Palestinians began fasting for Ramadan on Monday as the Muslim holy month arrived with cease-fire talks at a standstill, hunger worsening across the Gaza Strip and no end in sight to the five-month-old war between Israel and Hamas.

Prayers were held outside amid the rubble of demolished buildings late Sunday. Some people hung fairy lights and decorations in packed tent camps, and a video from a U.N.-school-turned-shelter showed children dancing and spraying foam as a man sang into a loudspeaker.

But there was little to celebrate after five months of war that has killed over 30,000 Palestinians and left much of Gaza in ruins. Families would ordinarily break the daily fast with holiday feasts, but even where food is available, there is little beyond canned goods and the prices are too high for many.

“You don't see anyone with joy in their eyes," said Sabah al-Hendi, who was shopping for food on Sunday in the southernmost city of Rafah. “Every family is sad. Every family has a martyr."

It’s not just Israeli bombs that have killed children in Gaza. Now some are dying of hunger too

The United States, Qatar and Egypt had hoped to broker a cease-fire ahead of the normally joyous month of dawn-to-dusk fasting that would include the release of dozens of Israeli hostages and Palestinian prisoners, and the entry of a large amount of humanitarian aid, but the talks stalled last week.

Hamas is demanding guarantees that any such agreement will lead to an end to the war, while Israeli Prime Minister Benjamin Netanyahu has vowed to continue the offensive until “total victory” against the militant group and the release of all the remaining hostages.

The war began when Hamas-led militants stormed into southern Israel on Oct. 7, killing some 1,200 people, mostly civilians, and taking around 250 hostage. Hamas is still believed to be holding around 100 captives and the remains of 30 others following an exchange last year.

The war has driven around 80% of Gaza's population of 2.3 million people from their homes and pushed hundreds of thousands to the brink of famine. Health officials say at least 20 people, mostly children, have died from malnutrition and dehydration in northern Gaza.

Israeli forces have largely sealed off the north since October, and aid groups say Israeli restrictions, ongoing hostilities and the breakdown of law and order have made it nearly impossible to safely deliver desperately needed food in much of the territory.

Israel has meanwhile vowed to expand its offensive to the southern city of Rafah, where half of Gaza’s population has sought refuge, without saying where civilians would go to escape the onslaught. President Joe Biden has said an attack on Rafah would be a “red line” for him, but that the United States would continue to provide military aid to Israel.

Biden acknowledged in his annual Ramadan message that the holy month comes “at a moment of intense pain."

“As Muslims gather around the world over the coming days and weeks to break their fast, the suffering of the Palestinian people will be front of mind for many. It is front of mind for me,” he said.

The United States and other countries have begun airdropping aid in recent days, but humanitarian groups say such efforts are costly and insufficient. The U.S. military has also begun transporting equipment to build a sea bridge to deliver aid, but it will likely be several weeks before it is operational.

After months of warnings of famine in Gaza, some children begin to succumb in rising deaths

A ship belonging to Spanish aid group Open Arms carrying 200 tons of food aid was expected to make a pilot voyage to Gaza from nearby Cyprus, though it was not clear when it would depart. Israel says it welcomes the sea deliveries and will inspect Gaza-bound cargo before it leaves Cyprus.

The ship in Cyprus is expected to take two to three days to arrive at an undisclosed location in Gaza. The food is being supplied by the World Central Kitchen, a U.S. charity founded by celebrity chef José Andrés, which said contruction work on a jetty in Gaza began Sunday. Once the ship reaches Gaza, aid will be offloaded by a crane, placed on trucks and driven north.

The United States has provided crucial military support to Israel and shielded it from international calls for a cease-fire while urging it to do more to avoid harming civilians and facilitate humanitarian aid.

Gaza's Health Ministry said Monday that at least 31,112 Palestinians have been killed since the war began, including 67 bodies brought to hospitals in the past 24 hours. The ministry doesn’t differentiate between civilians and combatants in its count, but says that women and children make up two-thirds of the dead.

Israel blames the civilian death toll on Hamas because the militants fight in dense, residential areas and position fighters, tunnels and rocket launchers near homes, schools and mosques. The military says it has killed 13,000 Hamas fighters, without providing evidence.

Speaking on Saturday to MSNBC, Biden said Israel had the right to respond to the Oct. 7 attack but that Netanyahu “must pay more attention to the innocent lives being lost.” He added that “you cannot have 30,000 more Palestinians dead.”