RAFAH, Gaza Strip >> Famine is “imminent” in northern Gaza, where 70% of people are experiencing catastrophic hunger, according to a report issued today that warned escalation of the war could push half of Gaza’s total population to the brink of starvation.

The report, by the international community’s authority on determining the severity of hunger crises, came as Israel faces mounting pressure from even its closest allies to streamline the entry of aid into the Gaza Strip and to open more land crossings. Aid groups complain that deliveries by air and sea by the U.S. and other countries are too slow and too small.

The European Union’s top diplomat said the impending famine was “entirely man-made” as “starvation is used as a weapon of war.”

Israeli forces, meanwhile, launched another raid on the Gaza Strip’s largest hospital early today, saying Hamas militants had regrouped there and fired on them from inside the Shifa Hospital compound.

Clashes continued all day in and around the hospital, where Palestinian officials say tens of thousands of people have been sheltering.

The Israeli military said troops killed 20 people it identified as Hamas militants, and one of its own soldiers was killed, though the identification of the dead as militants could not be confirmed. Among those killed was a senior commander in Gaza’s Hamas-led police forces who Israel said was hiding in the hospital. Gaza officials said the commander was coordinating the protection of aid convoys.

The army last raided Shifa Hospital in November after claiming that Hamas maintained an elaborate command center within and beneath the facility. The military revealed a tunnel leading to some underground rooms, as well as weapons it said were found inside the hospital. But the evidence fell short of the earlier claims, and critics accused the army of recklessly endangering the lives of civilians.

RAFAH OFFENSIVE COULD PUSH HALF OF GAZA TO STARVATION

The latest findings on hunger in Gaza came from the Integrated Food Security Phase Classification, or IPC, an initiative first set up in 2004 during the famine in Somalia that now includes more than a dozen U.N. agencies, aid groups, governments and other bodies to determine the severity of food insecurity.

It says virtually everyone in Gaza is struggling to get enough food, and that around 677,000 people — nearly a third of the population of 2.3 million — are experiencing the highest level of catastrophic hunger. That means they face extreme lack of food and critical levels of acute malnutrition. The figure includes around 210,000 people in the north.

Outright famine is projected to occur in the north anytime between now and May, it said. An area is considered to be in famine when 20% of households have an extreme lack of food, 30% of children suffer from acute malnutrition and at least two adults or four children per every 10,000 people die daily.

The report said the first condition has been fulfilled, and it is “highly likely” the second has as well. The death rate is expected to accelerate and reach famine levels soon, it said.

The report warned that if Israel broadens its offensive to the packed southern city of Rafah, as Prime Minister Benjamin Netanyahu has vowed to do, the fighting could drive over 1 million people — half of Gaza’s population — into catastrophic hunger and potentially cause famine in the south.

“This is the largest number of people facing imminent famine in the world today, and it has only taken five months to occur,” said Matthew Hollingworth, the acting World Food Program country director for the Palestinian territories.

Jamie McGoldrick, the U.N. humanitarian coordinator for the Palestinian territories, called for “all roads” to be opened for aid, including into northern and central Gaza. The WFP report said aid from airdrops is “negligible” compared to what is brought on trucks.

Northern Gaza, including Gaza City, was the first target of the invasion, and entire neighborhoods have been obliterated. It is now the epicenter of Gaza’s humanitarian catastrophe, with many residents reduced to eating animal feed. At least 27 people, mostly children, have died from malnutrition and dehydration in the north, according to the Health Ministry.

A spokesman for the Israeli military body that deals with Palestinian issues, Shimon Freeman, said Israel “places no limit on the amount of aid that can enter the Gaza Strip” and encourages countries to send aid. Israel has accused U.N. bodies of failing to distribute aid in a timely manner. Aid groups say distribution is impossible in much of Gaza because of hostilities, the difficulty of coordinating with the military and the breakdown of law and order.

Alex de Waal, the executive director of the World Peace Foundation at Tufts University and an expert on global famines, said Israel has had “ample warning” that if it continued to destroy key infrastructure, displace large numbers of people and obstruct aid operations, the results would be catastrophic.

“In failing to change course, it is culpable for these deaths,” he said.

EU foreign policy chief Josep Borrell said it was up to Israel to facilitate more aid.

“Israel has to do it. It is not a question of logistics. It is not because the United Nations has not provided enough support,” he said. “Trucks are stopped. People are dying, while the land crossings are artificially closed.”

‘WE’RE TRAPPED INSIDE’

The raid on Shifa Hospital began before dawn, when Israeli forces backed by tanks and artillery surrounded the complex and troops stormed into a number of buildings.

“We’re trapped inside,” said Abdel-Hady Sayed, who has been sheltering in the facility for months. “They fire at anything moving.”

In the evening, he said tanks were still in the hospital yard, and he could see three bodies outside the gates. “We can’t retrieve the dead,” he said.

Gaza’s Health Ministry said around 30,000 people are sheltering at the hospital, including patients, medical staff and people who have fled their homes seeking safety. The war has displaced around 80% of Gaza’s population.

Rear Adm. Daniel Hagari, the chief Israeli military spokesperson, said senior Hamas militants had regrouped in the hospital and were directing attacks from inside.

Among those killed in the raid was Faiq Mabhouh, a senior officer in the Gaza police, which is under Gaza’s Hamas-led government but distinct from the militant group’s armed fighting wing. The Israeli military said he was armed and hiding in Shifa, and that weapons were found in an adjacent room.

The Gaza government said Mabhouh was in charge of protecting aid distribution in the north and coordinating between aid groups and local tribes. Aid groups say Israeli strikes on police are one reason public order has collapsed, leading to desperate Palestinians overwhelming aid trucks on the road.

Hagari said the patients and medical staff could remain in the medical complex and that safe passage was available for civilians who wanted to leave.

Israel accuses Hamas of using hospitals and other civilian facilities to shield its fighters, and the Israeli military has raided several hospitals since the start of the war.

The Gaza Health Ministry said today that at least 31,726 Palestinians have been killed in Israel’s offensive. The ministry doesn’t differentiate between civilians and combatants in its count, but it says women and children make up two-thirds of the dead.

Palestinian militants killed some 1,200 people in Hamas’ Oct. 7 attack into southern Israel that triggered the war, and took another 250 people hostage. Hamas is still believed to be holding about 100 captives, as well as the remains of 30 others, after most of the rest were freed during a cease-fire last year.

Magdy reported from Cairo and Goldenberg from Tel Aviv, Israel. Associated Press writer Lorne Cook in Brussels contributed.