In the worst single massacre since Israel launched its campaign to ethnically cleanse Northern Gaza this month, the Israel Defense Forces (IDF) bombed a five-story residential building in the town of Beit Lahia Tuesday, killing 93 people, including 25 children.

That day, at least 143 people were killed in Israeli airstrikes throughout Gaza, with the vast majority—132—killed in Northern Gaza, Al Jazeera reported.

With the Palestinian civil defense almost entirely out of commission due to targeting by Israeli troops, dozens of people remained buried under the rubble, where they will most likely die awaiting rescue.

“A number of victims are still under the rubble and on the roads, and ambulance and civil defense crews cannot reach them,” Gaza’s health ministry said in a statement.

Mahmoud Basal, a spokesman for the Palestinian civil defense agency, said “There are appeals and stress calls for Civil Defense teams to save the wounded,” but civil defense forces have been either arrested by Israeli troops or “forcibly displaced due to the Israeli aggression in North Gaza.”

Witness Ismail Ouaida said in a video verified by Reuters, “There are tens of martyrs (dead)—tens of displaced people who were living in this house. The house was bombed without prior warning. As you can see, martyrs are here and there, with body parts hanging on the walls.”

Another survivor, a Palestinian mother, told Al Jazeera, “Both my sons with their entire families were killed. My unmarried daughter was also killed. And my other daughter with her five children. All killed. What wrong did they do? What did those innocent people do to be slaughtered like this?”

The health ministry said in a statement Tuesday that the wounded will not receive medical care as nearby doctors had been forced by Israeli troops to evacuate at gunpoint. “Critical cases without intervention will succumb to their destiny and die,” the ministry said in a statement.

With consummate hypocrisy, US State Department spokesman Matthew Miller called the bombing a “horrifying incident with a horrifying result.” In reality, the massacre is completely in keeping with US policy. The Biden administration has provided Israel with more than 14,000 2,000-pound bombs, which have been used to systematically target populated areas with the deliberate aim of killing as many people as possible.

Last week, US Secretary of State Antony Blinken met with Israeli Prime Minister Benjamin Netanyahu to discuss the so-called “General’s Plan” to ethnically cleanse Northern Gaza. Despite Netanyahu’s refusal to publicly disavow the plan, Blinken emerged from the meeting to give a blanket statement of support for Israel’s “right to defend itself.”

The official death toll in the Gaza genocide now stands at over 43,000 with tens of thousands more still missing and likely buried under the rubble. An article published in The Lancet earlier this year estimated the actual death toll—including from the effects of starvation and disease—as exceeding 186,000.

The massacre in Beit Lahia is part of a systematic effort by Israel to ethnically cleanse Northern Gaza through bombing and starvation and to kill everyone that remains. Over the past three weeks, at least 700 people have been killed in Northern Gaza as part of this campaign. At the start of this month, there were 400,000 people remaining in Northern Gaza. Now, that figure is estimated at around 100,000 people, with those that remain completely without food, fuel or medical supplies.

Tuesday’s massacre followed the passage by Israel’s parliament of a law banning the UN relief agency UNRWA from operating inside Gaza, further dismantling any remaining humanitarian operations in the region. UNRWA head Philippe Lazzarini described the move as “nothing less than collective punishment,” declaring that the move violates the UN Charter and violates the State of Israel’s obligations under international law.

In a letter to Israeli Prime Minister Benjamin Netanyahu, UN chief Antonio Guterres said that the move would have “devastating consequences” for Palestinians. “Israel, as the occupying power, continues to be required to ensure that the needs of the population are met.”

Stephane Dujarric, a spokesperson for Guterres, said that “UNRWA is the principal means by which essential assistance is supplied to Palestine refugees in the occupied Palestinian territory, and there is no alternative to UNRWA,” adding that “UNRWA is indispensable.”

James Elder, a spokesman for the United Nations Children’s Fund (UNICEF), warned, “If UNRWA is unable to operate, you would likely see the collapse of the humanitarian system in Gaza. … So a decision such as this suddenly means that a new way has been found to kill children.”

The amount of aid entering the Gaza Strip has fallen to the lowest level since the start of the genocide, the UN said. Only 704 trucks of humanitarian aid entered Gaza between October 1 and October 22, compared to the already extremely low level of 3,000 truckloads in September. “The areas that are being depopulated right now have received nothing,” Scott Paul, Oxfam America’s director for peace and security, said.

According to the IPC (Integrated Food Security Phase Classification), a global initiative for measuring food security, nearly 800,000 people in Gaza are facing “emergency” or “catastrophe” levels of hunger. The UN’s World Food Program warned that “by November more than 90% of Gaza’s population will face severe food insecurity.” In a statement, the UN’s World Food Program said that only 5,000 tons of food has entered Gaza this month.

The hospitals are facing total breakdown. Hussam Abu Safia, director of the Kamal Adwan Hospital in Northern Gaza, told Al Jazeera that “The hospital is left with no resources. No medical supplies and no medical staff.” He continued, “This is because many of our specialized doctors and surgeons have been detained. It is only me together with a single pediatrician—who cannot perform any surgery on the wounded—that are left inside the hospital. Above all, patients and the injured are strewn all over the hospital floor.”

Meanwhile, Israeli forces continued to push further north into Lebanon, with 77 people killed in strikes throughout the country. In a first-hand report, Al Jazeera wrote, “On Monday, the Israeli army set about maniacally bombarding the southern Lebanese coastal city of Tyre, striking residential buildings and converting the scene into a typical Israeli-induced horrorscape. Israel does its best to bomb the life out of Tyre.” The city is one of humanity’s oldest continuously-inhabited urban areas and is a UNESCO World Heritage Site.

On Tuesday, Israeli officials threatened further strikes on Iran following a bombardment of military facilities over the weekend. “We will once again know how to reach Iran, with capabilities that we did not even use this time,” said Herzi Halevi, chief of the Israeli military’s general staff.