Gaza is facing a “catastrophic” hunger crisis of unprecedented proportions, according to the UN, with everyone in the besieged coastal strip liable to face acute food insecurity in the coming weeks. At the same time, hopes of a temporary pause in fighting to allow a new prisoner exchange receded as Hamas rejected talks until Israel halted its military onslaught on Gaza. And a UN resolution aimed at increasing aid flows into Gaza remained mired in disagreement at the security council, with the US demanding changes, arguing that the current text could hurt humanitarian deliveries more than help them. Amid continuing alarm about the humanitarian crisis in Gaza, the UN declared “catastrophic” hunger levels, with thousands of people at risk of famine. A report by the UN and food security agencies said four out of five households in the north of Gaza, and half of those displaced in the south, were enduring days without any food. Noelia Monge, the head of emergencies for Action Against Hunger, said: “Everything we are doing is insufficient to meet the needs of 2 million people. It is difficult to find flour and rice, and people have to wait hours to access latrines and wash themselves. We are experiencing an emergency like I have never seen before.” The UN’s hunger monitoring system, Integrated Food Security Phase Classification (IPC), issued a report saying the “most likely scenario” in Gaza is that by 7 February “the entire population in the Gaza Strip [about 2.2 million people] would be at “crisis or worse” levels of hunger. “This is the highest share of people facing high levels of acute food insecurity that the IPC initiative has ever classified for any given area or country,” the report said. The IPC warned that by 7 February about 50% of the population are forecast to be in the “emergency” phase – defined as very high acute malnutrition and excess mortality. The IPC has a five-stage system for assessing food crises and its report said that in Gaza “at least one in four households”, over half a million people, would be facing phase-five catastrophic conditions. “Even though the levels of acute malnutrition and non-trauma related mortality might not have yet crossed famine thresholds, these are typically the outcomes of prolonged and extreme food consumption gaps,” it said. Starvation is compounding the threats of disease and exposure as winter sets in at a time when about 90% of Gaza’s population has been displaced by the Israeli military offensive, triggered by a surprise attack by Hamas. Hamas issued a statement on Thursday saying there “should be no talk about prisoners or exchange deals except after a full cessation of aggression”. It said the declaration represented a “Palestinian national decision”. About 120 Israelis are still being held by Hamas and Islamic Jihad in Gaza. More than 100 were released in an earlier deal under which hundreds of Palestinian prisoners were also freed and there was a temporary halt in fighting. Ismail Haniyeh, the Hamas leader based in Qatar, travelled to Cairo this week for discussions with Egyptian officials seeking to broker another agreement. The meeting ended without results. Benjamin Netanyahu, the Israeli prime minister, appeared to dismiss the prospect of another truce on Wednesday. “Whoever thinks that we will stop is detached from reality. We will not stop the fighting until all of the goals that we have set are achieved: the elimination of Hamas, the release of our hostages and the removal of the threat from Gaza,” he said in a statement. At the UN, diplomats were locked in a fourth day of debate about a security council resolution put forward by the United Arab Emirates that would call for a suspension of hostilities, while more humanitarian aid routes into Gaza are organised under UN supervision. The US objected to the language giving UN primacy without explicitly outlining Israel’s role in inspecting humanitarian cargoes. “The goal of this resolution is to facilitate and help expand humanitarian assistance getting into Gaza, and we cannot lose sight of that purpose,” said Nate Evans, the spokesperson for the US mission to the UN. “There are still serious and widespread concerns that this resolution as drafted could actually slow down delivery of humanitarian aid by directing the UN to create an unworkable monitoring mechanism. We must ensure any resolution helps and doesn’t hurt the situation on the ground.” Egypt’s foreign minister, Sameh Shoukry, said he was astonished that the UN security council, after a month of negotiations, had been unable to back a resolution calling for a humanitarian cessation of hostilities in Gaza. “We need to call things by their real name. We have a crisis,” he said. The World Health Organization said there were no functional hospitals left in the north of Gaza and only nine partly functional in the south. Richard Peeperkorn, the WHO’s representative in Gaza, said: “There are actually no functional hospitals left in the north. Al-Ahli was the last one but it is now minimally functional, still treating patients but not admitting new ones.” He said al-Ahli was a “shell of a hospital”, resembling a hospice providing very limited care. About 10 staff, all junior doctors and nurses, were providing basic first aid, pain management and wound care with scant resources, he said. “Until two days ago, it was the only hospital where injured people could get surgery in northern Gaza, and that was overwhelmed with patients needing emergency care,” he said. “There are no operating theatres any more due to the lack of fuel, power, medical supplies and health workers, including surgeons and other specialists.” Peeperkorn said corpses were lined up in the hospital’s courtyard because they could not be given safe and dignified burials. Some patients at al-Ahli had been waiting for surgery for weeks, and those who had been operated on were at risk of infection due to lack of antibiotics and other drugs. “All these patients cannot move and need to be transferred urgently to have a chance to survive,” he said. A humanitarian ceasefire was needed to “reinforce and restock remaining health facilities, deliver medical services needed by thousands of injured people and those needing other essential care, and above all to stop the bloodshed and death”, Peeperkorn said. Aside from al-Ahli hospital, three others in northern Gaza were barely functioning. Israeli forces said on Thursday that they had uncovered a network of tunnels with entrances connected to the homes of Hamas leaders in Gaza City. The IDF released images that appear to show spiral staircases leading to the tunnels, heavy blast doors, electricity infrastructure and plumbing. The Hamas government’s media office said on Wednesday that at least 20,000 people had been killed in Gaza since 7 October, including 8,000 children and 6,200 women. About 1,200 people were killed in Israel during Hamas’s murderous rampage on 7 October.