Israel’s siege, bombardment and ground offensive have created what the United Nations and aid officials call a man-made crisis of near starvation. Several hundred thousand Palestinians in northern Gaza face imminent famine, with little aid able to reach them, the UN says.

In Gaza’s southernmost city, a crowd of children and men thrust their pots and bowls out for meals being distributed by an aid group. An impromptu tent city has blanketed the edges of Rafah, filled with hundreds of thousands of Palestinians who fled Israel’s offensive in other parts of Gaza. The influx has swelled Rafah to some 1.4 million people, some five times the normal population.

In one photo, a girl looks on in shock as a man carries a child out of the rubble of a building in the southern city of Khan Younis, which has been the focus of Israel’s ground offensive for the past months. With entire blocks now in ruins, parts of Khan Younis are starting to resemble Gaza City in the north, where some estimates say about 70 percent of buildings have been destroyed or damaged.

At its six-month mark, it is not clear what direction the war will now take. Weeks of mediation by the United States, Egypt and Qatar for a longer ceasefire have so far been unable to make a breakthrough. But international pressure is ongoing for a halt in the war. Israel has also said it is determined to expand its offensive to Rafah, determined to uproot Hamas from what it says is its last stronghold. That has raised alarm over a possible dramatic increase in casualties and an escalation in the conflict.