Congress voted early Saturday to strip hundreds of millions of dollars from the United Nations agency that distributes most of the food, medicine and basic services to Palestinians in Gaza and across the Middle East, marking what critics say is a devastating blow to a region in crisis.

The United States, along with several other countries, suspended funding for the U.N. Relief and Works Agency (UNRWA) in January after Israel alleged that 12 of the agency’s 13,000 Gaza employees participated in Hamas’s cross-border attack on Oct. 7. These new restrictions, advanced by Republicans as part of an $1.2 trillion government spending package, extends the funding moratorium for at least a year.

UNRWA has become “a de facto subsidiary of Hamas,” Rep. Mario Diaz-Balart (R-Fla.) said in a speech from the House floor Friday, echoing claims by the Israeli government, which has long criticized the agency. “The passage of this bill means not one additional dollar from American taxpayers will go fund this deeply flawed organization.”

U.N. officials vehemently deny such assertions, and Israel has not publicly disclosed evidence to support its allegations about UNRWA workers’ involvement in the attack or its claims that the group has been infiltrated. The U.N. secretary general launched an independent investigation and intends to publish findings next month. Nevertheless, the consequences of the allegations have been sweeping.

UNRWA, established in 1949 to provide assistance to Palestinians who either fled or were expelled from their homes during the creation of the state of Israel, now administers the bulk of government-like services — including schools, health care, food and housing assistance — to millions of those refugees and their descendants spread across Gaza, the West Bank, Lebanon, Jordan and Syria.

The European Commission, Canada, Australia and Sweden this month unfroze their contributions to UNRWA. But U.S. contributions, which last year totaled $422 million, typically account for about 30 percent of UNRWA’s budget, the organization says. Slashing those resources now, with more than a million Gazans on the brink of famine, could be catastrophic, officials say. More than 32,000 have been killed during nearly six months of Israeli bombardment, according to local health officials.

“It’s the equivalent of the government closing up shop here,” said Bill Deere, director of UNRWA’s Washington office. “I don’t know what’s going to happen, but I can tell you it can’t possibly be good for regional stability when you remove the last vestiges of hope for millions of people.”

Some Democrats who voted against the spending bill cited the UNRWA cuts as among their key concerns. Others, who said they voted for the bill because it contained critical funding for the U.S. government, also voiced concerns about the potential impact it could have in Gaza.

Sen. Chris Van Hollen (D-Md.), a member of the Senate Foreign Relations Committee who earlier in the month hosted a briefing with UNRWA officials in an effort to stop the funding ban, called it “unconscionable.”

“Denying funding for UNRWA is tantamount to denying food to starving people and restricting medical supplies to injured civilians,” he said in a statement.

Rep. Jason Crow (D-Colo.) said Friday that his already “very deep concerns” about the humanitarian situation in Gaza and the Israeli military’s aggressive prosecution of the war had only grown since receiving a classified briefing that morning from U.S. intelligence officials.

“There is no other entity that exists and is capable of transporting and distributing aid in the quantities that are necessary to prevent famine within Gaza,” he said of UNRWA.

Many Republicans on Capitol Hill have argued that Hamas — whose operatives are believed to be hiding among civilians — bears sole responsibility for Gaza’s dead.

Others in the GOP have argued that other charitable organizations operating in Gaza can pick up the mantle for UNRWA in the absence of U.S. funding.

“I’ve been pushing for a ban on UNRWA for years,” said Sen. James E. Risch (R-Idaho), the Senate Foreign Relations Committee’s top Republican.

“There’s all kinds of NGO organizations” that can distribute aid in Gaza, Risch said. Anybody who claims otherwise “doesn’t work in the same space I do, in foreign relations,” he added.

Deere, of UNRWA’s Washington office, said that such statements are “just not based on the reality.” Other organizations in Gaza have only a small fraction of the personnel that UNRWA has, he said, adding that “they don’t have the experience, they don’t have the community acceptance.”

Without U.S. funding, UNRWA is anticipating about a $350 million deficit this year, unless other countries make up the loss, Deere said. It will mean less food aid, lost jobs, and schools and health clinics will be shuttered in impoverished Palestinian refugee camps across the region, including in deeply unstable Lebanon.

UNRWA has about 30,000 employees across the Middle East. “Right now we can make payroll through May,” Deere said. “But we’re going to have to live month to month here.”

“We store things at our warehouses. Our trucks are used for distribution,” Deere said, describing the agency’s footprint. The World Health Organization “may bring in the vaccines, but ultimately it’s the UNRWA nurse who jabs the child.”