“I met a little boy who was wounded by a tank shell at one of these sites on the final day of me leaving Gaza – I learnt that this little boy had since died of those injuries,” said UN Children’s Fund (UNICEF) spokesperson James Elder. “That speaks to both what is happening at these sites and what is not happening when it comes to medical evacuations.”

A recent online video featuring a dying 13-year-old Abed al-Rahman who Mr. Elder met while on mission in Gaza has been seen thousands of times since it was published on 6 June. In the clip, Abed explains that he has been asking for pain relief for his shrapnel wounds, but none is available.

Speaking to journalists from Amman, Mr. Elder explained that partly destroyed hospitals including Nasser Medical Complex in Khan Younis continue to treat wounded children, despite a shortage of medicine and medical supplies.

“Humanitarian aid is so much more than food in a box; it’s oxygen kits, it’s ventilators, it’s hygiene packs; it’s medicines, it’s incubators,” he explained. “It’s all those things the United Nations was doing just a couple of months ago.”

Mr. Elder added that parents whose children need oxygen have been leaving hospital “because of the fear that Nasser may come under attack again. As the doctors told me, if you have a child who needs oxygen and they leave without the oxygen, they will, over a matter of time, die in a tent.”

Desperation, starvation

The dire shortage of the most basic life-sustaining aid linked to Israeli restrictions continues to create desperation and starvation across Gaza.

“I spoke to a grandmother in tears saying, how am I possibly to get to these sites?” Mr. Elder explained. “I’ve met young men who’ve been seven times and never returned with anything. So, there’s a complete lack of equity. There’s a complete lack of sites. You cannot distribute aid in a militarised zone, in a combat zone, by one party to the conflict.”

Those most susceptible to the lack of fresh drinking water, food and fuel are the weakest Gazans: the young, pregnant women, the elderly and amputees, Mr. Elder said. 

It would be impossible for them to walk the long distances required to fetch scant supplies from controversial non-UN aid hubs.

Lethal choice

“You have half a million people facing starvation with a lethal choice of being forced into very small pockets where most people can’t access into what are officially known as combat sites,” the UNICEF spokesperson explained. “We know children [who have been] killed at these sites.”

Meanwhile, malnutrition and the impact of it on people’s weakened immune systems continues to take its toll, the UN World Health Organization (WHO) warned.

“The latest reports say 610 patients have been admitted due to severe malnutrition complications,” said WHO spokesperson Christian Lindmeier. “But what does that mean? That means these are the lucky ones who made it so far to get to a place. 

“This does not count the many who were too weak to reach any point, who are too weak, who cannot be transported because the roads are blocked, because there are no ambulances, or because the hospitals, some of the health emergency centres have been shelled and bombed and are being constantly shelled and bombed.”

This number represents a 25 per cent increase from 2023, marking the third consecutive year that violations have increased. 22,495 violations were committed against children themselves while the remaining targeted infrastructure such as schools and humanitarian aid intended for and used by children.

“The cries of 22,495 innocent children who should be learning to read or play ball — but instead have been forced to learn how to survive gunfire and bombings — should keep all of us awake at night,” said the Special Representative of the UN Secretary-General for Children and Armed Conflict, Virginia Gamba.

The report only details violations which could be independently verified by the United Nations, meaning the actual number of grave violations and children affected are likely much higher.

‘Children should not be a casualty of war’

The report attributed the increase to indiscriminate attacks — especially urban warfare — in addition to disregard for peace agreements and deepening humanitarian crises worldwide.

“Children living amidst hostilities are being stripped of their childhood … When we allow this to happen, we are not just failing to protect children – we are taking away their chance to grow up safe, to go to school, and to live a life with dignity and hope,” Ms. Gamba said.

In addition to the broader increase, the number of children subjected to multiple grave violations increased by 17 per cent.

The highest number of violations, 8,554, occurred in Israel and the Occupied Palestinian Territories – more than double the number in the Democratic Republic of the Congo (DRC) which followed.

Governments ‘blatantly’ ignore international law

The report noted that while non-State actors played an out-sized role in violations against individual children, government actors were the main forces responsible for killing and maiming children, attacking schools and hospitals, and denying humanitarian access.

“Instead of recognizing the special protection afforded to children, governments and armed groups around the world blatantly ignore international law that defines a child as anyone under 18,” Ms. Gamba said.

The report listed eight countries whose government forces violated international law and committed grave violations against children — the DRC, Israel, Myanmar, Somalia, South Sudan, Sudan, Syria and Russia.

‘A wake-up call’

In 2024, 16,482 children formerly associated with armed forces or groups received protection or reintegration support, but numbers of violations against children still remain staggeringly high.

The Secretary-General called on all Member States to adhere to their obligations under international law by upholding the rights and special protections of children while also expanding services to treat children who are victims of conflict.

Ms. Gamba reiterated this call, saying that the increase in grave violations should be a “wake-up call” and reminding the international community that indifference to such violations will not bring peace.

“We face a choice that defines who we are: to care, or to turn away …  We all share the duty to act—with urgency, with determination—to bring this suffering to an end. Not tomorrow. Not someday. Today,” she concluded.