With almost 40,000 Palestinian deaths in Gaza since October, one has to wonder how many more will be added to this monstrous figure. As shocking as it already is, it will get much, much worse. The likelihood is that the figure will rise massively once the rubble is cleared. More mass graves await discovery. This will be accompanied by a cacophony of vile cynicism from anti-Arab gargoyles who like to endlessly dispute the basic realities of events and throw tonnes of mud at Palestinians as they process their daily losses. Death by Israeli bombing may pale into insignificance compared to death by Israeli starvation and disease. Most would agree that an immediate death by an American-made bomb would be preferable to an inexorable slow death by starvation, dehydration or disease. The UN has warned that, by mid-July, more than a million Palestinians will face death by starvation. About 210,000 people in northern Gaza are already in famine conditions. The assessments take time, so by now the situation is undoubtedly much worse. This is a human-made famine. Israel has used starvation as a weapon of war — an accusation the International Criminal Court prosecutor has leveled at Israeli Prime Minister Benjamin Netanyahu and Defense Minister Yoav Gallant. Thus far, there have been 32 known deaths attributed to malnutrition, including 28 children aged under five. Yet these numbers can rise so fast. According to the UN, more than 8,000 children under the age of five have already been diagnosed with acute malnutrition. Many are well beyond the reach of such assessments. Israel has kept the Rafah crossing closed since the beginning of May. Despite promises to the contrary, it has not allowed Gaza to be flooded with aid. Israeli leaders still have a liking for the total siege imposed last October and have been fobbing off international pressure with gestures like the short pause in bombing over the weekend. Those responsible for getting the aid in and distributing it have also been killed. More aid workers have been killed in this war than any war since the advent of the UN. It is time to clearly state that not only has Israel not made the requisite efforts to avoid harming aid workers, but it has actually targeted them. Disease will likely kill even more Palestinians. UN World Food Programme Deputy Executive Director Carl Skau described the challenges as “like nothing I have ever seen.” The situation in southern Gaza is quickly deteriorating. One million people in southern Gaza have no access to clean water or sanitation. “We drove through rivers of sewage,” Skau said. Diseases are spreading, including skin diseases, hepatitis, gastroenteritis and respiratory illnesses. With the summer heat hitting Gaza, a major cholera outbreak is probable. Israel has had a huge hand in this. Four out of the six wastewater treatment plants in Gaza — vital in handling the buildup of sewage and the spread of disease — have reportedly been damaged or destroyed. The other two have also shut down because of a lack of fuel or other supplies. Deaths by disease, exacerbated by malnutrition and unsanitary conditions, will rocket, not least because Israel has smashed Gaza’s health service. The World Health Organization has recorded 464 attacks on healthcare in Gaza since October. Not a single hospital is functioning in Rafah. Palestinians have been compelled to drink filthy or saline water. During a June 7 assessment at Deir Al-Balah, the average water availability per person per day was less than two liters at one displacement site and as low as 0.7 liters at another. This is below the internationally recognized minimum requirement for survival of three liters per day. Even when water is available, it is not always clean and safe. Satellite data analysis determined that half of Gaza’s water and sanitation sites had been destroyed as of April. The situation has deteriorated further since then. This cannot be allowed to continue. Israel is still playing games with aid into Gaza. Less aid entered in May than in April. Last Wednesday, an aid truck filled with medical and food aid for 10,000 Palestinian children was turned around for “no reason,” according to UNICEF. A failure to act will see far more people dying from malnutrition and disease than the bombing. Chris Doyle The immediate solutions remain clear, if distant. A ceasefire is required, along with full humanitarian access and the ability to distribute aid across Gaza. Many will need critical treatment outside of the Strip. A failure to act will see far more people dying from malnutrition and disease than the bombing. It will also serve to harden the abundance of evidence that what Israeli is engaging in is nothing short of genocide, precisely enacting the threats of so many of its leaders, including the president, prime minister and defense minister. Death by disease and starvation is not a process that can be switched off at the flick of a switch. Thousands of Palestinians may have already reached the point of no return. Others are on the brink. A ceasefire may halt the bombs, but these drivers of mortality have their own inexorable momentum. Chris Doyle is director of the Council for Arab-British Understanding in London. X: @Doylech