Hundreds of close relatives of American citizens are stuck in Gaza amid heavy Israeli bombardment and growing mass starvation and their family members in the U.S. say the government is doing nowhere near enough to help.

In addition to evacuating U.S. citizens themselves more than 300 of whom are still in Gaza the Biden administration has publicly pledged to help the spouses and parents of Americans exit Gaza through its southern border with Egypt. The State Department has extended that pledge to include unmarried children and siblings of Americans who are younger than 21 and to the spouses and under-21 children of green card holders.

But efforts to get those individuals on the daily lists of people permitted to exit Gaza via the Rafah Crossing into Egypt are slow, confusing and unpredictable, several members of affected families told HuffPost. Many of them worry their family members will be killed in Israeli airstrikes or succumb to Gazas growing health crisis before they can get the assistance they were promised, and many observers say the U.S. is doing too little to provide even limited aid to those stuck in Gaza.

Whatever the United States is doing, its not helping Americans leave, said Susan Abdelsalaam, an Indiana resident whose husband of 42 years traveled to Gaza in September to visit relatives he hadnt seen in more than a decade. He was still there on Oct. 7, when an attack by Hamas killed 1,200 Israelis, and Israel in turn began a retaliatory military campaign in Gaza (which has so far killed more than 17,000 people, a large proportion of them women and children, according to the United Nations ). Roughly 90% of the Gazan population is now displaced. Aid, food and clean water are scarce, and people are unable to find shelter as Israeli bombardment continues to rain on civilians.

Like many Americans with family in Gaza, once it became clear a war had begun, Abdelsalaam filled out State Department forms to request assistance to evacuate her husband. Since then, her husband has tried to leave Gaza through the Rafah Crossing three times and been rejected each time, losing more faith in his government with each denial, she said. She told HuffPost the lack of support has left her relying on Facebook groups with other Americans who also have families stuck in Gaza for ideas on how to help her husband.

Several U.S. citizens with relatives trapped in the besieged strip said in the absence of effective official guidance, people are discussing ways to get on the Rafah exit list by bribing Egyptians with hundreds or even thousands of dollars. Its hard to balance the fear of being scammed, and depriving families of the limited cash they have on hand in a war zone, with the fear of losing loved ones, they say.

Im sad that Im not being helped by people Ive voted for, said Moh Ghraiz, who lives in Illinois and is trying to help his parents and siblings flee Gaza. A month after he submitted their names, only his mothers name has made it onto the Rafah exit list, though his father is also eligible under the State Departments terms, a reflection of the inconsistencies many interviewees described. He recounted multiple frustrating calls with the U.S. Embassy in Jerusalem, saying diplomats are reading off scripts rather than expressing empathy and have refused to transfer him to more senior personnel.

Its unfair not to help these people and to help other people around the world, Ukrainians and Israelis and whoever else, Ghraiz told HuffPost. Im a good citizen. ... I expect my Congress, my government to help me to help my family. These are the times when I really need the help.

Last week, the State Department shut down the online intake form it previously maintained to gather information about Americans and others eligible for U.S. help evacuating from Gaza. The department has acknowledged internally that Israeli authorities have prevented some eligible people from leaving Gaza, according to diplomatic cables viewed by HuffPost, and U.S. officials have privately shared that assessment with some U.S. citizen family members in informal conversations.

The Department of State has no higher priority than the safety and security of U.S. citizens overseas. We continue to work in partnership with Egypt and Israel towards safe passage out of Gaza for U.S. citizens, LPRs [legal permanent residents], and their immediate family members. So far, we have assisted almost 1,300 U.S. citizens, LPRs, and family members to depart Gaza through the Rafah crossing into Egypt, a State Department spokesperson told HuffPost via email, saying the intake form was not the only way for Americans to seek assistance for relatives. We are aware that this is a difficult situation for U.S. citizens, LPRs, and their families who are seeking to depart Gaza, and we are doing what we can to assist. There is no second-class U.S. citizen an American is an American.

Meanwhile, humanitarian groups are expressing unprecedented alarm about the worsening conditions for Gazas population of 2.3 million. As the leaders of some of the worlds largest global humanitarian organizations, we have seen nothing like the siege of Gaza, the leaders of Mercy Corps, Oxfam America, the Norwegian Refugee Council, Refugees International, and Save the Children Fund wrote in a New York Times op-ed published on Monday.

Aid workers say the U.S. can and should do far more to speed up the flow of assistance into the region through Egypt, and they are unsure why the Biden administration is failing to do so. David Satterfield, a retired ambassador who President Joe Biden appointed as a special envoy for Middle East humanitarian issues one week into the war, has not responded to requests for meetings with major humanitarian organizations, officials at three groups told HuffPost.

A State Department spokesperson told HuffPost that Satterfield and his team have engaged with a number of humanitarian groups doing important work across the region.

We have worked with all partners to significantly increase the flow of aid. Both Israel and Egypt have expanded inspection and logistics capacity for aid delivery, in addition to the U.N., the spokesperson wrote in an email. We also want to get to a point where more commercial goods are able to enter Gaza. We have been working on these very complex issues tirelessly and continue to do so.

Yet experts say they are disappointed the procedures for bringing aid into Gaza are still deeply flawed more than two months into the war. Food and water shortage is putting many at risk of infection and even death. Photos portray civilians standing on long lines for water and supermarket shelves that are bare. Aid organizations have struggled to deliver life-saving necessities. Last month, barely 200 aid trucks per day crossed at Rafah an underwhelming count far short of what experts said was needed during the weeklong cease-fire. However, since the fighting resumed, the number of vehicles has since dropped , with some days no aid being delivered at all.

Getting the logistics right can help alleviate human suffering, and I dont think the United States has been effective on either the policy or the logistics and the operations of aid delivery, said Dave Harden, who led the U.S. Agency for International Development operations in Gaza and the occupied West Bank between 2013 and 2016.

For relatives of those suffering because of American policy failures, the daily pain is nearly unbearable.

Were living in the greatest country in the world Im sure theres something they can do, said Heiam Alsawalhi of Massachusetts. Alsawalhis sister and her family of eight are sheltering in one room not far from the Egyptian border, and send her daily updates of their attempts to remain alive.