The World Court has ordered Israel to "take all necessary and effective" action to ensure access to food and medical supplies for Gaza's Palestinian population in an effort to improve the humanitarian situation.
Thursday's unanimous order from the International Court of Justice's panel of judges came after South Africa sought more provisional measures, including a ceasefire, as part of its case accusing Israel of state-led genocide in Gaza.
Israel has rejected the accusations, saying it respected international law and would "expand" the current flow of humanitarian aid in Gaza.
In the legally binding order, the judges said Palestinians in the war-ravaged enclave faced worsening conditions.
"The court observes that Palestinians in Gaza are no longer facing only a risk of famine […] but that famine is setting in," the judges said in their order.
The measures are to be taken "without delay", the judges said, and should include "increasing the capacity and number of land crossing points and maintaining them open for as long as necessary".
They told Israel to report back in a month on its implementation of the orders.
Gaza's governing body Hamas said the ruling did not go far enough.
Senior Hamas official Basem Naim said a permanent ceasefire was needed to end the suffering of Palestinians.
"We welcome any new demands to end this humanitarian tragedy in Gaza and especially in the northern Gaza Strip," Mr Naim told Reuters.
"But we hoped the court ordered a ceasefire as an absolute solution to all the miseries our people in Gaza are living through."
South Africa also welcomed Thursday's decision, calling it "significant".
"The fact that Palestinian deaths are not solely caused by bombardment and ground attacks, but also by disease and starvation, indicates a need to protect the group's right to exist," the South African president said in a statement.
After initially sealing Gaza's borders in the early days of the war, Israel began to permit entry of humanitarian supplies.
It says it places no restrictions on the amount of humanitarian aid allowed into Gaza and accuses the United Nations of failing to properly organise the deliveries.
On Tuesday, the army said it inspected 258 aid trucks, but only 116 were distributed within Gaza by the UN.
The UN and international aid groups say deliveries have been impeded by Israeli military restrictions, ongoing hostilities and the breakdown of public order.
The Israeli foreign ministry accused South Africa of making "cynical attempts" to exploit the World Court to undermine Israel's right to self-defence and to win the release of remaining hostages.
Ministry spokesperson Lior Haiat said Hamas continues to hold some 100 hostages and the remains of 30 others either killed during the October 7 terrorist attack or who died in captivity.
"Israel will continue to promote new initiatives, and to expand existing ones, in order to enable and facilitate the flow of aid to the Gaza Strip … despite the operational challenges on the ground and Hamas' active and abhorrent efforts to commandeer, hoard and steal aid," he said in a statement.
"As has been repeatedly affirmed, Israel is committed to international law, including with respect to allowing and facilitating the transfer of essential humanitarian aid to the civilian population in the Gaza Strip."
The UN Security Council voted on Tuesday to demand an immediate ceasefire and the immediate and unconditional release of all hostages. The United States abstained from — but did not veto — the vote.
Israeli leaders have said Hamas can end the war by surrendering, freeing all hostages it holds in Gaza and handing over for trial those involved in the October 7 attack.
The Israeli Army said it continued to operate around the Al-Shifa Hospital complex in Gaza City after storming it more than a week ago.
Its forces had killed about 200 gunmen since the start of the operation "while preventing harm to civilians, patients, medical teams, and medical equipment", the Israeli military said.
Shortages of food, water and medicine
Gaza's health ministry said wounded people and patients were being held inside an administration building in Al-Shifa that was not equipped to provide them with healthcare.
Five patients had died since the Israeli raid began due to shortages of food, water and medical care, the ministry said.
Ismail Al-Thawabta, the director of the Gaza Hamas-run government media office, said the Israeli army was carrying out "field killings and executions against hundreds of civilians" when asked about the Israeli Army statement.
"Everyone inside the Shifa complex are civilians, and there are no military personnel inside the compound," he told Reuters.
Al-Shifa, the Gaza Strip's biggest hospital before the war, had been one of the few healthcare facilities even partially operational in north Gaza before the latest fighting. It had also been housing displaced civilians.
Unverified footage on social media showed its surgery unit blackened by flames and nearby apartments on fire or destroyed.
The armed wings of the Hamas and Islamic Jihad militant groups said in a statement they "bombed, with a barrage of mortar shells, gatherings of Israeli soldiers in the vicinity of the Al-Shifa Complex," in a joint operation.
Israel said it is targeting Hamas militants who use civilian buildings, including apartment blocks and hospitals, for cover. Hamas denies doing so.
At least 32,552 Palestinians have been killed and 74,980 wounded in Israel's military offensive in the Gaza Strip since October 7, the territory's health ministry said on Thursday.
Thousands more dead are believed to be buried under rubble and more than 80 per cent of Gaza's 2.3 million population is displaced.
The war erupted after Hamas militants broke through the border and rampaged through communities in southern Israel, killing 1,200 people and abducting 253 hostages according to Israeli figures.
Two more hospitals besieged
In Rafah, where more than a million people have been sheltering, health officials said an Israeli air strike on a house killed at least 12 people.
Israel says it plans a ground offensive into Rafah, in the far south of the enclave, where it believes most Hamas fighters are now sheltering.
Its closest ally and main arms supplier, the US, opposes such an assault, arguing it would cause too much harm to civilians who have sought refuge there.
Israeli forces also continued to blockade Al-Amal and Nasser hospitals in Khan Younis, in southern Gaza, while several other areas came under Israeli fire, residents said.
The Palestinian Red Crescent said seven people working for the organisation arrested in a raid on Al-Amal hospital on February 9 had been released after 47 days in Israeli prisons.
Among them was the director of ambulance and emergency services in the Gaza Strip, Mohammed Abu Musabeh. Eight members of the association were still being detained, it said in a statement.
Israel said soldiers from its Commando Brigade had arrested dozens of Palestinian militants in the Al-Amal area and discovered explosives and dozens of Kalashnikov-type weapons.
The World Health Organization said Al-Amal Hospital had ceased to function due to fighting, leaving just 10 of 36 hospitals in the Gaza Strip partially operational.
AP/Reuters
