Israel and Hamas Face Growing Pressure for a Cease-Fire Deal

With Israel and Hamas under increasing international pressure to halt fighting in Gaza after seven months of war, a delegation of Hamas leaders traveled to Cairo on Saturday for talks aimed at clinching a cease-fire and hostage-release agreement, the group's officials said.

Over the past few days, Israel and mediators in the talks — Egypt, Qatar and the United States — have been waiting for Hamas's response to the latest cease-fire proposal from Israel. Husam Badran, a senior Hamas official, said in a text message that the group's representatives arrived in Cairo "with great positivity" toward the latest proposal.

As the Saturday drew to a close, though, the mediators were still waiting for an answer. Hamas officials said they were still talking about the central impasse in negotiations: Hamas is seeking a deal that would lead to a permanent cease-fire and the full withdrawal of Israeli troops from Gaza, while Israel wants a temporary cease-fire and has pledged to eventually carry out a ground offensive against Hamas in the southern city of Rafah.

"We are still talking about the main issues, which are the complete cease-fire and complete withdrawal from Gaza," a spokesman for Hamas, Osman Hamdan, said in an interview with the Al Jazeera television network.

Qatari mediators also arrived in Cairo on Saturday, a Qatari official said, joining William J. Burns, the head of the Central Intelligence Agency, who reached the city on Friday to help shepherd the talks.

Israel has yet to dispatch a delegation to Cairo as it did in previous rounds of talks, according to two Israeli officials who spoke on the condition of anonymity.

Even if Hamas announces in Cairo that it has accepted the proposed deal, the truce would not start right away, one of the Israeli officials said. Hamas's approval would be followed by intensive negotiations to hash out the details of a cease-fire, and such talks are likely to be protracted and difficult, the official said.

Though the details are still being negotiated, the current proposed agreement has three phases and would begin with a six-week truce, during which up to 33 hostages held in Gaza would be released in exchange for hundreds of Palestinians imprisoned by Israel, the officials said.

The deal would also allow the return of hundreds of thousands of displaced Palestinian civilians to northern Gaza with few restrictions, officials say, previously a major sticking point for Israel.

Fuad Khuffash, a political analyst close to Hamas, said Hamas officials view the current proposal as being closer to their preferred framework than previous Israeli positions. "Israel has slowly retreated from its demands due to rising pressure, even as Hamas has stayed steadfast," he said.

In Israel, Mr. Netanyahu faces substantial opposition within his governing coalition to the proposed deal. Some of his far-right partners have harshly criticized its provisions as a Hamas victory and threatened to oppose it, particularly if it were to put a definitive end to the war.

Agreeing to the deal would be "humiliating surrender," Bezalel Smotrich, the country's finance minister, wrote on Facebook late last month. "It would bestow victory to the Nazis on the backs of hundreds of heroic soldiers who died in battle."

For weeks, Mr. Netanyahu has vowed that Israeli forces will enter Rafah, where many of Hamas's remaining military forces are believed to be arrayed alongside some of its leaders. The plan has prompted widespread criticism, including from the Biden administration, fueled by concern for safety of the over one million Palestinians sheltering there.

Senior Biden administration officials have spoken repeatedly with their Israeli counterparts to discuss how Israel might safely evacuate and protect Palestinian civilians during a ground operation in Rafah. Israel has yet to present an acceptable proposal to Washington, Mr. Blinken said.

"Absent such a plan, we can't support a major military operation going into Rafah, because the damage it would do is beyond what's acceptable," he said.

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The director of the World Food Program, Cindy McCain, says that parts of the Gaza Strip are experiencing a "full-blown famine" that is rapidly spreading throughout the territory after almost seven months of war.

Ms. McCain is the second high-profile American leading a U.S. government or U.N. aid effort who has said that there is famine in northern Gaza, although her remarks do not constitute an official declaration, which is a complex bureaucratic process.

"There is famine — full-blown famine in the north, and it's moving its way south," Ms. McCain said in excerpts released on Friday of an interview with "Meet the Press." The interviewer, Kristen Welker, asked Ms. McCain to repeat herself.

"What you are saying is significant," Ms. Welker said. "You are saying there is full-blown famine in northern Gaza?"

"Yes, I am," Ms. McCain replied. "Yes, I am."

The first American official to say there was famine in Gaza during the conflict was Samantha Power, the director of the U.S. Agency for International Development, who made her remarks in congressional testimony last month.

Ms. McCain was appointed by President Biden as the American ambassador to the U.N. Agencies for Food and Agriculture in 2021 and became head of the W.F.P., a U.N. agency, last year.

An official declaration of famine typically involves both the United Nations and the government of the country where the famine is taking place, and it is unclear what local authority might have the power to do that in Gaza.

In the interview, Ms. McCain did not explain why an official famine declaration has not been made. But she said her assessment was "based on what we have seen and what we have experienced on the ground."

"It is horror," she said. "It is so hard to look at, and it is so hard to hear, also. I am so hoping we can get a cease-fire and begin to feed these people, especially in the north, in a much faster fashion."

Gaza has been gripped by what experts have called a severe human-made hunger crisis as a result of Israeli bombardment and restrictions that have made delivering aid to the territory extremely challenging. The amount of aid entering Gaza has increased recently, but aid groups say it is far from adequate.

For the first several weeks of the war, Israel maintained what it called a "complete siege" of Gaza, with Defense Minister Yoav Gallant saying that "no electricity, no food, no water, no fuel" would be allowed into the territory. The Israeli military also destroyed Gaza's port, restricted fishing and bombed many of its farms.

Israel eventually loosened that siege but instituted a meticulous inspection process that it says is necessary to ensure that supplies do not fall into the hands of Hamas. Aid groups and foreign diplomats have said the inspections create bottlenecks, and have accused Israel of using them to turn away aid for spurious reasons, including water filters, solar lights and medical kits that contain scissors.

Volker Türk, the U.N. human rights chief, said in a statement last month that Israel's policies regarding aid in Gaza could amount to a war crime.

Israel has faced increasing pressure in recent weeks to allow aid into Gaza after its military killed seven international aid workers from World Central Kitchen in an airstrike.

When Cindy McCain, the director of the World Food Program, said that parts of the Gaza Strip were experiencing a "full-blown famine," her remarks did not constitute an official declaration.

For aid groups and the United Nations, officially determining that a famine exists is a technical process. It requires analysis by experts, and only government authorities and top U.N. officials can declare one.

Ms. McCain did not explain why an official famine declaration has not been made. But she said her assessment was "based on what we have seen and what we have experienced on the ground."

So how is famine defined? Here's a closer look.

What is a famine?

Food insecurity experts working on the Integrated Food Security Phase Classification, or I.P.C., an initiative controlled by U.N. bodies and major relief agencies, identify a famine in an area on the basis of three conditions:

• At least 20 percent of households face an extreme lack of food.

• At least 30 percent of children suffer from acute malnutrition.

• At least two adults or four children for every 10,000 people die each day from starvation or disease linked to malnutrition.

Since the I.P.C. was developed in 2004, it has been used to identify only two famines: in Somalia in 2011, and in South Sudan in 2017. In Somalia, more than 100,000 people died before famine was officially declared.

I.P.C. analysts expressed grave concern about food insecurity in Yemen and Ethiopia, related to the civil wars in those countries, but said not enough information was available from governments to issue a formal assessment.

The classifications of famine in Somalia and South Sudan galvanized global action and spurred large donations. Aid workers and hunger experts point out that the hunger crisis in Gaza is already dire, with or without a famine classification.

What is the situation in Gaza?

Palestinians, particularly in the north, have been fighting starvation. The amount of aid entering Gaza has increased recently, but aid groups say it is still not adequate.

The first I.P.C. report on Gaza, released in December, found that the enclave's entire population was experiencing food insecurity at crisis or worse levels. Though the group said Gaza had not yet crossed the famine threshold, it warned that the risk of famine-level hunger would increase if the war did not stop.

A second food security analysis in March found projected that famine was "imminent" for the 300,000 Palestinian civilians in northern Gaza, and that such conditions would develop by the end of May.

What are the complications?

The December I.P.C. analysis relied on publicly available data from international and local aid groups in Gaza that the group said met its methodology standards. But I.P.C. analysts said they lacked recent data on the prevalence of acute malnutrition. Getting that data is very difficult in a war zone and poses a burden on already overwhelmed health care workers, the group added.

The organization's criteria were originally designed to address weather-related famine, not crises like the one in Gaza. But most severe hunger crises in recent history have been driven by conflict rather than climate.

And while I.P.C. experts perform the analysis that can classify a famine, it is up to government authorities and the United Nations to formally declare one.

In some cases, countries have hesitated to do so. In 2022, Somalia's president expressed reluctance to declare a famine during a severe hunger crisis brought on by a drought. And in 2021, Ethiopia blocked the declaration of famine in the Tigray region through heavy lobbying, according to a top U.N. official.

It is unclear exactly what authority could declare a famine in Gaza. The I.P.C. group said the process typically involves the government in a country and its top U.N. official. Determining who that authority would be in Gaza was beyond the organization's scope, it said.

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Two Israeli men who were believed to have been taken hostage by Hamas fighters on Oct. 7 were actually killed during the attacks that day, according to Israeli authorities and relatives of the men.

One of the men, Dror Or, 49, was killed during a brutal assault on the Kibbutz Be'eri in which at least 97 people died, and the attackers took his body with them when they retreated back to Gaza, the kibbutz said in a statement released on Thursday.

The Israeli military announced that the remains of a second man who had been listed as a hostage, Elyakim Libman, had been found in Israeli territory after an investigation and forensic tests. He, too, was killed on Oct. 7, the military said.

Their cases are not isolated. The Israeli authorities have determined through investigation and forensic evidence that at least five other people who were initially thought to have been taken hostage were actually killed during the Oct. 7 Hamas-led attacks. In some cases, their bodies were taken and are still held in Gaza. At least three hostages were killed by the Israeli military during its ground operations in Gaza, and another was killed in a failed rescue mission.

Israeli authorities have said that about 250 people were taken, alive or dead, by Hamas and other armed groups and transported to Gaza. More than 100 have been returned, most of them during a weeklong autumn cease-fire. In February, Israeli authorities estimated that dozens of the remaining hostages inside Gaza were already dead, leaving as many as about 100 hostages still alive.

Many family members of hostages have become increasingly angry with how the Israeli government is handling the war, saying it should be doing more to secure a deal that would release their loved ones, even if that means toning down or halting the offensive against Hamas. Talks for a cease-fire deal have stalled for months; on Thursday, Hamas leaders hinted at progress and said they were reviewing Israel's latest proposal.

Mr. Or's brother, Elad Or, criticized the Israeli government for failing to stop the terrorist attacks on Oct. 7 and for not winning the release of the hostages.

"We need an immediate agreement!" he was quoted as saying in the kibbutz statement. "Enough with the foot-dragging and political games! Only an agreement can bring back the living hostages, crying to come home, and afterward, also return Dror's body for burial in Israel."

Mr. Or's two children, Noam Or, 17, and his sister, Alma, 13, were also taken hostage. They were released from Gaza on Dec. 1. Their mother, Yonat, was killed in the Oct. 7 attacks.

Mr. Or's nephew, Liam Or, 18, was also taken hostage at his home and released in November.

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A Palestinian doctor from the Gaza Strip, detained by Israeli forces and held for four months, has died in detention, Palestinian officials and detainee rights groups say.

Dr. Adnan Ahmad Albursh, 50, the head of orthopedics at Al-Shifa Hospital, the Gaza Strip's biggest medical center, was detained along with other doctors in December by Israeli forces when they raided a hospital, according to the Palestinian Commission of Detainees' Affairs and the Palestinian Prisoners Club, which advocate for the rights of Palestinian detainees held by Israel.

Israel's military and prison service did not immediately respond to requests for comment. The Times of Israel cited the military as confirming that the Israeli prison service had declared Dr. Albursh dead on April 19, without giving a cause of death. It said he had been detained for national security reasons.

Israel has detained thousands of Palestinians from Gaza, including women and children. Former detainees have said that they suffered beatings and other physical abuse in Israeli custody, and the United Nations human rights office has said Israel's treatment of detainees might amount to torture, which Israel denies. International human rights groups say they have been denied access to detainees.

Dozens of Palestinians have died in Israeli custody since Oct. 7, according to the Israeli military and rights groups. The Israeli military has said it is aware of the deaths of 27 Palestinians in its custody.

The prisoner rights groups accused Israel of abusing and killing Dr. Albursh, but did not offer evidence for their claims, or say how they knew about the circumstances of his confinement and death.

Dr. Albursh was detained while at Al Awda Hospital, where he fled after leaving Al Shifa, they said.

"He had a determination to continue treating his fellow countrymen," said his nephew Khaled Albursh. "He could have left but he insisted on continuing to treat the wounded in the hospitals and even in the homes."

Milena Ansari, an Israel and Palestine assistant researcher at Human Rights Watch, said Dr. Albursh's death raised grave concerns about the treatment of Palestinian detainees, and called for an independent investigation into the deaths of Palestinians in Israeli custody.

"This is not an isolated case," she said, adding, "Those responsible for grave abuses should be prosecuted."

The Israeli military has alleged that Hamas, the Palestinian political and armed group that took control of Gaza in 2007, built a command center in tunnels underneath Al-Shifa. Hamas and hospital administrators have rejected that claim.

Gaza's medical system has come under sustained attack since Israel began its devastating bombing campaign and invasion of Gaza, in response to the Hamas-led attack in Israel on Oct. 7. Nearly 500 medical workers have been killed, the Palestinian Ministry of Health said.

The World Health Organization said that since Oct. 7, it has documented 443 attacks on health care facilities resulting in 723 fatalities.

On Dr. Albursh's Facebook page, what appeared to be his last post appeared on Nov. 20.: "We will die standing and we will not kneel," it said.

Rawan Sheikh Ahmad contributed reporting.