The “worst-case scenario of famine is currently playing out in the Gaza Strip,” the leading international authority on food crises said in a new alert Tuesday, predicting “widespread death” without immediate action.

The alert, still short of a formal famine declaration, follows an outcry over images of emaciated children in Gaza and reports of dozens of hunger-related deaths after nearly 22 months of war.

The international pressure led Israel over the weekend to announce measures, including daily humanitarian pauses in fighting in parts of Gaza and airdrops of supplies. The United Nations and Palestinians on the ground say little has changed, and desperate crowds continue to overwhelm and unload delivery trucks before they can reach their destinations.

The Integrated Food Security Phase Classification, or IPC, said Gaza has teetered on the brink of famine for two years, but recent developments have “dramatically worsened” the situation, including “increasingly stringent blockades” by Israel.

The IPC has issued several similar warnings during the war in Gaza, including one in May, which Israel dismissed as “flawed.”

Israel said in response at the time that “even according to the IPC’s own analysis,” there was no famine in Gaza, and noted that previous IPC projections about impending famine have “repeatedly failed to materialize.”

However, over the past year, conditions have worsened to the point where the IPC has issued its highest level of warning, without officially declaring that famine is present in Gaza.

A formal famine declaration, which is rare, requires the kind of data that the lack of access to Gaza and mobility within has largely denied.

The IPC has only declared famine a few times — in Somalia in 2011, South Sudan in 2017 and 2020, and parts of Sudan’s western Darfur region last year.

But independent experts say they don’t need a formal declaration to know what they’re seeing in Gaza.

“Just as a family physician can often diagnose a patient she’s familiar with based on visible symptoms without having to send samples to the lab and wait for results, so too we can interpret Gaza’s symptoms. This is famine,” Alex de Waal, author of “Mass Starvation: The History and Future of Famine” and executive director of the World Peace Foundation, told The Associated Press.

An area is classified as in famine when all three of the following conditions are confirmed: At least 20 percent of households have an extreme lack of food, or are essentially starving. At least 30% of children six months to 5 years old suffer from acute malnutrition or wasting, meaning they’re too thin for their height. And at least two people or four children under 5 per 10,000 are dying daily due to starvation or the interaction of malnutrition and disease.

The report, based on available information through July 25, said the crisis has reached “an alarming and deadly turning point.” It said data indicate that famine thresholds have been reached for food consumption in most of Gaza — at its lowest level since the war began — and for acute malnutrition in Gaza City.

The report said nearly 17 out of every 100 children under the age of 5 in Gaza City are acutely malnourished.

Mounting evidence shows “widespread starvation,” and essential health and other services have collapsed, the report found. According to the UN’s World Food Program, one in three people in Gaza is going without food for days at a time.

Hospitals in Gaza have been reporting a rapid increase in hunger-related deaths in children under 5.

The IPC’s previous analysis in May warned that Gaza would likely fall into famine if Israel failed to lift its blockade and stop its military campaign. Its new alert called for immediate and large-scale action and warned: “Failure to act now will result in widespread death in much of the strip.”

The World Food Program warned Tuesday that the disaster unfolding in Gaza was reminiscent of last century’s famines seen in Ethiopia and Biafra in Nigeria.

“This is unlike anything we have seen in this century,” WFP emergency director Ross Smith told reporters in Geneva.

“It reminds us of previous disasters in Ethiopia or Biafra in the past century,” he said, speaking via video-link from Rome. “We need urgent action now.”

While the IPC did not officially classify the situation as “famine,” Jean-Martin Bauer, WFP’s food security and nutrition analysis director, insisted that “what we’re seeing is mounting evidence that a famine is there.”

“All the signals are there now,” he added.

Israel has restricted aid to varying degrees throughout the war. In March, it cut off the entry of all goods, including fuel, food and medicine, to pressure Hamas to free hostages.

Israel eased those restrictions in May and pushed ahead with a new US-backed aid delivery system, the Gaza Humanitarian Foundation, that has been wracked by chaos and violence. The traditional, UN-led aid providers say deliveries have been hampered by Israeli military restrictions and incidents of looting, while criminals and hungry crowds swarm entering convoys.

While Israel says there’s no limit on how many aid trucks can enter Gaza, UN agencies and aid groups say even the latest humanitarian measures are not enough to counter the worsening starvation. In a statement Monday, Doctors Without Borders called the new airdrops ineffective and dangerous, saying they deliver less aid than trucks.

Prime Minister Benjamin Netanyahu has said no one is starving in Gaza and that Israel has supplied enough aid throughout the war, “otherwise, there would be no Gazans.” The Israel Defense Forces on Monday criticized what it called the “false claims of deliberate starvation in Gaza.”

While the premier has acknowledged that the situation facing Gaza’s residents is “difficult,” he said that “Hamas benefits from attempting to fuel the perception of a humanitarian crisis.”

“As such, they have been releasing unverified numbers to the news media while circulating images that are carefully staged or manipulated,” he said.

The premier did not offer evidence to back up the claim that images of starving children that have circulated globally were “staged” by Hamas (though the veracity of one image was debunked by the IDF). In contrast, US President Donald Trump said earlier Monday that the images of starvation in Gaza are “real,” adding: “You can’t fake that.”

The reports of an increasingly dire humanitarian situation in the Gaza Strip — including growing levels of malnutrition, and children dying by starvation — led Israel on Sunday to declare that it would implement a “tactical” pause in daily military operations in densely populated areas of Gaza, along with several other changes, to allow for the safe distribution of humanitarian aid.

At the same time, Israel has denied using hunger as a weapon of war, and accused the United Nations and other aid agencies of failing to pick up and distribute supplies delivered to Gaza’s border crossing points.