AMY GOODMAN: This is Democracy Now!, democracynow.org, The War and Peace Report. I’m Amy Goodman.

In Gaza, the death toll has now topped 32,600, including 14,000 children, with over 75,000 people wounded. At least 31 people, including 27 children, have already died of malnutrition and dehydration.

For more, we go to Rafah in Gaza, where we’re joined by James Elder, spokesperson for UNICEF, which stands for the United Nations International Children’s Emergency Fund.

Welcome to Democracy Now!, James Elder. Thank you so much for joining us as you stand outside a hospital in Rafah. Talk about where you’ve been in Gaza and what’ve you found.

JAMES ELDER: Amy, hi there.

Look, I’ve been south to north, north to south. If we start here in the south, in Rafah, this is a city that’s normally 300,000 people, and it’s now about 1.5 million, so you can imagine the congestion. I’m looking now at a field hospital. The number of times, Amy, well, I’ll walk around and just think this place feels like a war zone. Now, of course, it is a war zone. So, if I’m in a hospital, you’re talking about being in a hospital, and it is absolutely heaving with people. So, the corridors are now no longer corridors. They are tented up, people using blankets, whatever they can, thousands and thousands of people trying to take refuge in hospitals, and, of course, thousands and thousands of people with the wounds of war in hospitals. So, here, Rafah, this is a city of children, Amy. This is where most people from Gaza have now fled, with a very real fear of an offensive here.

When you go further north, to the very north, as I’ve been to Jabaliya and Gaza City, well, first you see the devastation. I’m seeing, Amy, entire cities turned to rubble, more or less, things I’ve never seen before, every street. When I go with people from that city, drivers who — drivers who grew up in that city, and who simply don’t know how to get around anymore, Amy, because they’ve lost those landmarks to direct them. And then you see the nutritional status, those children you spoke about. More children died overnight in the last couple of days, dehydration, malnutrition. I see those families, Amy. I see mothers in tears, crouched over cots with children and babies who are paper thin, thousands of people on the street doing that universal sign: food now.

That’s some sense, north to south. Whatever it is, it’s desperation, and it’s exhaustion. People have done everything. They break their last piece of bread to share if they have four or five families stay with them. But I’ve sat with families this morning that I can speak to. They’re exhausted. And yeah, they’re confused as to why they don’t have the world’s attention.

AMY GOODMAN: I wanted to get your response to the latest news, James Elder.

JAMES ELDER: I’ve got no hearing, guys.

AMY GOODMAN: The International Court of Justice has ordered Israel to ensure unhindered aid could get into Gaza. The legally binding order was issued after a request by South Africa, which brought the genocide case to Israel in January. The court noted in its latest order, “Palestinians in Gaza are no longer facing only a risk of famine, but … famine is setting in.” The judges also cited U.N. data which finds at least 31 people, including 27 children, having already died of malnutrition and dehydration. The court is ordering Israel to submit a report within a month showing how it’s implemented the order. The significance of this, as the U.N. warns famine is imminent in northern Gaza? And the number of children who have been affected, James?

JAMES ELDER: Yes. I mean, we saw a report, Amy, almost two weeks ago by the most respected nutrition body in terms of crises on the planet, and it is talking about more people now being in that, what we call catastrophic food insecurity than in their 20 years of reporting. If we look at the north of Gaza, where before this war, less than 1% of children under the age of 5, less than 1%, suffered acute malnutrition. Now if we look at those north, to 2-year-olds, the most vulnerable, Amy, it’s one in three. One in three. This is the speed at which we’ve seen this catastrophic decline.

So, yes, at the United Nations, from my own executive director to the secretary-general, have been calling for months and months for unhindered, safe — sort of very difficult place to work — safe access for aid. Now, that’s road access. The most efficient and effective way to get supplies, lifesaving supplies, food — food, water, medicines, to people is on the road network, not just from the south, because that can be difficult. It’s 30 or 40 — 30 miles, doesn’t sound like a long way. It is a long way when you’ve got tens of thousands of people on the street. Amy, there are crossings that are 10 minutes away from those people who are hand to mouth, from those mothers who are cradling children who are severely malnourished. Ten minutes away.

So, in the same way that this crisis, this nutritional crisis affecting children and civilians in Gaza, is man-made and preventable, it can be turned around. Now, if you want to be a glass half-full, that’s good news. This can be reversed. But we do need those decisions to be made. We need all hindrances gone, all obstructions gone. We need safety. You know, we know that more my United Nations colleagues have been killed in this war than in any war since the creation of the United Nations. We’ve seen those horrendous videos of desperate people, desperate because they see a truck of food once a week — there is no consistency — desperate people being killed accessing food. There are crossings in the north. If those are opened, we can flood the Gaza Strip with aid, and this is solved within a matter of weeks, magic pace that UNICEF has, changes their lives dramatically.

But we’re not seeing that. Instead, UNRWA, the biggest U.N. agency here, the backbone of humanitarian aid on the Gaza Strip, that was sending 50% — Amy, 50% of the food to the north, they’ve been blocked. So we have to be very clear and very, very honest in terms of what the restrictions are. The restrictions currently are why we are seeing this level of malnutrition, particularly among children.

AMY GOODMAN: So, why — what is Israel saying to you, to the international body, the United Nations, to you particularly at UNICEF, why they’re not letting this aid go, and particularly saying they will not work with UNRWA at all in northern Gaza?

JAMES ELDER: Yes. Look, obviously, you know, we function here based on our impartiality, and we talk to anyone. So you’re right to ask. I’m not privy to the exact conversations. Like anyone else, you hear the statements made that there is, you know, limitless access here. The reality on the ground says differently. In the first three weeks of March, one-quarter of aid convoys were denied. As I say, the restrictions on UNRWA are immense.

I can speak to my own experience of the complexities of even getting that food aid to the north, which is why if you come in from the north in those crossings, that’s a game changer. In the same way that the world has focused a little bit on airdrops and ships, obviously, right now the desperation is so great that those people who have been forcibly put into this position will take food aid wherever it comes from. It shouldn’t be the case, when, I mean, in the north, you’re talking about an area that was famed for strawberries — not for malnutrition, for strawberries. But we have to be clear that when a ship comes in, it has the equivalent tonnage of around 12 trucks. There are hundreds and hundreds and hundreds of trucks, you know, five miles from where I am now. You could get hundreds and hundreds of trucks within 10 minutes, if that border crossing was open in the north, to those people who are cut off. That’s an important thing to remember.

When I was in the north, Amy, those people are cut off. You’re past the last checkpoint when we access those people. When I’m on the street, every person, the first thing they want to tell me, in English or Arabic, is “We need food. We need food.” Now, I know this, of course. This is my work. But of course I listen to them. What was revealing is why they’re saying that. They are saying that because their assumption is the world doesn’t know, because how would this be allowed to happen if the world knew?

AMY GOODMAN: Can you talk about the effects on children of malnutrition? If they don’t die of hunger, the effects of the dehydration and malnutrition that they’re experiencing now?

JAMES ELDER: Yeah, look, in one sense, it’s one of the saddest things you’ll see, because a malnourished child, literally, their body starts to feed on itself in its last desperate acts. As my executive director said when she was — she’s been in malnutrition centers around the world. Remember, in UNICEF, we are serving children around the world, and critical, critical scenarios for children particularly on nutrition, from places from Sudan to Ethiopia. And she spoke of just the silence in a malnutrition ward, because babies do not have the energy to cry.

But what usually kills children with this most severe form of malnutrition is a disease, a simple thing, pneumonia, a simple childhood disease. Children with severe acute malnutrition are 10 times more likely to be killed by that. And that is something that UNICEF has been warning about here for months. Because now Rafah has become a city of children, because the water system and the sanitation system have been devastated, it’s impossible to have the services here that children need. I mean healthcare. Never before in Gaza have so many children needed healthcare. Only one-third, one in three, hospitals are partially functioning. Toilets — toilets, both in terms of dignity but in terms of sanitation, Amy — the global standard in an emergency is one toilet for 20 people. Here we’re looking at about one toilet for 800. For a shower, multiply that by four, one shower for three-and-a-half thousand people. Imagine for a teenage girl, much less, yes, a pregnant woman or a child. So, our great fear, which we are starting to see, is when you have severe malnutrition and you add in disease, this is the perfect storm. This is when this horror show for children becomes just as lethal on the ground as it currently is from the skies.

AMY GOODMAN: Now, of course, this is aside from the — I think the number has topped 14,000 of children who have died, uncounted number of them still in the rubble. If you can talk about this death toll, and also compare Gaza to other conflict zones you’ve been in, James Elder? You’ve been all over the world, to say the least.

JAMES ELDER: Yeah, look, for me, Amy, in a way, I’m loath to make the comparison, simply because, for UNICEF and myself, of course, a child is a child wherever they are. And when you see what’s happened to children, you know, from Ukraine to Afghanistan, it’s horrendous, and that’s why my colleagues are frontline workers in all of these places.

Yes, though, there is something particular here, the intensity of devastation. Obviously, it’s such a big child population in a compact space with, let’s be clear, indiscriminate attacks. The numbers you’re sharing there, it’s unprecedented. And when you see in a hospital those wounds of war to children, Amy, remembering that when there is a missile or a bomb on a family home, it’s not just one injury to a child. It’s the broken bones. It’s the burns. It’s very hard to look, but we must keep looking, the burns on a child. And it’s the shrapnel. These are the images that I turn, every time I turn around in a hospital, and I don’t think I’ve seen that, that consistency.

You have these rare moments, Amy, of clutching onto some hope. And once was a moment in a hospital, a little boy Mohamed, now, he had bad burns, but as I walked in to Mohamed, he made this little effort — it hurt him — to put a little thumbs-up, an unsolicited movement. And I just thought, “Wow! What a character!” And then the adult with him explained that Mohamed was also the best student in his school, showed me photographs of this beautiful little boy receiving awards. And I thought, “This little guy’s going to be OK.” And you hold onto these moments. Then that adult explained to me that when the missile hit Mohamed’s home, it killed everyone. And because families are hunkering down, I mean everyone — mother, father, siblings, grandparents, aunts, uncles, cousins. Mohamed didn’t know this yet, but Mohamed is now the last surviving member of his entire family.

These horror stories, Amy, are being normalized here. I didn’t think I’d ever hear such a thing in Gaza, but I’m hearing it time and again, time and again. So, yes, and these wounds of war, I should add, you know, in the last two days, I made a point to go to hospitals since the ceasefire decision, which was a cause of great hope here. Great hope. Well, that hope has been well and truly drowned out right now by bombs. And I saw many children who doctors did not think would still be alive today based on the bombings that have occurred since Monday’s decision.

AMY GOODMAN: You’re standing, James Elder, in Rafah. If you can talk about what’s happening right now in Rafah? You have Prime Minister Benjamin Netanyahu saying, absolutely, an invasion, ground invasion, will happen. It’s not a matter of “if,” it’s a matter of “when.” You have talked about a possible ground invasion in Rafah. What would this mean?

JAMES ELDER: The horrors in Gaza do start to outstrip our ability to describe them. And it would be a catastrophe. But, of course, that word has been rightly used many times. But this is a city of children, as I say. This city, Rafah, now has twice the population density of New York City, but — I don’t know what you can see, OK, but that’s as tall as they get. This is ground level. And most people — most people are in tents. They’re in street corners. They’re on beaches. They’re in what was agriculture, what was agriculture. They’re ground level, 600,000 children here.

And what they’ve endured, I mean, we’re in uncharted territory when it comes to the mental health of these children. Amy. Night after night, even for me — and I get to leave this place — for me, I lie in bed, and you hear the bombardments that wake you, and your building shakes, and you lie there feeling like lying in a coffin. Like, what are the chances of waking tomorrow morning? Children here go through that with their families every night. Every night with a mother and child, there’s no lullaby you sing to a child to drown that out.

And so, for those people here, not only are they just holding on, their coping mechanisms at a wit’s end, they have nowhere to go. We have to understand that. It’s not — the social services are devastated. Khan Younis, the city next door, as I say, I’ve never seen that level of annihilation. Gaza City, further north, the same. There’s talk of an area near here, al-Mawasi. It’s a beach. You know, literally, you’d be doubling the population density again. So, it’s a terrifying thought, Amy. I didn’t imagine it would come to this, but, yes, as you rightly say, the conversation is very commonplace now. I just wish people could see the density of people here, could see the exhaustion, could listen to a doctor as I speak to him in a hospital as he’s treating a child with massive head wounds, and the doctor’s in tears, saying, “What did this child do?” Well, we will see that on a scale I don’t think any of us, certainly not me, can imagine.

AMY GOODMAN: Finally, what would an immediate ceasefire mean for the children of Gaza, for the whole population there?

JAMES ELDER: You know, I’m glad you end like that, because that gives me a chill. Everyone asks still: Do we have hope? Is there hope? And most people hold on to this idea, Amy, of like, as a mother said, “I’ve lost my — I’ve lost two children. I’ve lost my home. I’ve lost my ability to earn income. I’ve lost my ability to feed my remaining child. All I have is hope.”

Now, a ceasefire is a game changer. Ceasefire. Firstly, let’s get the hostages home. There are children somewhere, after five-and-a-half months. End the torment. End the torment for they and their families. A ceasefire enables us finally to flood the Gaza Strip with aid and bring this nutritional crisis, imminent famine — make no doubt about it, imminent famine. And a ceasefire, Amy, means that those families that I spoke of, who tonight again will endure what I mentioned there, they will go to bed, if there’s a ceasefire, a mother and her child, and they will know, for the first time in months, that they will wake up tomorrow.

AMY GOODMAN: James Elder, UNICEF spokesperson — UNICEF stands for the United Nations International Children’s Emergency Fund — joining us today from Rafah in the Gaza Strip. Thank you so much, and be safe.

When we come back, we speak with the head of a corporate activist group who was just subpoenaed before Jim Jordan’s House panel. We’ll talk about shareholder and corporate responsibility. Stay with us.