Twenty-one months into Israel’s war in Gaza, the enclave is gripped by escalating scenes of death and hunger, with some killed while trying to reach aid, others dying of starvation and growing condemnation of Israel’s conduct even among many of its closest allies.

Palestinians in Gaza are suffering from man-made “mass starvation” due to the aid blockade on the enclave, the chief of the World Health Organization warned reporters at a briefing on Wednesday.

“Parents tell us their children cry themselves to sleep from hunger,” Director-General Tedros Adhanom Ghebreyesus said. “Food distribution sites have become places of violence.”

The United Nations says more than a thousand people have been killed by Israeli forces while seeking food since late May, when a controversial new Israel- and US-backed aid group, the Gaza Humanitarian Foundation, began operating.

Of those, hundreds have died near GHF sites, according to the UN. The GHF was created to replace the UN’s aid role in Gaza and has been widely criticized for failing to improve conditions.