The Hague, Netherlands - The world's top court on Thursday ordered Israel to "ensure urgent humanitarian assistance" in Gaza without delay, saying "famine has set in."

The International Court of Justice's latest order comes as Israel continued to pummel Gaza and a major medical charity said it "hasn't seen any change" since a UN Security Council resolution this week demanding an immediate ceasefire.

"Israel shall... take all necessary and effective measures to ensure, without delay... the unhindered provision... of urgently needed basic services and humanitarian assistance" in Gaza, the ICJ said.

This included food, water, electricity, fuel, shelter, clothing, hygiene, and sanitation requirements, as well as medical supplies and medical care to Palestinians throughout Gaza, its judges said.

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"Palestinians in Gaza are no longer facing only a risk of famine, but... famine is setting in," the Hague-based court said.

The war erupted after Hamas's attack on Israel on October 7, resulting in about 1,160 deaths and about 250 hostages being taken, 130 of which are believed to remain in Gaza.

Israel's retaliatory campaign has killed at least 32,552 people – mostly women and children – created a catastrophic famine in the strip, and led to deafening accusations of war crimes and genocide.

At the ICJ, South Africa has charged that Israel is perpetrating a genocide in Gaza. In a ruling in mid-January that made headlines worldwide, the court ordered Israel to do everything it could to prevent genocide during its Gaza offensive.

The court also ruled that Israel must punish incitement to genocide and allow aid into Gaza to ease the desperate humanitarian situation there.

South Africa followed up with a request for fresh measures a few weeks later, citing an announced incursion into the city of Rafah, but the court declined to impose additional measures.

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Undeterred, Pretoria tried again, this time urging the court to impose emergency measures to "save the Palestinian people in Gaza already dying of starvation."

All 16 ICJ judges unanimously agreed Thursday that the mid-January rulings "do not fully address the consequences arising from the changes in the situation... thus justifying the modification of these measures."

They ordered Israel to "Take all necessary and effective measures to ensure, without delay, in full co-operation with the United Nations, the unhindered provision at scale by all concerned of urgently needed basic services and humanitarian assistance."

Six judges also published separate opinions arguing that the only way to ensure this was for Israel to suspend all military activities in Gaza.

"The alarm has now been sounded by the Court," Judge Abdulqawi Yusuf wrote. "All the indicators of genocidal activities are flashing red in Gaza."