GAZA CITY, Gaza Strip (AP) — The world’s leading authority on food crises said Friday the Gaza Strip’s largest city is gripped by famine, and that it is likely to spread across the territory without a ceasefire and an end to restrictions on humanitarian aid.

The Integrated Food Security Phase Classification, or IPC, said famine is occurring in Gaza City, home to hundreds of thousands of Palestinians, and that it could spread south to Deir al-Balah and Khan Younis by the end of next month.

The IPC determination comes after months of warnings by aid groups that Israel’s restrictions of food and other aid into Gaza, and its military offensive, were causing high levels of starvation among Palestinian civilians, particularly children.

Israel rejected the report, with Prime Minister Benjamin Netanyahu calling it an “outright lie.”