Gaza urgently needs more aid or its desperate population will suffer widespread famine and disease, the heads of three major U.N. agencies warned Monday, as authorities in the enclave reported that the death toll in the Israel-Hamas war had surpassed 24,000.

While the U.N. agency chiefs did not directly point a finger at Israel, they said aid delivery is hobbled by the opening of too few border crossings, a slow vetting process for trucks and goods going into Gaza, and continuing fighting throughout the territory – all of which Israel plays a deciding factor in.

Israel’s war against Hamas in Gaza, sparked by the militant group’s Oct. 7 attack on southern Israel, has prompted unprecedented destruction in the tiny coastal enclave and triggered a humanitarian catastrophe that has displaced most of Gaza’s 2.3 million population and pushed more than a quarter into starvation, according to the U.N.

It has also stoked regional tensions, with Iran-backed groups in Lebanon, Syria, Iraq and Yemen carrying out strikes in support of the Palestinians. A missile fired by Yemen’s Houthi rebels hit an American-owned cargo ship on Monday, days after U.S.-led strikes against the group over its attacks on international shipping.

In Gaza, civilians have grown desperate. Footage shared online by Al Jazeera showed hundreds of people rushing toward what appeared to be an aid truck in what the news outlet said was Gaza City. The Associated Press couldn’t independently verify the video and it wasn’t clear when it was filmed.

A day after the White House said it was time for Israel to scale back its military offensive, the World Food Program, UNICEF and the World Health Organization said that new entry routes need to be opened to Gaza, more trucks need to be allowed in each day, and aid workers and those seeking aid need to be allowed to move around safely.

U.N. Secretary-General Antonio Guterres said U.N. agencies and their partners “cannot effectively deliver humanitarian aid while Gaza is under such heavy, widespread and unrelenting bombardment.” He said the deaths of 152 U.N. staffers in Gaza since the start of the war is “the largest single loss of life in the history of our organization.”

Death toll rises

The Health Ministry in Hamas-ruled Gaza said Monday that the bodies of 132 people killed in Israeli strikes were brought to Gaza hospitals over the past day, raising the death toll from the start of the war to 24,100.

The ministry, which doesn’t distinguish between fighters and noncombatants in its tally, says two-thirds of those killed in the war were women and children. Israel says its forces have killed roughly 8,000 militants, without providing evidence.

Israel blames Hamas for the high Palestinian death toll, saying its fighters make use of civilian buildings, and launch attacks from densely populated urban areas.

On Monday, the military said its forces and aircraft targeted militants in the second-largest city Khan Younis, a current focus of the ground offensive, as well as in northern Gaza, where the Israeli military says it continues to expand its control.

In Israel, a woman was killed and 12 other people were wounded in a car-ramming and stabbing attack in a suburb of Tel Aviv that police said was carried out by at least two Palestinians. They were later arrested. The suspects stole three different cars and attempted to run down pedestrians, police said.

Hamas praised the attack, but neither it nor other Palestinian armed groups claimed responsibility for it.

Palestinians have carried out a number of attacks against Israelis since the start of the war, mainly in Jerusalem or the occupied West Bank. Around 350 Palestinians have been killed by Israeli forces in the West Bank, according to the Palestinian Health Ministry, mostly in confrontations during Israeli arrest raids or violent protests.

Hamas says two hostages killed in airstrikes

The war began on Oct. 7, when a Hamas-led surprise attack into Israel killed some 1,200 people, mostly civilians. The militants captured around 250 people and are still holding nearly half of them after releasing more than 100 in exchange for Palestinians imprisoned by Israel during a November cease-fire.

Hamas released a video late Monday showing three hostages – Noa Argamani, 26, Yossi Sharabi, 53, and Itay Svirsky, 38. It includes brief individual statements from all three, likely speaking under duress, in which they call on Israel to halt the war and say they have little food and water and are in danger from Israeli airstrikes.

Later in the video, Argamani says separate airstrikes killed Sharabi and Svirsky and that she herself was wounded. Footage then shows what appear to be the bodies of Sharabi and Svirsky.

Rear Adm. Daniel Hagari, the Israeli military spokesman, said the army had told the families of Svirsky and another hostage that it was “very concerned” over whether they were still alive. He said Israel had struck a building near where the hostages were being held but did not know their location at the time.

Unprecedented humanitarian crisis

The fighting, now in its 101st day, has set off an unprecedented humanitarian crisis in Gaza, which was already struggling from a lengthy blockade imposed by Israel and Egypt after Hamas took power in 2007.

The crisis has been especially severe in northern Gaza: The U.N. said Sunday that less than a quarter of aid convoys have reached their destinations in the north in January, because Israeli authorities denied most access. Israeli officials had no immediate comment.

The U.N. agencies said they want access to the Israeli port of Ashdod, located about 40 kilometers (24 miles) north of Gaza, which they say would allow larger amounts of aid to be shipped in and then sent directly to northern Gaza, much of which Israel leveled in the opening weeks of the war.

Israel has blamed the U.N. and other groups for the problems with aid delivery.

Moshe Tetro, an official with COGAT, an Israeli military body in charge of civilian Palestinian affairs, said last week that aid delivery would be more streamlined if the U.N. provided more workers to receive and pack the supplies. He said more trucks were needed to transfer the aid to Israel for security checks and that the working hours at the Rafah crossing between Gaza and Egypt needed to be extended.

Israel sealed off Gaza after Hamas’ Oct. 7 attack. It relented after its top ally, the U.S., pressed it to loosen its restrictions. The U.S., as well as the U.N., have continued to push Israel to ease the flow of aid.