People in Gaza are starving to death. 5 things to know about efforts to feed them

Airdrops of food, a new sea route to deliver aid by ship, and trucks entering through two border crossings haven't been enough to stave off starvation across Gaza more than five months into the war there.

Hundreds of thousands of Palestinians in Gaza face "imminent" famine that may already have struck the north, the world's leading authority on hunger said Monday. More than two dozen children have died of malnourishment, Gaza's Ministry of Health says.

The Integrated Food Security Phase Classification (IPC) Famine Review Committee says 210,000 people in northern Gaza are at "catastrophe," its most severe assessment. The IPC committee adds that the entire population of Gaza "is facing high levels of acute food insecurity."

To reach people who most need food, community leaders — a network of traditional family clans — are being recruited to help distribute food inside Gaza and fill a growing security void.

The nascent plan could help families in need. It could also lay the ground for a new security framework in Gaza when the war is over, tying the struggle to regulate aid to the greater battle over who should control the territory.

Here are five things to know.

1. The U.N. is looking to local groups to distribute aid in Gaza

This past weekend, urgently needed flour reached some starving families in northern Gaza.

Social media videos by people in Gaza City showed thousands of people waiting at a school run by UNRWA, the U.N. agency that delivers aid to Palestinians, where large sacks of flour weighing 5 kilograms (11 pounds) each were distributed.

This was in sharp contrast to the chaotic scenes from past weeks of people rushing toward crates of food being dropped by the U.S. and other countries by parachute, landing in the sea and haphazardly over Gaza.

In the deadliest aid incident, Gaza's Ministry of Health says at least 115 people were killed trying to get food off trucks in Gaza City last month.

Additionally, the killing of Gaza police by Israel's military has complicated efforts by aid agencies to securely distribute food.

The United Nations' humanitarian coordinator for Gaza, Jamie McGoldrick, describes a complex process that involves working with "community leaders" and nongovernmental organizations (NGOs), as well as coordinating with the Israeli military and Gaza's police on aid routes and distribution.

"We are working with the community leaders. We're working with local NGOs and local groups to set up distribution systems so that we can make sure that we reach all the families concerned," McGoldrick told reporters on Monday.

Several media reports, including by the Turkish Anadolu news agency and the United Arab Emirates' The National, said that local family tribes helped the U.N. distribute the aid in northern Gaza over the weekend.

A group called the Home Front in Gaza issued a statement saying a convoy of 12 trucks of aid reached northern Gaza on Sunday with assistance from "popular committees." Such groups of armed men have organized in southern Gaza in recent weeks to protect trucks loaded with supplies. The group called on people to continue cooperating with popular committees to ensure aid reaches people in the north.

Days earlier, McGoldrick spoke with NPR and said the U.N. was reaching out to "mukhtars," or leaders of prominent families and clans in Gaza, to help distribute food fairly in their territories of influence in northern Gaza.

"We hope that works, along with the support from police," he said. "We want to make sure we can get closer to people in real need."

But he also made one thing clear: "We are not having arms near us anywhere. ... We are doing this through the communities. If the communities arm themselves, we'll no longer work with them."

2. Israel plays a central role in the Gaza food crisis

Aid agencies say Israel must open more border crossings and let more aid in.

"This is an entirely man-made disaster, and the [IPC] report makes clear that it can be halted," U.N. Secretary-General António Guterres said, before calling on Israel to allow unrestricted access of humanitarian goods throughout Gaza.

Israel insists it's allowing "extensive humanitarian aid" into Gaza after stringent security screenings. It accuses Hamas of siphoning off aid for its fighters and says disruptions to aid are ultimately a consequence of the war sparked by Hamas' attack on Israel on Oct. 7.

But even the rigidly circumscribed transfer of aid is unpopular among Israelis. A poll conducted in mid-February found that 68% of Jewish Israelis oppose the transfer of humanitarian aid to Gaza. Israeli demonstrators frequently protest at border crossings and disrupt the flow of aid trucks into Gaza, opposing the entry of aid into Gaza while Hamas continues to hold Israeli hostages.

3. Palestinian clans in Gaza reject cooperation with Israel

Right now, aid is the most valuable currency in Gaza, but traditional family clan leaders are in a tough spot: They do not want to be seen as taking part in a plan to replace Hamas.

Israeli Prime Minister Benjamin Netanyahu has published a "Day After Hamas" plan that calls for "local figures with administrative experience" to run Gaza's civilian affairs and to maintain law and order. It is widely seen as an effort to recruit prominent family clans in Gaza that can take responsibility, preventing the return of a unified Palestinian leadership in the West Bank and Gaza.

The Biden administration has a different plan for Gaza: to replace Hamas with the Western-backed Palestinian Authority, which governs parts of the West Bank. Palestinian Authority officials say there are proposals to train new security forces to replace Hamas after the war.

While prominent families and clans have had conflicts with Hamas over the years, and some are armed and known to be involved in drug trafficking and smuggling, many refuse to collaborate with Israel.

The chairman of the Supreme Tribal Committee in Gaza, Abu Salman Al-Moghani, who's now displaced from Gaza City to the southern area of Al-Mawasi, told NPR that Israel has been trying to recruit the "mukhtars" to take over some governing responsibilities.

"There was some communication, but there has been a definitive no," says Al-Moghani, who's also a mukhtar. "Clans have certain roles of reconciliation, maintaining good social ties and protecting members of the clans."

He says tribes and clans have no desire to replace any entity on the ground, calling it "a red line."

"Our job is not to govern nor to administer the state," he says. "We are here to help our people through these harsh conditions."

This stance was affirmed in a formal statement recently issued by the heads of Palestinian tribes, clans and families in Gaza, saying they are not an alternative to any Palestinian political system. The statement stressed "national unity" as a priority and denounced Israel as an occupier.

McGoldrick says the U.N. is not seeking to replace local governing powers and isn't "replacing anybody with anybody."

"That's not our job. We're not involved in that," McGoldrick told NPR.

4. Efforts are complicated by targeting and threats

Hamas issued its own statement applauding the stance taken by clans and families in Gaza.

In a sign of concern that some may still cooperate with Israel, Hamas also warned firmly against collaborating with Israel.

A Hamas-affiliated website, Al-Majd, warned that the group would strike with an "iron fist" anyone who attempted to work with Israel, saying communicating with Israel in its plans to work with local clans and mukhtars will not be tolerated.

The Israeli newspaper Yedioth Ahronoth reported that figures from two prominent clans in northern Gaza were killed by Hamas.

Hamas denied that, saying the claim aims to destabilize Gaza's "internal front and cause chaos."

Meanwhile, Israel continues to kill what it deems to be Hamas militant targets throughout Gaza, including the local police.

Last week, five people were killed in the southern city of Rafah in an Israeli airstrike on an aid distribution compound containing diapers and baby formula. The target was a police officer guarding the aid.

Israel says he was a member of Hamas' military wing, which it accuses of siphoning aid for Hamas operatives.

Hamas says a gathering of tribal groups involved in securing and distributing aid in northern Gaza, known as the Popular Protection Committees, was targeted in an Israeli airstrike in Gaza City Tuesday evening at a main roundabout where aid convoys deliver food, killing 23 people.

NPR has reached out to the Israeli military for comment, which did not immediately respond.

5. People are in dire need of more aid

With agricultural production decimated by the war, Gaza's population of 2.2 million people relies entirely on humanitarian assistance allowed in by Israel.

The U.N. World Food Programme says that to address the basic food needs of people in Gaza, at least 300 trucks' worth of aid must enter and be distributed daily.

The WFP says only nine convoys of aid, the latest with 18 trucks, have managed to make it to northern Gaza since the start of the year due to Israeli restrictions and looting by hungry crowds.

One out of every three children under age 2 in northern Gaza suffers from acute malnutrition, according to UNICEF, the U.N. Children's Fund. In the southern border city of Rafah, where most people have been displaced, child malnutrition rates have spiked to 10%, according to UNICEF.

"We have to get more food in there and prevent desperation from creating insecurity and self-distribution and looting," the U.N.'s McGoldrick says.

NPR's Aya Batrawy reported from Dubai, United Arab Emirates, and Daniel Estrin reported from Tel Aviv, Israel. NPR's Anas Baba in Rafah, Gaza Strip; Omar El Qattaa in Gaza City; and Abu Bakr Bashir in London contributed reporting.

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