliveries and UN warehouses have been bombed.

There is little infrastructure and few aid workers in place to facilitate the delivery and allocation of aid, in part because Israel has killed many aid workers. One hundred and fifty-two UN staff members have been killed, the “the largest single loss of life in the history of our organization,” Secretary-General António Guterres tweeted. Other humanitarian groups like Doctors Without Borders have also suffered losses. Conflict conditions also make delivery of aid difficult to people who are out of reach in northern Gaza, which aid agencies struggle to deliver to. Images of desperate people trying to get food is used to further the perception some have; that aid is reaching the Palestinians, but it is being diverted for nefarious purposes. A spokesperson for the Israeli government agency Coordination of Government Activities in the Territories, responsible for the logistics of providing aid to Gaza from the Israeli side, said that people “should not forget that it is in the DNA of the Arab and Gazan population to ‘hoard.’”

The flow of aid cannot be divorced from a violent military occupation, when aid enters an area only following the whims of said military, who enforces these rules with the threat of its weapons. You can’t call for the flow of desperately needed aid without a cease-fire; you can’t increase the aid to sufficient levels to address the crisis unless the siege is lifted.

Many Democratic members of Congress seem to think otherwise. While Senators Bernie Sanders and Elizabeth Warren have called for an increase an aid and an end to hostilities, both refuse to say “cease-fire.” Senator Van Hollen has called for one since returning from Rafah; he joins Senators Merkely, Dick Durbin, and Peter Welch in doing so. Throughout the war, Democrats have urged the need for more aid, without supporting a cessation of military activity. This position runs counter to that of the United Nations.

Secretary General António Guterres, like other UN officials, has called for a cease-fire, saying that it is the only way to begin to meet the needs of the people of Gaza. Guterres explained that this is not merely about trucks entering the strip but also the ongoing military campaign’s creating dangerous logistical difficulties. An aid operation requires four things, he added: “security, staff who can work in safety, logistical capacity, and the resumption of commercial activity.” None of these are found in Gaza.

These sentiments were echoed by the director general of the World Health Organization, Dr. Tedros Adhanom Ghebreyesus, who said that while the UN resolution “appeared to provide hope of an improvement in humanitarian aid distribution within Gaza,” WHO staff have not reported an improvement. “What we urgently need, right now, is a cease-fire to spare civilians from further violence,” he said.

Now, the International Court of Justice has issued preliminary orders in the case South Africa brought against Israel on the charge of genocide. Among the other orders, including one to comply with Article 2 of the genocide convention, the court ordered Israel to immediately let in more aid to address “the adverse conditions of life faced by Palestinians in the Gaza Strip.” A day later, the US and 8 other countries announced they would suspend aid to UNRWA, the biggest UN agency working in Gaza, because of allegations made by Israel that 12 employees were involved in the Oct 7^th attacks. This move means that even the stated commitment to aid is on shaky ground. The Government of Norway and others have pointed out how disastrous this would be.

Yet it is becoming clear, that for some, including in my field of public health, no amount of Palestinian death matters enough to call for a cease-fire. What these people may not realize is that their callous indifference undermines global health cooperation. Already, the pandemic strained such ties, as when the Global South had to take a place in back of the line waiting for Covid vaccines and distribution was far from equal. The blatant disregard for Palestinians’ basic human rights has undermined this even further. As employees of global health organizations like the WHO do the important work of tackling global health emergencies and crises remain committed to their mission, they find themselves constrained by the political whims of governments.

As global health challenges increase, from pandemics to climate change, now is the time to strengthen global health cooperation under a shared commitment to human rights, not undermine it—and right now, as a starting point—that looks like calling for a cease-fire, a release of all those held in captivity, and an end to the siege. Calling for more aid may seem like humane thing to do, but the conditions on the ground show us this call is essentially meaningless. Freedom for Palestinians will take us further toward a world of peace and good health for us all.