One hundred twenty-seven people, 85 of them children, have died from hunger or malnutrition as a result of Israel’s siege of Gaza, according to Gaza’s Health Ministry.

Israeli Prime Minister Benjamin Netanyahu blocked all aid to Gaza in March, claiming that it was to pressure Hamas into accepting a ceasefire that Israel broke unilaterally later that month.

This week, the Israeli government has blamed the United Nations for the situation, even accusing its aid agency of working with Hamas to restrict food from getting to people.

This was not the first time Israel blocked aid from entering Gaza. In March 2024, Israel stopped UN aid convoys from reaching northern Gaza as it attempted to starve the population there into fleeing.

In September, 15 international aid organisations said Israel was blocking 83 percent of Gaza’s aid.

In both instances, Israel denied blocking aid, blaming either UN inefficiency or Hamas for aid not reaching people in areas it has claimed to control for much of the war.

Here’s what we know.

So is there no aid system in Gaza now?

After receiving much criticism over the increased threat of famine that its siege had inflicted on Gaza, Israel, along with its US ally, backed the creation of the GHF in May.

The GHF was intended to replace the UN and international aid agencies, which have operated some 400 aid distribution points across Gaza, with four erratically operated distribution points in Gaza’s centre and south.

Since May, the Israeli military and private contractors, understood to be American, have killed more than 1,000 people trying to access food at GHF distribution points.

There are still some limited UN aid distribution operations, but they are so severely restricted that their effect cannot be felt.

Does Israel accept that there’s starvation in Gaza?

It does not.

On Friday, Israel’s Coordinator of Government Activities in the Territories (COGAT), which is responsible for coordinating aid into Gaza, contradicted the claims of numerous aid agencies, asserting that “there is no famine in the Gaza Strip”.

However, it said, there were “pockets” across Gaza where people had “issues of access to food”.

So Israel claims that there’s enough aid being distributed?

Not so much.

Israel claims that shortfalls are occurring because much of the aid lies “rotting in the sun” because the UN has not distributed it.

Israel’s military radio, Kan, recently reported that the Israeli army has burned or buried some 1,000 trucks’ worth of aid that it deemed spoiled or expired.

David Mencer, a spokesperson for Netanyahu’s office, told the BBC on Friday that the UN in Gaza is a “billion-dollar racket” and accused the UN of working with Hamas to “restrict … aid to its own people”.

Mercer did not provide any reason as to why the UN might do that, or any evidence to back his claims.

Is the UN working with Hamas?

Not according to the UN itself.

On Wednesday, addressing the UN Security Council, Israel’s ambassador, Danny Danon, accused UN aid chief, Tom Fletcher, as well as the Office for the Coordination of Humanitarian Affairs, of somehow being affiliated with Hamas.

Danon provided no evidence.

Responding in writing the following day, Fletcher said, “I expect the Israeli authorities to immediately share any evidence that led them to make such claims.”

In January 2024, Israel accused another UN aid body, the UN Relief and Works Agency, of working with Hamas.

An independent review into Israel’s allegations concluded in April 2024 that it had provided no evidence to support its claim.

Is Hamas stealing aid?

Not according to Israel’s military and its principal ally, the US.

Citing unnamed Israeli military officials, The New York Times reported on Saturday that the UN aid operation was relatively reliable and less vulnerable to interference than others, adding that there was no evidence Hamas regularly stole from the UN.

An internal report by the US’s development agency, USAID, in late June also concluded that there was no evidence of the systematic looting of US-provided aid by Hamas.

So far, the only evidence of aid being systematically looted points to criminal gangs now partnering with Israel and the GHF.

So, why isn’t aid reaching people in Gaza?

Months of Israel’s siege have led to the effective breakdown of Gaza’s society, with food convoys at risk of being overwhelmed by starving, desperate crowds, the UN says.

To deliver aid to where it is needed, the UN would need the support of the Israeli military.

On Wednesday, UN spokesperson Stephane Dujarric said half of the 16 food distribution requests submitted to the Israeli military had been refused.

“Bureaucratic … and other operational obstacles imposed by Israeli authorities; ongoing hostilities and access constraints within Gaza; and incidents of criminal looting, and more shooting incidents that have killed and injured people gathering to offload aid supplies along convoy routes” have limited efforts to deliver aid, Dujarric told reporters.

What is the outcome of that?

Starvation. As we noted above, 127 people, most of whom are children, have already died of starvation in Gaza.

Death through hunger occurs over three stages.

The first starts as early as a skipped meal; the second comes with any prolonged period of fasting when the body relies on stored fats for energy.

The third, and often fatal, stage is when all stored fats have been depleted and the body turns to bone and muscle as sources of energy.

It is, according to Dr Omar Abdel-Mannan, a British-Egyptian paediatrician and neurologist who has volunteered in Gaza, “a very cruel, slow death”.

Why have more children died than adults?

Because their bodies are using less to do more.

Children, especially infants and toddlers, have much less muscle and fat to draw on during famine, while their basic metabolism is working harder as they grow.

The outcome is that they have a much-reduced buffer when food intake stops.

What are the chances that Israel’s siege might end?

Nobody knows.

Netanyahu’s right-wing coalition has so far seemed immune to international outrage and internal dissent over its war on Gaza.

It dismisses the accusations of engaging in crimes against humanity and disregarding international law as “anti-Semitic” and “blood libel”.

In the minds of most analysts, the only power with the influence capable of restraining Israel in Gaza and the region is US President Donald Trump.

However, predicting how the notoriously mercurial US president may behave is generally regarded as a job beyond the abilities of most analysts.