GENEVA — A year ago, U.N. Secretary-General Antonio Guterres condemned Hamas’ Oct. 7 attacks in Israel but said in remarks to the Security Council that they “ did not happen in a vacuum.” That phrase was immediately denounced by Israel and still looms over U.N. activities in the Middle East.

Outraged Israeli officials and civilians accused the U.N. chief of trying to justify the horrors that day, in which some 1,200 people were killed and about 250 taken hostage.

Palestinian leaders praised Guterres for voicing a defense of human rights and recognizing the troubles that Palestinians have faced in over a half-century of occupation.

While Israel’s poor relations with the world body date back decades before Guterres was in charge — with Israeli leaders long accusing the U.N. of anti-Israel bias — the secretary-general’s Oct. 24, 2023, comment set a tone for ties between the two during the conflict.

Those relations are at a low ebb — many say the lowest ever.

Here’s a look at the fraught, but in many ways fundamental, relationship between the U.N. and Israel and its implications for people in Gaza, the West Bank and Lebanon:

Why are Israel-U.N. relations so bad?

The longtime strains in Israel’s relationship with the 193-nation U.N. have worsened in recent months.

On Oct. 2, Israel’s Foreign Minister Israel Katz deemed Guterres “persona non grata” — not welcome — in the country.

He tweeted that the U.N. chief had not “unequivocally” condemned an Iranian attack on Israel the night before and claimed Guterres was giving backing to militant groups in region, which would be “remembered as a stain on the history of the U.N.”

Israel also has stepped up its effort to get rid of the U.N. agency helping millions of Palestinian refugees, known as UNRWA. Two bills approved by an Israeli parliamentary committee this month to ban its operations in Israeli territory are awaiting final approval from the Knesset, its parliament.

The head of UNRWA says the adoption could cause the agency to collapse and leave hundreds of thousands of people in need.

Israel alleges that some of the thousands of employees of UNRWA, the top aid provider in Gaza, participated in the Oct. 7 attacks. More than a dozen staffers were subsequently fired following an internal probe.

In Lebanon, where an Israeli offensive is underway, Israeli forces have repeatedly fired on U.N. peacekeepers monitoring a 2006 Hezbollah-Israeli cease-fire near southern border with Israel.

Israel says Hezbollah has built up military infrastructure next to U.N. positions and that the peacekeepers are essentially serving as human shields by refusing Israeli demands to evacuate.

Over the summer, the U.N.’s top court issued a nonbinding opinion saying Israel’s presence in the occupied Palestinian territories was unlawful and called for it to end, prompting Prime Minister Benjamin Netanyahu to retort that the areas were part of the historic homeland of the Jewish people.

And Netanyahu attacked the world body in a speech to the U.N. General Assembly last month, saying that until Israel “is treated like other nations, until this antisemitic swamp is drained, the U.N. will be viewed by fair-minded people everywhere as nothing more than a contemptuous farce.”

In May, the General Assembly overwhelmingly passed a resolution granting the non-member observer state of Palestine new rights and calling on the Security Council to reconsider its request for full U.N. membership.

Israel’s retaliatory offensive has killed more than 42,000 Palestinians in Gaza and wounded tens of thousands, according to local health authorities, who don’t say how many were combatants but say more than half were women and children. It has caused major devastation and displaced around 90% of Gaza’s population of 2.3 million.

The United Nations says the war in Gaza has caused more deaths of U.N. personnel in a single conflict that any other since the world body’s founding after World War II in 1945.

Where has the U.N. been effective during the conflict?

Despite the ill-feeling and sour relations, U.N. aid agencies have had a few pockets of success.

UNICEF says its cash distribution programs have helped offset the economic fallout from soaring unemployment and spiking prices when food and other aid doesn’t get through. Its trucks ferry in water, and its teams help rebuild desalination plants. It has brought in 1.2 million polio vaccine doses.

The World Health Organization has used “humanitarian pauses” in the fighting to carry out a polio vaccination campaign for kids in Gaza. However, it was unable to start vaccinating children in northern Gaza on Wednesday because of fighting and insecurity.

Despite a repeated lack of access, WHO has provided water, sanitation and hygiene services to nearly 2 million people.

Despite intense pressure from Israel, UNRWA remains essential, with its network of drivers, loaders, warehouse staff, shelter personnel, trash collectors, water-well maintenance teams and more. Since Oct. 7, 2023, it has provided nearly 6 million medical consultations in Gaza — roughly equal on average to three per person.

“UNRWA’s the backbone,” and without it, “the whole thing falls apart,” UNICEF spokesman James Elder said. “Particularly, as UNRWA has been more restricted, everyone has had to step up. But everyone’s had to step up knowing full well they can’t step into those shoes.”

In Lebanon, the U.N.’s World Food Program said it was well-prepared before the conflict between Hezbollah and Israel intensified and is delivering hot meals, ready-to-eat rations, food parcels and cash assistance to more than 200,000 people in shelters.

Where has the U.N. faced challenges?

The list of hurdles faced by the U.N. to ease the fallout is much longer. Guterres and the heads of every U.N. agency say what’s needed most is a cease-fire.

The United Nations has been shut out of cease-fire talks, and its efforts to provide desperately needed food and other aid have faced numerous obstacles.

Even if convoys cross the border into Gaza, getting help to people has become exceedingly difficult. U.N. officials point to many problems: fighting, numerous Israeli evacuation orders, lawlessness and stripping of aid convoys, Israeli delays of preapproved deliveries, and lack of security for drivers and humanitarian staff.

At a U.N. Security Council meeting last week, Israel’s U.N. Ambassador Danny Danon pointed to Hamas for the lack of humanitarian aid in Gaza.

“The terrorist organization steals, stores and sells the aid that enters the Gaza Strip and uses it to feed its terrorist machine and not to feed the Gazans.” He said defeating and disarming Hamas is “the only way to improve the humanitarian situation in Gaza.”

The latest report from international experts said the threat of famine looms over Gaza and around 86% of Gaza’s population are experiencing crisis levels of hunger.

The United States, Israel’s closest ally, has given the government 30 days to expand humanitarian deliveries to 350 trucks every day or face the threat of cuts in weapons funding.

U.N. teams bemoan a lack of access to aid: Medicines, food, fuel and other needed items, as well as Israel’s limitations on the number and duration of visas for some U.N. staff.

Just over 5,100 people have been evacuated from Gaza for health reasons, and more than three times that many still await urgent medical evacuations, WHO said. Israel’s closing of the Rafah border with Egypt has been one obstacle to getting sick and wounded Palestinians out of Gaza.

Dr. Hanan Balkhy, head of the WHO eastern Mediterranean region, which covers Lebanon and Palestinian areas but not Israel, said her staff faced “major problems” accessing some areas, like beleaguered northern Gaza.

WFP is among the many agencies that say they need more financial support: It’s appealing for $116 million to help up to 1 million people through year-end — if ports and supply lines can remain open.

Lederer reported from the United Nations.

related stories

• Blinken urges Israel to seek enduring deal, as officials say a limited cease-fire has been discussed
• Israeli strike on Gaza shelter kills 17 as Blinken says cease-fire talks will resume