International outcry over images of emaciated children and increasing reports of hunger-related deaths have pressured Israel to let more aid into the Gaza Strip. This week, Israel paused fighting in parts of Gaza and airdropped food.

But aid groups and Palestinians say the changes have only been incremental and are not enough to reverse what food experts say is a ” worst-case scenario of famine” unfolding in the war-ravaged territory.

The new measures have brought an uptick in the number of aid trucks entering Gaza. But almost none of it reaches U.N. warehouses for distribution.

Instead, nearly all the trucks are stripped of their cargo by crowds that overwhelm them on the roads as they drive from the borders. The crowds are a mix of Palestinians desperate for food and gangs armed with knives, axes or pistols who loot the goods to then hoard or sell.

Many have also been killed trying to grab the aid. Witnesses say Israeli troops often open fire on crowds around the aid trucks, and hospitals have reported hundreds killed or wounded. The Israeli military says it has only fired warning shots to control crowds or at people who approach its forces. The alternative food distribution system run by the Israeli-backed Gaza Humanitarian Foundation has also been marred by violence.

International airdrops of aid have resumed. But aid groups say airdrops deliver only a fraction of what trucks can supply. Also, many parcels have landed in now-inaccessible areas that Palestinians have been told to evacuate, while others have plunged into the Mediterranean Sea, forcing people to swim out to retrieve drenched bags of flour.

Here’s a look at why the aid isn’t being distributed:

A lack of trust

The U.N. says that longstanding restrictions on the entry of aid have created an unpredictable environment, and that while a pause in fighting might allow more aid in, Palestinians are not confident aid will reach them.

“This has resulted in many of our convoys offloaded directly by starving, desperate people as they continue to face deep levels of hunger and are struggling to feed their families,” said Olga Cherevko, a spokesperson for the U.N. Office for the Coordination of Humanitarian Affairs, or OCHA.

“The only way to reach a level of confidence is by having a sustained flow of aid over a period of time,” she said.

Israel blocked food entirely from entering Gaza for 2 months starting in March. Since it eased the blockade in late May, it allowed in a trickle of aid trucks for the U.N., about 70 a day on average, according to official Israeli figures. That is far below the 500-600 trucks a day that U.N. agencies say are needed – the amount that entered during a six-week ceasefire earlier this year.

Much of the aid is stacked up just inside the border in Gaza because U.N. trucks could not pick it up. The U.N says that was because of Israeli military restrictions on its movements and because of the lawlessness in Gaza.

Israel has argued that it is allowing sufficient quantities of goods into Gaza and tried to shift the blame to the U.N. “More consistent collection and distribution by U.N. agencies and international organizations = more aid reaching those who need it most in Gaza,” the Israeli military agency in charge of aid coordination, COGAT, said in a statement this week.

With the new measures this week, COGAT, says 220-270 truckloads a day were allowed into Gaza on Tuesday and Wednesday, and that the U.N. was able to pick up more trucks, reducing some of the backlog at the border.

Aid missions still face ‘constraints’

Cherevko said there have been “minor improvements” in approvals by the Israeli military for its movements and some “reduced waiting times” for trucks along the road.

But she said the aid missions are “still facing constraints.” Delays of military approval still mean trucks remain idle for long periods, and the military still restricts the routes that the trucks can take onto a single road, which makes it easy for people to know where the trucks are going, U.N officials say.

Antoine Renard, who directs the World Food Program’s operations in Gaza and the occupied West Bank, said Wednesday that it took nearly 12 hours to bring in 52 trucks on a 10-kilometer (6 mile) route.

“While we’re doing everything that we can to actually respond to the current wave of starvation in Gaza, the conditions that we have are not sufficient to actually make sure that we can break that wave,” he said.

Aid workers say the changes Israel has made in recent days are largely cosmetic. “These are theatrics, token gestures dressed up as progress,” said Bushra Khalidi, Oxfam’s policy lead for Israel and the Palestinian territories.

“Of course, a handful of trucks, a few hours of tactical pauses and raining energy bars from the sky is not going to fix irreversible harm done to an entire generation of children that have been starved and malnourished for months now,” she said.

Breakdown of law and order

As desperation mounts, Palestinians are risking their lives to get food, and violence is increasing, say aid workers.

Muhammad Shehada, a political analyst from Gaza who is a visiting fellow at the European Council on Foreign Relations, said aid retrieval has turned into the survival of the fittest. “It’s a Darwin dystopia, the strongest survive,” he said.

A truck driver said Wednesday that he has driven food supplies four times from the Zikim crossing on Gaza’s northern border. Every time, he said, crowds a kilometer long (0.6 miles) surrounded his truck and took everything on it after he passed the checkpoint at the edge of the Israeli military-controlled border zones.

He said some were desperate people, while others were armed. He said that on Tuesday, for the first time, some in the crowd threatened him with knives or small arms. He spoke on condition of anonymity, fearing for his safety.

Ali al-Derbashi, another truck driver, said that during one trip in July armed men shot the tires, stole everything, including the diesel and batteries and beat him. “If people weren’t starving, they wouldn’t resort to this,” he said.

Israel has said it has offered the U.N. armed escorts. The U.N. has refused, saying it can’t be seen to be working with a party to the conflict – and pointing to the reported shootings when Israeli troops are present.

Uncertainty and humiliation

Israel hasn’t given a timeline for how long the measures it implemented this week will continue, heightening uncertainty and urgency among Palestinians to seize the aid before it ends.

Palestinians say the way it’s being distributed, including being dropped from the sky, is inhumane.

“This approach is inappropriate for Palestinians, we are humiliated,” said Rida, a displaced woman.

Momen Abu Etayya said he almost drowned because his son begged him to get aid that fell into the sea during an aid drop.

“I threw myself in the ocean to death just to bring him something,” he said. “I was only able to bring him three biscuit packets”.