Doctors and aid workers inside Gaza, themselves overworked and underfed, have been warning for months about the critical lack of food and the spiraling cost of the little that was available due to Israel’s offensive and crippling aid restrictions. They say that their worst fears are coming to pass.

“We are now facing a massive health disaster,” Dr. Ahed Jabr Khalaf, a pediatrician and intensive care specialist at Nasser Hospital in Khan Younis, told NBC News’ crew on the ground. He said Wednesday that several more children had died from malnutrition that day alone.

The warnings came as the world’s leading body on hunger, the Integrated Food Security Phase Classification, or IPC, sounded the alarm that the “worst-case scenario of famine” was now unfolding in the Palestinian enclave under Israel’s deadly military offensive and crippling aid restrictions.

A ‘tipping point’ ?

International outrage has grown as scenes show starvation spreading through the enclave, with dozens dying from malnutrition in recent weeks and people collapsing in the dirt. In the face of this mounting pressure the Israeli military began limited pauses in fighting to allow more supplies in — but aid officials have warned this is still far from enough.

It feels like the crisis may have already reached a “tipping point,” said Jeremy Konyndyk, president of Refugees International.

“Day after day, there are reports of multiple deaths from starvation,” said Konyndyk, an official with the U.S. Agency for International Development during the Obama and Biden administrations. “That is new, and that suggests that the population has now reached a point of vulnerability and deprivation,” he said in a phone interview Monday before the IPC’s report was released.

“And when you start to see that in small numbers, that tells you that bigger numbers are coming.”

“We’ve seen this in previous famine conditions, where once the numbers, the mortality numbers, start to rise, we have to act quickly and urgently to stem the tide of deaths due to starvation,” said Jeanette Bailey, the IRC’s Global Practice Lead and Director of Research for Nutrition. “If we don’t act now, we will see these numbers increasing exponentially, very quickly.”

The Palestinian health ministry in Gaza said Wednesday that 154 people had died from starvation since the war began, including 89 children. In a sign of how the situation has shifted, it is only in the past few weeks that the ministry has released daily updates of that tally.

“We know from pretty much every past famine, that the data always takes time to catch up to the reality on the ground,” Konyndyk said, noting the particular difficulties in accessing data given Israeli restrictions on access to Gaza.

“The situation has reached a critical inflection point,” agreed Emily Keats, an assistant scientist in international health at the Johns Hopkins Bloomberg School of Public Health in Baltimore. She said that it would only “continue to worsen unless the population is able to safely access food and adequate health services.”

Israeli Prime Minister Benjamin Netanyahu’s office said Tuesday following the IPC’s alert that the situation in Gaza was “difficult” but claimed Hamas had benefited from “attempting to fuel the perception of a humanitarian crisis.”

‘The impact is permanent’

Regardless, several health experts and advocates said children growing up in Gaza now would suffer from the health impacts of the hunger crisis for years to come.

“Their little bodies are shutting down,” Lanning said.

There had been a “spike in the number of children and infants who are being admitted to the hospital for malnutrition,” she said.