Top US humanitarian aid official says report warning of imminent famine in Gaza “is a horrific milestone”
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March 18, 2024 Israel-Hamas war

By Kathleen Magramo, Antoinette Radford, Maureen Chowdhury, Aditi Sangal, Elise Hammond and Chris Lau, CNN

Updated 5:04 p.m. ET, March 19, 2024
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10:42 p.m. ET, March 18, 2024

Top US humanitarian aid official says report warning of imminent famine in Gaza “is a horrific milestone”

From CNN's Mike Callahan

Children wait with bottles to get water in Rafah, Gaza on March 16.
Children wait with bottles to get water in Rafah, Gaza on March 16. Yasser Qudaih/Anadolu/Getty Images

The top US humanitarian aid official called a report warning that famine is set to break out in northern Gaza sometime between now and May “a horrific milestone” and urged Israel to open more land routes to deliver aid into the enclave.

“We continue to call on Israel to open more land routes into Gaza and reduce bottlenecks and inspection delays to get land crossings operating at full capacity, even as we pursue air and maritime options to supplement these land routes,” US Agency for International Development (USAID) Administrator Samantha Power said in a statement.

The report, published by the Integrated Food Security Phase Classification (IPC), said that the sustained fighting and lack of humanitarian aid means famine is now "imminent in the northern governates" of Gaza and "projected to occur anytime between mid-March and May 2024." 

Power said the "catastrophic levels of hunger and malnutrition" detailed in the report "should be unimaginable in the current era, but for hundreds of thousands of Palestinians in Gaza, this is the reality."

“With just two previous Famine declarations in the twenty-first century, this is a horrific milestone," she added.

5:04 p.m. ET, March 19, 2024

Biden and Netanyahu talk as devastation and starvation in Gaza worsen. Here's what to know

From CNN staff

US President Joe Biden spoke with Israeli Prime Minister Benjamin Netanyahu on Monday — their first known phone conversation in over a month as the rift deepens between the two leaders. 

It came as the Israel Defense Forces (IDF) surrounded the Al-Shifa Medical Complex, where the Ministry of Health in Gaza said about 3,000 people are sheltering. Israel has been waiting for the "right time to act" at the Gaza City hospital, according to IDF spokesperson Rear Adm. Daniel Hagari.

Here's what to know:

  • US and Israel leaders talk: During the phone call, Biden voiced "deep concerns" over Israel's plans for a major operation in Rafah, according to a top national security official, explaining that it could be catastrophic for Palestinian civilians and slow the flow of aid. Netanyahu reiterated Israel's commitment to achieving its goals in the war, including eliminating Hamas and releasing hostages, a readout from the prime minister's office said. Both leaders called for more aid to enter the enclave.
  • More concern about Rafah: Canadian Prime Minister Justin Trudeau expressed his concern about Israel’s plans in Rafah while speaking to Israeli war cabinet minister Benny Gantz, according to a readout from Trudeau’s office. The Canadian leader also stressed the need for humanitarian aid to reach civilians “without delay.”
  • Fighting around Gaza's largest hospital: Hamas' military wing said its fighters engaged in “fierce clashes” with Israeli forces around the Al-Shifa Medical Complex. The IDF said it launched an operation there based on intelligence that the hospital was being used by “senior Hamas terrorists." The Palestinian health ministry said there were multiple casualties. CNN cannot independently verify either claim. 
  • Journalist arrest: Hagari also said that the IDF arrested over 200 "terror suspects" at Al-Shifa Hospital. One was Al Jazeera Arabic correspondent Ismail Al-Ghoul, the network said. The United Nations said it stands "against any harassment of journalists anywhere in the world," a spokesperson said. The US is aware of the arrest and has asked Israel for more information, a State Department official said.
  • Hamas commander killed: Israel killed a senior Hamas commander in an airstrike last week, according to the White House. Marwan Issa was one of the planners of the October 7 attack against Israel, an IDF spokesperson said last week. Hagari did not confirm the information today but said that Israeli forces attacked an underground compound used by senior Hamas officials on March 9. The IDF was not able to verify if Issa was killed, he said.
  • Humanitarian crisis: A report published by the World Food Programme's Integrated Food Security Phase Classification (IPC) warned that the sustained fighting and lack of humanitarian aid means famine is now "imminent in the northern governates" of Gaza sometime between now and May. A growing number of children are dying of starvation and dehydration, according to the World Health Organization and Palestinian officials, and doctors say malnutrition is complicating the recovery of children from their injuries.

Correction: An earlier version of this post quoted a Gaza Health Ministry estimate that 30,000 people were sheltering at Al-Shifa. The ministry says it made a typographical error in its estimate and meant to say 3,000.

5:52 p.m. ET, March 18, 2024

Medical organization calls for protection of staff and patients in Al-Shifa Hospital after heavy fighting

From CNN's Hamdi Alkhshali and Celine Alkhaldi

Doctors Without Borders recounted reports from its staff of heavy fighting around Al-Shifa Hospital in Gaza as Israeli forces announced a military operation inside and around the facility on Monday.

A staff member of the organization, also called Médecins Sans Frontières (MSF), reported hearing “drones, tanks, and shelling” near the hospital in the early hours of Monday, witnessing a fire rising from Al-Shifa's main building. 

Clashes were also reported around the organization's clinic and office in Gaza City where some staff and their families are sheltering.

"We call on all warring parties to respect the grounds and perimeter of Al-Shifa Hospital and ensure the safety of medical personnel, patients, and civilians," MSF said in a statement.

According to MSF staff, Israeli forces conducted “mass arrests in the area surrounding Al-Shifa,” and one of the organization’s staff members is currently unreachable.

Israel Defense Forces spokesperson Rear Adm. Daniel Hagari said on Monday that Israel has been waiting for the “right time to act” at Al-Shifa Hospital, in comments addressing Israel’s military operation there. Hagari said that the IDF arrested over 200 “terror suspects” who are “now under investigation.”

7:30 p.m. ET, March 18, 2024

Malnutrition is complicating children’s recovery from injuries in Gaza, doctors say

From CNN's Aditi Sangal

A child waits with empty pots as Turkish NGO IHH Humanitarian Relief Foundation workers distribute food to people in Gaza City, Gaza, on March 14.
A child waits with empty pots as Turkish NGO IHH Humanitarian Relief Foundation workers distribute food to people in Gaza City, Gaza, on March 14. Dawoud Abo Alkas/Anadolu/Getty Images

Malnutrition is complicating the recovery of children from their injuries in war-torn Gaza’s collapsing health care system, doctors say.

A growing number of children are dying of starvation and dehydration, according to the World Health Organization and Palestinian officials. Acute malnutrition doubled within one month among children in northern Gaza, according to UNICEF.

Project Hope is a US-based health and humanitarian aid organization that operates in regions facing health crises. Its emergency teams report that 5%-15% of the children arriving at its two clinics in Deir Al-Balah and Rafah are malnourished.

“Malnutrition amplifies the fragility of the situation,” Rondi Anderson of Project Hope said. “If you’re malnourished, you’re weak. A child’s immune system is weak, it gets infected, then the healing can’t happen, and it gets prolonged.”

CNN spoke to multiple doctors who have been to Gaza since the war began. They reported seeing a lot of orthopedic injuries like limb injuries as well as burns, which present multiple layers of treatment.

In these situations, a patient needs good pain management, nutrition, antibiotic care and fluid management. In Gaza, “all those four pillars are gone,” said Dr. Amber Alayyan from Doctors Without Borders, also known as Médecins Sans Frontières (MSF). Adding a malnourished state to that means the healing is complicated, she added.

“People who have really huge injuries are dying on the spot,” she said. “At the beginning, we were seeing people with really big abdominal injuries and thoracic injuries and things like that. And now, I think that I truly think that they’re dying on the spot, because we’re seeing fewer and fewer. You do see them, but they don’t necessarily make it to the ICU very quickly.”
5:03 p.m. ET, March 19, 2024

Israel has been waiting for the right time to act at Al-Shifa Hospital, military spokesperson says

From CNN's Lauren Izso in Tel Aviv, Jessie Gretener and Lauren Kent in London

Israel has been waiting for the "right time to act" at Al-Shifa Hospital in central Gaza, Israel Defense Forces spokesperson Rear Adm. Daniel Hagari said on Monday. 

Speaking at his daily news conference, Hagari alleged that Hamas individuals had "fled to the area of the hospital, hid in it, and turned it into a headquarters." He said the IDF has been "following this compound for some time and have been waiting for the right time to act."

Israeli forces surrounded the Al-Shifa Medical Complex early Monday, where the Ministry of Health in Gaza said about 3,000 people are sheltering.

Hagari said an "exchange of fire ensued" after alleging that "surprised terrorists barricaded themselves in a number of buildings in the hospital and opened fire at our forces." Israeli forces returned fire and killed more than 20 people described as "terrorists" inside the hospital.

He said that an IDF soldier was killed in the operation. 

Hagari also said that the IDF also arrested over 200 "terror suspects."

Israel also released an edited video of the operation at Al-Shifa Hospital. In the footage, soldiers can be seen moving through what appears to be the hospital building and firing their weapons. 

Some of the IDF's handout footage was blurred. One of the images appears to be a dead body, which the IDF labeled as an "eliminated terrorist." 

CNN cannot independently verify the claims in the video. It is unclear if the video was filmed in one location as it appears to show multiple places. In parts of the edited IDF video, the audio has been removed. 

CNN’s Celine Alkhaldi contributed to this report.

Correction: An earlier version of this post quoted a Gaza Health Ministry estimate that 30,000 people were sheltering at Al-Shifa. The ministry says it made a typographical error in its estimate and meant to say 3,000.

4:41 p.m. ET, March 18, 2024

Senior Hamas commander killed in Israeli airstrike last week, White House says

From CNN's Sam Fossum and Mick Krever

Jake Sullivan speaks during a news briefing at the White House in Washington, DC on March 18.
Jake Sullivan speaks during a news briefing at the White House in Washington, DC on March 18. Anna Moneymaker/Getty Images

Israel killed a senior Hamas commander in an airstrike last week, the White House said Monday.

“Israel has made significant progress against Hamas. They have broken a significant number of Hamas battalions. Killed thousands of Hamas fighters, including senior commanders. Hamas’ number three, Marwan Issa, was killed in an Israeli operation last week,” said White House National Security Advisor Jake Sullivan.

Asked to confirm the White House's statement, the Israel Defense Forces told CNN it would not comment.

Rear Admiral Daniel Hagari, the IDF spokesperson, said on March 9 that Israeli forces had attacked an underground compound used by Issa and other senior Hamas officials in the Nazirat area of central Gaza. Because the compound was underground, the IDF was not able to verify whether Issa was killed, Hagari said. 

An Israeli military spokesperson said last week that Issa is the deputy of Mohammed Deif, the head of Hamas' military division, and was one of the planners of the October 7 attack against Israel.

Sullivan was describing President Joe Biden’s call with Israeli Prime Minister Benjamin Netanyahu earlier Monday when he said the senior commander was killed. He said Biden stressed the importance of a “coherent and sustainable strategy” to defeat Hamas. 

This post has been updated with comments from the Israel Defense Forces.

5:07 p.m. ET, March 18, 2024

Hamas military wing says it engaged in "fierce clashes" near Al-Shifa hospital

From CNN’s Celine Alkhaldi and Lauren Izso

People leave the area around Al-Shifa Hospital after “fierce clashes” reported between Israeli forces and Hamas on March 18.
People leave the area around Al-Shifa Hospital after “fierce clashes” reported between Israeli forces and Hamas on March 18. Dawoud Abo Alkas/Anadolu/Getty Images

Al Qassam Brigades, Hamas' military wing, said its fighters have been engaged in “fierce clashes” with Israeli forces since dawn in the area surrounding the Al-Shifa Medical Complex in Gaza City.

Al Qassam Brigades said it targeted "Zionist vehicles, causing death and destruction among their ranks."

Hamas said Israel assassinated Gaza’s Police Service Commander, Brigadier General Fayek al-Mabhouh, during its attack on Al-Shifa Hospital.

"We affirm that our people and the security forces will continue to strike the enemy’s malicious plans. The criminal enemy will not succeed in its effort to spread chaos," Hamas said in a statement on Telegram.

Israel Defense Forces spokesperson Daniel Hagari said on Monday that "20 terrorists" had been killed in the area of the hospital, including Al-Mabhouh, who the IDF said served as head of the Special Operations Directorate of Hamas Internal Security.  

More on the Al-Shifa raid: The Israel Defense Forces said it launched an operation at Al-Shifa Hospital in central Gaza based on intelligence that the hospital was being used by “senior Hamas terrorists." The Palestinian health ministry said there were multiple casualties. CNN cannot independently verify either claim. 

2:55 p.m. ET, March 18, 2024

Biden voiced "deep concerns" at Rafah operation in call with Netanyahu, national security adviser says

From CNN's Kevin Liptak and Nikki Carvajal

US President Joe Biden voiced "deep concerns" over Israel's plans for a major operation going after Hamas in Rafah during his phone conversation with Israel's Prime Minister Benjamin Netanyahu on Monday, according to a top national security official.

While he affirmed support for Israel's right to defend itself, Biden sought to explain why the plan for Rafah could prove catastrophic for Palestinian civilians and hamper the flow of humanitarian aid into Gaza, national security adviser Jake Sullivan said.

Biden asked Netanyahu to send a senior delegation of military leaders to Washington to discuss the issue further and to lay out an alternative approach to go after Hamas in Rafah. Netanyahu agreed to dispatch such a group, and Sullivan said the meeting would occur at the end of this week or early next week.

"A military plan cannot succeed without an integrated humanitarian plan and political plan. And the president has repeatedly made the point that continuing military operations need to be connected to a clear strategic end game," Sullivan said at the White House, noting that more civilians had died in Gaza than any previous conflict in the enclave.  

Speaking with Netanyahu, Biden "explained why he is so deeply concerned about the prospect of Israel conducting major military operations in Rafah."

He said those concerns fell within three areas:

  • Civilians sheltering in Rafah have nowhere safe to go
  • Rafah is an entry point for critical humanitarian assistance
  • Neighboring Egypt has voiced serious concerns about a potential military operation there.

Sullivan described the call as "businesslike” and said it “did not end abruptly."

5:03 p.m. ET, March 19, 2024

Israeli military launches operation at Al-Shifa Hospital in Gaza. Here's what else we know

From CNN staff

The Israel Defense Forces (IDF) surrounded the Al-Shifa medical complex early Monday, where the Palestinian Health Ministry in Gaza said about 3,000 people were sheltering.

The IDF claimed that its operation on Gaza's largest hospital was based on intelligence that the hospital was being used by "senior Hamas terrorists."

Israeli forces shared video footage of what they said showed "terrorist fire" coming from buildings inside Al-Shifa hospital toward Israeli troops on Monday, according to a joint statement from the IDF and Israel Security Agency Shin Bet (ISA).

The Palestinian health ministry said there were multiple casualties.

CNN cannot independently verify either claim. 

Here's what we know:

  • On the ground at Al-Shifa: Hamada Abdelhadi, a displaced Palestinian at Al-Shifa, told CNN "military vehicles are firing at the hospital buildings’ windows, and at anyone who is caught moving between the hallways." While talking to him over the phone, incoming strikes could be heard. According to Abdelhadi, the Israeli military operation started at around 2 a.m. local time.
  • Journalist arrested at hospital: Israeli forces have "arrested" Al Jazeera Arabic correspondent Ismail Al-Ghoul at the Al-Shifa Medical Complex in Gaza City, according to Al Jazeera. Al-Ghoul and his crew were “severely beaten” before being taken to an undisclosed location, Al Jazeera said in a statement. CNN has reached out to the IDF for comment on the matter, but has not heard back. The US is aware of the arrest and has asked Israel for more information, according to a State Department official.
  • WHO chief voices concern over raid: The World Health Organization's head expressed concern about the situation in the Al-Shifa Hospital. The organization's chief, Tedros Adhanom Ghebreyesus highlighted the situation in a post on X, saying: "Hospitals should never be battlegrounds." 
  • Aid program warns of famine: The World Food Programme released a statement Monday on their Integrated Food Security Phase Classification (IPC) report about food security in the Gaza Strip that found 88% of the region’s entire population faces "emergency or worse" food insecurity and warns that famine in northern Gaza is "imminent."
  • Biden and Netanyahu: US President Joe Biden spoke with Israeli Prime Minister Benjamin Netanyahu on Monday — their first known phone conversation in more than a month as the rift deepens between the two men. According to a White House readout, the two leaders discussed Rafah and humanitarian assistance to Gaza.

Correction: An earlier version of this post quoted a Gaza Health Ministry estimate that 30,000 people were sheltering at Al-Shifa. The ministry says it made a typographical error in its estimate and meant to say 3,000.