In July sixty-three people, including more than twenty children, died of starvation in the Gaza Strip, according to Gaza’s Health Ministry. More have been dying this week. Israel is now facing increased international pressure to end the war, and, more immediately, to insure that greater quantities of aid are allowed into the territory. American negotiators have proposed an “all-or-nothing” deal that would end the hostilities if Hamas agrees to disarm and to release the remaining Israeli hostages it took during the October 7, 2023, attack. There are believed to be around twenty still alive, and one of them was shown emaciated and hungry on a recently released video. But Hamas disarmament seems unlikely, and the group has said that it will not even consider doing so without the establishment of a Palestinian state, which Netanyahu opposes. Meanwhile, Netanyahu has shown no real willingness to end the Israeli campaign.

Even before October 7th and the ensuing war, Gazans were largely reliant on international aid; many of them had trouble accessing sufficient amounts of food and clean water. The war has worsened the situation on the ground and resulted in an estimated sixty thousand deaths. In March, Israel decided to end a temporary ceasefire with Hamas, and then cut off aid almost entirely for more than two months. When aid distribution resumed, it was primarily overseen by the Gaza Humanitarian Foundation, a hazily organized nonprofit staffed by American contractors, and set up with a significant degree of Israeli influence. The U.N., which had until then largely controlled aid distribution, was relegated to a minor role. Within weeks, hundreds of Gazans were being killed at or near G.H.F. sites, and desperate civilians were surrounding U.N. trucks in the hopes of getting food. The situation is bleak enough that, even if aid increases rapidly in the coming weeks, deaths from starvation are almost certain to rise.

I recently spoke by phone with Alex de Waal, one of the world’s leading experts on famine, and the director of the World Peace Foundation at Tufts’ Fletcher School of Law and Diplomacy. De Waal has written numerous books about Africa, including several on Sudan, which is also currently beset by war and hunger. During our conversation, which has been edited for length and clarity, we discussed the immediate steps needed to prevent more starvation in Gaza, why returning to the old system of delivering aid is now insufficient, what makes Gaza unique among the catastrophes de Waal has studied, and what the Trump Administration’s attack on foreign aid has done to Sudan.

What do people in Gaza need right now? Does the fact that the situation has become so bad recently change how you answer this question?

You’ve put your finger on it. If you’d asked me this question at the beginning of June, I would have said that the United Nations has an action plan, the resources, the skills, the networks, the distribution plans, et cetera. It’s on standby. All you need to do is give them the green light. You’re not going to solve all the problems because there are a whole lot of fundamental problems to do with basic services: water, sanitation, the state of the health-care system. But you’re going to be able to stabilize the food situation. And so I would say if you did that, you are pretty much in the clear in terms of large-scale starvation.

Today, you have a situation in which it’s impossible to know the true numbers, but there are an increasing number of children—probably in the thousands—that need to be in the hospital because they can’t eat food. They have got to that stage of severe acute malnutrition where their bodies just can’t digest food. And so those kids need to be in intensive care. I was just trying to figure out how many hospital beds there are in Gaza. It looks like there are about eighteen hundred total surviving beds, but the number fluctuates daily for all sorts of reasons. So on top of flooding Gaza with food, which remains essential, there needs to be a massive emergency infusion of intensive-care capability.

So people going through starvation reach a point where food alone is insufficient?

The process of starvation goes through several stages. When you’ve used up all your body fat, which in the case of children isn’t much, you get to the stage where the body starts consuming itself for energy. It starts basically cannibalizing the brain—it’s eating essential organs: heart, kidney, liver, brain, stomach lining. When you get to that stage, you are going to die or you are getting into intensive care to stop you from dying.

I want to take a step back. You alluded to the system that the United Nations had in place before we got to this point—how did that work and why may it be insufficient now?

As of February, during the ceasefire, the U.N. and its partner organizations had about four hundred places where they were giving assistance directly to people. And that would include hot food. There were sometimes about eight hundred and fifty thousand hot meals being served every day, and then a whole lot of nutritional supplements and specialized food for kids.

So it was working at a minimal level, but not enough was getting in. And one of the big problems it was facing was Israel’s very unpredictable permission system. The supplies were unreliable because of the arbitrary and unpredictable conditions and checks imposed by Israel at the border. Some trucks were totally blocked, some were disrupted, and some were able to move. For those that were able to move there had to be some security, and some of them had a lot of hassles either from armed gangs or from Israel, which would, even during the ceasefire period, disrupt them in some way. Then, in early March, you had the complete siege imposed and nothing moved. Israel started military action again. Then, in May, access was permitted again in two forms. One was the Gaza Humanitarian Foundation. The other was limited U.N. activities.

It’s important to note that there were U.N. efforts to get the locals—sometimes clans, sometimes community groups—to protect the aid because the biggest threat was from armed gangs. Actually, the biggest armed gang is a group called the Abu Shabab gang, which is supported by Israel. [Yasser Abu Shabab, the group's leader, has denied that it receives support from Israel.] But there were reasons it was hard to make that work. There was one case on the twenty-sixth of June where a community group organized its own youth, who were armed to protect some aid trucks. A video was taken of this and circulated by members of the Israeli government who said, Look, this is Hamas stealing aid. So that system, which was tried for one day, didn’t continue. That shipment was actually tracked, and it went to a World Food Programme warehouse and was safely distributed. [The I.D.F. did not respond to a request for comment.]

In late May, the G.H.F. became the major provider of aid in Gaza. Hundreds of people have been killed at these sites. There are only four of them, as opposed to the four hundred you were talking about. When you said in your first answer that you can’t just turn the old U.N. system back on again—is that because some children now need more than food, or because of logistics? My sense is that even getting the trucks to these four hundred sites would be chaotic now, because people are so desperate.

I meant primarily the medical stuff, but what you say about the desperation and the breakdown in social order is also true. I really don’t know how one would address that problem. But one thing I would say is that if people have the confidence that more aid is coming that’s much better. One of the reasons why you have problems with U.N. distribution is that no one knows when the next one is coming. If you’re doing this in Somalia, say, you enlist the community and you say, O.K., this is what we’re going to do. This is the amount that’s coming. This is going to go to place A; this is going to go to place B. Everyone sort of knows what’s going on. Then you can enlist the communities to provide protection.