Tens of thousands of Palestinians trapped in northern Gaza are rationing their last supplies of lentils and flour to survive, as Israel’s monthlong siege has virtually halted food deliveries to the region, forcing some residents to scavenge through rubble for canned goods amid constant bombardment.

“We are being starved to force us to leave our homes,” said Mohammed Arqouq, whose family of eight remains determined to stay in the north despite deteriorating conditions. “We will die here in our homes.”

The humanitarian crisis has intensified as Israel’s military campaign, aimed at rooting out militants, severs the area with checkpoints. An estimated 70,000 people remain in the northern region, where no aid has reached towns like Beit Lahiya, Beit Hanoun, and Jabaliya refugee camp for 30 days, according to Louise Wateridge, spokesperson for the U.N. agency for Palestinian refugees (UNRWA).

The situation has prompted urgent warnings from food security experts, who said Friday that famine is either imminent or already occurring in the north. The crisis comes as Israel falls significantly short of the Biden administration’s mandate to allow 350 aid trucks daily into Gaza or risk U.S. military funding restrictions.

According to Israel’s military agency COGAT, an average of 81 trucks entered Gaza daily in early November, up from 57 in October. The U.N. reports even lower figures — just 37 trucks daily since October — citing military operations and lawlessness preventing aid collection.

Dr. Rana Soboh, a nutrition specialist at Gaza City’s Patient Friend Benevolent Hospital, reports seeing approximately 350 cases of moderate to severe acute malnutrition daily. “The bone of their chest is showing, the eyes are protruding,” she said, describing patients who struggle to concentrate. The hospital documented 4,780 malnourished children in September, up from 1,100 in July.

Palestinians describe desperate searches for food. “Sometimes you find a half-empty package of flour, canned food and lentils,” said Arqouq, who ventures out at night to search bombed buildings. Um Saber, a widow sheltering with six children, said: “We are like dogs and cats searching for their food in the rubble.”

The crisis extends to Gaza City, where hundreds of thousands of displaced Palestinians strain limited resources. Lubna, a 38-year-old mother of five who fled Jabaliya, described sifting moldy flour scavenged from destroyed homes to feed her family, including her visibly malnourished young daughter Selina.

U.S. State Department spokesman Matthew Miller acknowledged Israel’s steps to open new delivery routes but emphasized more action is needed. “It’s not just sufficient to open new roads if more humanitarian assistance isn’t going through those roads,” he said.

The situation has raised concerns among Palestinians that Israel seeks to permanently empty northern Gaza through what they view as a surrender-or-starve strategy. While the Israeli military denies receiving such orders, witnesses report troops forcing building-to-building evacuations toward Gaza City.

“We are suffering, facing the ghost of famine that is hovering over Gaza,” Soboh said, as winter approaches and displaced residents seek shelter in damaged buildings and makeshift camps, where sanitation facilities are largely destroyed.