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The heads of the United Nations World Food Programme and UN children's agency UNICEF have privately appealed to Israeli Prime Minister Benjamin Netanyahu for help "alleviating the suffering of countless civilians" in the Gaza Strip, West Bank and Lebanon, according to a letter seen by Reuters on Monday.

"Effective and meaningful humanitarian action is possible with your political will and commitment," wrote UNICEF Executive Director Catherine Russell and WFP Executive Director Cindy McCain in the previously unreported letter dated October 11.

Netanyahu's office did not immediately respond to a request for comment on the letter. The amount of aid entering Gaza has plummeted to its lowest level all year, according to UN data. In addition, a global hunger monitor has warned of a looming famine, and the UN has accused Israel of denying and impeding dozens of attempts this month to deliver aid, particularly to Gaza's north which has been under a heavy offensive over the past two weeks, which has killed hundreds.

The United States said last week it was watching to ensure that its ally's actions on the ground show it does not have a "policy of starvation" in the north. Israel has claimed there is not a lack of aid in Gaza and accused Hamas of "hijacking the humanitarian assistance". Hamas has repeatedly denied Israeli allegations that it was stealing aid and says Israel is to blame for shortages.

"We call on your support, as Prime Minister, to ensure that the government of Israel upholds its obligations and commitments to enable effective emergency relief operations, and to protect the safety and security of our staff and the civilians they serve," Russell and McCain wrote.

They sent their letter just after Gaza marked one year of Israel's brutal military campaign, which has now killed at least 42,603 Palestinians, with thousands more feared buried under rubble. The enclave has witnessed a catastrophic humanitarian crisis since, with hunger and diseases spreading at an alarming rate.

The UN appeal also came two days before the United States told Israel it must take steps within 30 days to improve the humanitarian situation in Gaza or face potential restrictions on US military aid. Russell and McCain - both Americans who were put forward for their top UN jobs by US President Joe Biden - listed six areas where they want "clear and concrete commitments" from Netanyahu.

They asked Netanyahu to appoint a "high-level focal point" for them to address the issues they raised in the letter.

'Rules of engagement'

They called on all parties to exercise maximum restraint to protect civilians and critical civilian services. They also wrote that the UN and aid groups "need unequivocal security assurances to ensure a safe operating environment," specifically streamlined operating procedures with the Israeli military.

"The rules of engagement and their implementation in practice, in the Gaza Strip, the West Bank, and Lebanon, must reflect the IDF's obligation and commitment to respect, protect, and facilitate humanitarian action," said Russell, a former senior aide to Biden, and McCain, Biden's former ambassador to the UN agencies for food and agriculture in Rome.

They urgently appealed for an effective humanitarian notification system that the Israeli military "acknowledges and supports," citing the success of using area-specific pauses in fighting to allow for the polio vaccination of children in Gaza.

"We request this be applied consistently to facilitate humanitarian action at scale," Russell and McCain wrote. The United Nations needs action to combat the breakdown of law and order in Gaza, they said, asking for all access points to be opened, expanded operating hours, approval of more routes within Gaza and urgent road repairs.

The UN has repeatedly complained of obstacles to getting aid into Gaza and distributing it, blaming impediments on Israel and lawlessness. Health authorities in Gaza say more than 42,000 people have been killed and almost the entire population of 2.3 million displaced.

At least 312 aid workers, including 230 UN staff, have been killed in Gaza, according to UN figures. Commercial goods must start flowing again, wrote McCain and Russell, because "humanitarian assistance alone cannot sustain two million people." Israel has stopped processing requests from traders to import food to Gaza, Reuters reported last week. Their final request was for all parties work toward securing a ceasefire across Israel, the Gaza Strip, and Lebanon, including the immediate and unconditional release of all hostages held by Hamas in Gaza for the past year.

The UN is also now dealing with a humanitarian crisis in Lebanon, where Israel has stepped its aggression, conducting airstrikes mostly in Beirut and the country's south, before and launching a ground operation on October 1.