The Israeli military says it has begun the “initial stages” of its offensive on Gaza City, as it declared the largest urban centre in the besieged territory a “combat zone” and announced the suspension of daily pauses in fighting there that allowed the entry of humanitarian aid to the famine-hit city.

“We are not waiting. We have begun preliminary operations and the initial stages of the attack on Gaza City,” Israeli military spokesman Avichay Adraee wrote in a post on X on Friday.

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“We are currently operating with great force on the outskirts of the city,” he said.

The announcement came as the Israeli military confirmed it suspended so-called “tactical pauses” in its attacks on the city in northern Gaza that had previously allowed limited humanitarian operations there.

“Starting today at 10:00am (07:00 GMT), the tactical-local ceasefire of military activity will not apply to the Gaza City area, which constitutes a dangerous combat zone,” the military said on X.

Last week the Integrated Food Security Phase Classification (IPC) initiative said that famine was occurring in the Gaza governorate, a region where hundreds of thousands of Palestinians live that includes Gaza City.

The UN’s children’s agency warned on Friday that staff at a nutrition centre in Gaza City are struggling to cope with a surge in malnourished children.

“It’s clear on the ground that famine is absolutely ravaging Gaza City,” UNICEF spokesperson Tess Ingram told Al Jazeera during a visit to the facility, where desperate parents bring their children to be screened and treated. She said she had met “so many” parents who were “in complete despair because they have run out of options”.

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Health workers at the centre assess malnutrition by measuring children’s upper arms, with those at risk given fortified, high-energy biscuits as a preventative measure. Severely malnourished children receive ready-to-use therapeutic food, a concentrated paste designed to help them recover over several weeks.

“It’s basically a medicine that’s administered to children like a paste,” Ingram explained. “But we just don’t have enough, the demand is really high, and supplies are low.”

The IPC also warned that famine could soon spread to other areas of Gaza, as Israel continues to impose severe restrictions on supplies of humanitarian aid amid a deepening hunger crisis across the territory.

The Palestinian health ministry reported on Friday that at least five people, including two children, died of starvation and malnutrition in Gaza over the past 24 hours.

The deaths bring the total number of people killed by hunger and malnutrition since the war began to 322, including 121 children.

Israeli assault on Gaza City

Israeli forces have carried out a sustained bombardment on Gaza City since early August, as the military prepares for a larger assault to seize Gaza’s largest urban centre – in an operation that could forcibly displace a million Palestinians to concentration zones in southern Gaza.

The relentless bombardment from the air and land has forced residents to flee to the western parts of the city, the Palestinian Ministry of Health has told Al Jazeera.

Gaza’s Civil Defence estimates that more than 1,000 residential buildings in the Zeitoun and Sabra neighbourhoods of Gaza City have been flattened since August 6.

Residents described relentless bombardment and attacks from helicopters. “They launched a firebelt attack only 150 metres (500ft) away from us. They scorched the entire area,” said Nihad Madoukh from Sheikh Radwan in northwestern Gaza City, speaking to Al Jazeera. “It was very scary bombardment.”

Displaced resident Ahmed Moqat said he had been moving constantly to escape Israeli attacks. “Here’s the debris that fell last night next to my head,” he said. “Now I will go out in the street, only God knows where I will go.”

Dozens killed across Gaza

At least 41 Palestinians, including six aid seekers, were killed in attacks across Gaza on Friday, medical sources told Al Jazeera.

Palestinian health workers told Al Jazeera that three of the aid seekers were shot dead by Israeli forces near the Netzarim Corridor in central Gaza on Friday.

Medical sources said Israeli air strikes hit the so-called “safe zone” of al-Mawasi, west of Khan Younis, killing at least five people and wounding dozens as they slept in tents.

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“We were sleeping when the bombing happened,” said a man caring for his grandchildren, whose father was killed two months ago. “The strike hit our area … We took the wounded ourselves to Nasser Hospital before the ambulances arrived. Stop this war against us. Have mercy on the children.”

More than 62,600 Palestinians, mostly women and children, have been killed by Israel in its nearly two-year war on Gaza, and at least 157,600 have been wounded, according to Palestinian health authorities.