From the earliest days of the Israel-Hamas war, the United States and much of the international community have pressed Israel to allow more humanitarian aid into the Gaza Strip. But as the fighting rages on with no end in sight, the humanitarian catastrophe there has only worsened.

United Nations agencies and aid groups say the ongoing hostilities, the Israeli military’s refusal to facilitate deliveries and the breakdown of order inside Gaza make it increasingly difficult to bring vital aid to much of the coastal enclave.

The World Food Program said Tuesday it has paused food deliveries to isolated northern Gaza, where the U.N. children’s agency says one in six children are acutely malnourished. A U.N. report in December found that a quarter of Gaza’s 2.3 million people are starving.

“You find that there are people who have missed meals for a day or two days or three days — they have severe hunger,” Matthew Hollingworth, country director for WFP, said Wednesday. “But you also have people who have acute hunger, that is, they are not eating for a week.”

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Hollingworth described the halt as a “temporary pause” and said the WFP was talking to “all the parties” to resume aid shipments. “We have to flood the area with assistance, if we’re going to mitigate and stop a famine,” he said.

Footage from Gaza in recent weeks has shown scenes of chaotic desperation with hundreds of people surrounding trucks and emptying them. Some Palestinians say they have resorted to making bread out of animal fodder. New mothers say baby formula is hard to come by or unaffordable.

Israel denies it is restricting the entry of aid and has shifted the blame to humanitarian organizations operating inside Gaza, saying hundreds of trucks filled with aid sit idle on the Palestinian side of the main crossing. The U.N. says it can’t always reach the trucks at the crossing because it is at times too dangerous.

The U.N. has called on Israel to open more crossings, including in the north, and to improve the coordination process.

Here’s a look at how the situation grew so dire.

WHY DOES GAZA DEPEND ON AID?

Gaza has been under an Israeli and Egyptian blockade since Hamas seized power from rival Palestinian forces in 2007. Israel said the blockade was needed to keep the militant group from importing arms, while critics decried it as a form of collective punishment.

Even before the war, Gaza’s unemployment rate hovered around 50% — among the highest in the world — and years of isolation along with four previous wars devastated the private sector. Still, around 500 trucks entered each day, carrying commercial goods, fuel and aid.

Israel imposed a complete siege after Hamas’ Oct. 7 attack and said nothing would enter until it released the estimated 250 hostages taken that day. Seeking to put pressure on Hamas, it claimed the group was hoarding food and supplies and could care for the general population if it truly wanted.

Israel later relented under U.S. pressure and began allowing dozens of trucks to enter each day from the Rafah crossing between Egypt and Gaza. But aid groups said they faced a cumbersome inspection process that allowed only a trickle of aid to enter even as needs mounted, with some 80% of Palestinians displaced from their homes. Israel says the inspections are needed for security reasons.

In December, following more U.S. pressure, Israel reopened its own Kerem Shalom crossing with Gaza, the territory’s main cargo terminal, and streamlined the inspection process. But even then, the average number of trucks entering a day was only a third of the prewar level.

COGAT, the military body that oversees Palestinian civilian affairs, says there are no restrictions on importing humanitarian aid. It also denies that right-wing Israeli protests at the crossings in recent weeks have succeeded in blocking aid.

Instead, the main obstacles now appear to be on the other side of the fence.

WHY CAN’T ORGANIZATIONS DISTRIBUTE AID INSIDE GAZA?

Once aid trucks enter Gaza, there’s often not much further they can go.

Israel has isolated northern Gaza since the opening days of the ground offensive in late October after ordering its population to flee to the south. Tens of thousands of people remained there, despite the flattening of entire neighborhoods and severe shortages of food and water.

Aid groups say the Israeli military often denies their requests to access northern Gaza, and that even when it is granted, little protection is provided.

The drive from southern Rafah to Gaza City, in the north, used to take around 45 minutes. It now takes several hours because of ongoing hostilities and roads that have been damaged, blocked or closed by the army.

Earlier this month, a U.N. official accused Israeli forces of firing on a food convoy. Hamas-run police had provided security escorts to protect the convoys from crowds or bandits — and, according to Israel, were themselves siphoning off aid.

But U.N. officials say the escorts vanished after recent Israeli airstrikes targeting security forces in the southern border city of Rafah, where most aid operations are concentrated and where more than half of Gaza’s population has sought refuge from fighting elsewhere.

Israel has vowed to expand the ground offensive to Rafah in the coming weeks, which aid groups say would be catastrophic.

HOW HAS THE UNRWA CONTROVERSY AFFECTED AID DELIVERIES?

The largest provider of humanitarian aid in Gaza is the U.N. agency for Palestinian refugees, known as UNRWA. Last month, Israel said 12 of its employees took part in the Oct. 7 attack, prompting the United States and other donors to suspend funding.

UNRWA immediately fired the 10 surviving employees and has launched investigations. It denies Israeli allegations that it collaborates with or turns a blind eye to Hamas, and says Israel has not shared evidence implicating the 12 fired employees. It says if funding is not restored it will have to halt operations in April.

In the meantime, the agency says Israel has imposed a number of financial restrictions that hinder its operations and is holding up a shipment of food that could sustain 1.1 million people for a month.

Israel has called for UNRWA to be disbanded, but no other U.N. agencies or aid groups are capable of immediately replacing it.

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Find more of AP’s coverage at https://apnews.com/hub/israel-hamas-war

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