Palestinians were seen coming and going from the Zikim area on Saturday, where they were seeking aid from trucks entering with supplies, a day after the world's leading authority on food crises said the Gaza Strip's largest city was gripped by famine.

The Integrated Food Security Phase Classification, or IPC, said famine is happening in Gaza City, home to hundreds of thousands of Palestinians, and could spread south to Deir al-Balah and Khan Younis by the end of next month.

The determination comes after months of warnings by aid groups that Israel's restrictions of food and other aid into Gaza, and its military offensive, were causing starvation among Palestinian civilians, particularly children.

Israel rejected the report, with Prime Minister Benjamin Netanyahu calling it an “outright lie.”

The grim milestone — the first time the IPC has confirmed a famine in the Middle East — is sure to ramp up international pressure on Israel, which has been fighting Hamas since the militant group's Oct. 7, 2023, attack. Israel says it plans to seize Gaza City and other Hamas strongholds, an escalation experts say will exacerbate the hunger crisis.

The IPC said hunger has been driven by fighting and the blockade of aid, and magnified by widespread displacement and the collapse of food production in Gaza, pushing hunger to life-threatening levels across the entire territory after 22 months of war.

More than half a million people in Gaza, about a quarter of its population, face catastrophic levels of hunger, with many at risk of death from malnutrition-related causes, the IPC report said.

U.N. Secretary-General António Guterres said the findings show a “human-made disaster, a moral indictment, and a failure of humanity itself” and appealed for an “immediate ceasefire.”

Netanyahu denies there's hunger in Gaza, calling reports of starvation “lies” promoted by Hamas. “The IPC report is an outright lie. Israel does not have a policy of starvation,” his office posted on X.

The U.S. State Department also sought to cast doubt on the report. It said the humanitarian situation in Gaza “is a serious concern,” but blamed Hamas and looters for the difficulties in delivering aid.

After the publication of images of emaciated children in Gaza and reports of hunger-related deaths in recent weeks, Israel announced measures to let more humanitarian aid in. Yet the United Nations says what's entering is far below what's needed.

The Israeli military agency in charge of transferring aid to the territory, known as COGAT, called the report “false and biased.” It said significant steps had been taken to expand the amount of aid entering the strip in recent weeks.

Israel's Foreign Ministry said more than 100,000 trucks of aid have entered Gaza since the start of the war, including a massive influx in recent weeks. But experts say Gaza is still reeling from the tightening of the blockade from early March until mid-May, when Israel barred the import of all food, medicine and other goods.

Netanyahu says more military pressure is needed to achieve Israel’s goals of freeing the hostages held by Hamas and eliminating the militant group altogether.

Formal famine determinations are rare. The IPC says a famine exists in an area when all three of the following conditions are confirmed:

At least 20% of households have an extreme lack of food, or are essentially starving. At least 30% of children six months to five years old suffer from acute malnutrition or wasting, based on a weight-to-height measurement; or 15% of that age group suffer from acute malnutrition based on the circumference of their upper arm. And at least two people, or four children under five per 10,000 are dying daily due to starvation or the interaction of malnutrition and disease.

The data analyzed between July 1 and Aug. 15 showed clear evidence that thresholds for starvation and acute malnutrition have been reached. Gathering data for mortality has been harder, but the IPC said it is reasonable to conclude from the evidence that the necessary threshold has likely been reached.

The IPC warned that a third of Gaza’s population could face catastrophic levels of hunger by the end of September, and that this is probably an undercount.

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Witnesses, health officials and the U.N. rights office say hundreds of people have been killed by Israeli forces while seeking aid from both providers, while Israel says it has only fired warning shots and that the toll is exaggerated.