The international court of justice has ordered Israel to allow unimpeded access of food aid into Gaza, where sections of the population are facing imminent starvation, in a significant legal rebuke to Israel’s claim it is not blocking aid deliveries. A panel of judges at the UN’s top court, which is already considering a complaint from South Africa that Israel is committing genocide in the Palestinian territory, issued the ruling after an emergency measure in January obliging Israel to admit emergency aid. The judges, who were unanimous in their decision, said Palestinians in Gaza were facing worsening conditions of life, and famine and starvation were spreading. “The court observes that Palestinians in Gaza are no longer facing only a risk of famine … but that famine is setting in,” the judges said. In its legally binding order, the court told Israel to take “all necessary and effective measures to ensure, without delay, in full cooperation with the United Nations, the unhindered provision at scale by all concerned of urgently needed basic services and humanitarian assistance” including food, water, fuel and medical supplies. The ICJ also ordered Israel to immediately ensure “that its military does not commit acts which constitute a violation of any of the rights of the Palestinians in Gaza as a protected group under the convention on the prevention and punishment of the crime of genocide, including by preventing, through any action, the delivery of urgently needed humanitarian assistance”. Israel denies it is committing genocide and says its military campaign is self-defence. The judges also called for the immediate release of all hostages being held by Hamas, echoing the demand of a UN security council resolution that was passed on Monday. While Israel has claimed it is allowing aid into Gaza, senior UN, US and other international officials, as well as NGOs, have accused the country of obstructing life-saving aid to Gaza’s population of 2.3 million. Israel says it needs to inspect every shipment to make sure no cargo can be used to the benefit of its Hamas enemies. Even trucks travelling from Egypt, which has a peace treaty with Israel, are inspected by Israeli forces. Aid officials criticise the slow and often arbitrary inspection process, which in practice blocks aid, with trucks waiting weeks for approvals. Israeli officials did not issue a direct response to the ICJ’s order. According to media reports, Benjamin Netanyahu’s domestic issues are nearing crisis levels. The Israeli prime minister is facing the most serious threat yet to his administration as he struggles to bridge a major split in the shaky national-unity government, caused by Israel’s supreme court on Saturday ordering an end to government subsidies for many ultra-Orthodox men who are historically exempt from conscription. In his coalition, the powerful bloc of ultra-Orthodox parties demands that religious men be exempted, while the centrist members of his war cabinet insist all sectors of Israeli society must share the burden of the war in Gaza. The ruling follows warnings from the UN’s top rights official that Israel may be committing a war crime by obstructing aid, and despite Israel’s urging of the court in The Hague not to issue new measures. The new measures were requested by South Africa as part of its case that accuses Israel of state-led genocide in Gaza as well as incitement to genocide in statements by top Israeli officials. Under international law, using starvation as a weapon of war is explicitly prohibited, while occupying forces are also legally obliged to ensure those in areas they control are supplied with the means of life. The UN said on Wednesday that famine was “ever closer to becoming a reality in northern Gaza” and that the health system was collapsing owing to the continuing hostilities and “access constraints”. Heavy fighting took place around two key hospitals in Gaza on Thursday, while a third was reportedly under Israeli siege. The most intense fighting once again appeared to be focused on the al-Shifa complex, Gaza City’s main hospital before the war, where the Israeli army said it continued to operate around the site after storming it more than a week ago. Israeli tanks and armoured vehicles had also massed around Nasser hospital in the southern city of Khan Younis, the Gaza health ministry said. Shots were fired but no raid had been launched, it said. The Red Crescent said thousands of people were trapped inside. Israeli forces were also blockading al-Amal hospital in Khan Younis, and several other areas in the city had come under Israeli fire, local people said. The Israel Defense Forces claim to have killed about 200 gunmen in the area of al-Shifa hospital since the start of the operation there, “while preventing harm to civilians, patients, medical teams and medical equipment”. Early on Thursday, the Israeli army said militants had fired on troops from within and outside the hospital’s emergency ward. The Gaza health ministry said wounded people and patients were being held inside an administration building in al-Shifa that was not equipped to provide them with healthcare, adding that five patients had died since the Israeli raid because of shortages of food, water and medical care. Unverified footage on social media showed al-Shifa’s surgery unit blackened by flames and nearby buildings on fire or destroyed. The armed wings of the Hamas and Islamic Jihad militant groups said in a statement they had “bombed, with a barrage of mortar shells, gatherings of Israeli soldiers in the vicinity of the al-Shifa complex” in a joint operation. The claims of neither side could be independently verified. The Palestinian Red Crescent said seven people working for the organisation who were arrested in a raid on al-Amal hospital on 9 February had been released after 47 days in Israeli prisons. The World Health Organization said al-Amal hospital had ceased to function as a result of the fighting, leaving only 10 of 36 hospitals in Gaza partly operational. The WHO’s director general, Tedros Adhanom Ghebreyesus, wrote on X on Thursday: “Once more, WHO demands an immediate end to attacks on hospitals in Gaza, and calls for protection of health staff, patients, and civilians.” A series of harrowing witness reports from international medical teams who visited healthcare facilities have emerged in recent days. On Thursday, a team of doctors who visited al-Aqsa hospital in the town of Deir al-Balah in central Gaza told the Associated Press that a toddler there had died from a brain injury caused by an Israeli strike that fractured his skull, while his infant cousin is fighting for her life with part of her face blown off by the same strike. The team said a 10-year-old boy, who was not related, screamed out in pain for his parents, not knowing that they had been killed in the strike; he did not recognise his sister beside him because burns covered almost her entire body, they said. “I spend most of my time here resuscitating children,” said Tanya Haj-Hassan, a paediatric intensive-care doctor from Jordan who has extensive experience in Gaza and often speaks out about the war’s devastating effects. “What does that tell you about every other hospital in the Gaza Strip?” On Thursday, the Palestinian prime minister, Mohammad Mustafa, formed a new cabinet in which he will also serve as foreign minister, making an immediate ceasefire and Israeli withdrawal from Gaza a top priority. Mustafa, an ally to the president, Mahmoud Abbas, and a leading business figure, was appointed premier this month with a mandate to help reform the Palestinian Authority, which exercises limited self-rule in the Israeli-occupied West Bank. The authority’s forces were driven from Gaza when Hamas seized power in 2007, and it has no power there. The US has called for a revitalised authority to administer postwar Gaza before eventual statehood. Israel has rejected that idea, saying it would maintain open-ended security control over Gaza. On the diplomatic front, the White House said it was working to rearrange a visit by an Israeli delegation to Washington that was abruptly cancelled by Benjamin Netanyahu after the US decision not to veto Monday’s UN security council resolution calling for an immediate ceasefire in Gaza and the release of hostages held by militants. Karine Jean-Pierre, the White House press secretary, confirmed reports that the Israeli prime minister had climbed down over the visit and agreed to reschedule it. “We’re now working with them to find a convenient date that’s obviously going to work for both sides,” she said. Guardian Newsroom: The unfolding crisis in the Middle East On Tuesday 30 April, 7-8.15pm GMT, join Devika Bhat, Peter Beaumont, Emma Graham-Harrison and Ghaith Abdul-Ahad as they discuss the fast-developing crisis in the Middle East.