A United Nations-affiliated panel of experts has warned that Gaza's population is at imminent risk of famine, with more than 90 percent of its 2.2 million people facing “acute food insecurity” and a quarter of the population facing a “catastrophic” situation The extent of hunger is affected.”
Even before the war between Israel and Hamas, almost 70 percent of Gaza residents were dependent on humanitarian food aid, as the area has been under Israeli and Egyptian blockade since 2007. Now only 20 to 30 percent of what the people there need are left across the border with the Gaza Strip, according to the World Food Program. Lack of electricity and fuel and the inability to move safely have exacerbated challenges in producing food or providing it to people. Most people can go a day or more without eating, the expert panel said.
As with most other food crises, the panel, the Famine Review Committee, has concluded in the 20 years since its founding that the situation in Gaza is not environmental but man-made. But Gaza is unusual for the speed at which people are being pushed into malnutrition.
In interviews, nutrition experts and doctors described what can happen when people don't get food.
Children often fail first
Children, pregnant and breastfeeding women, people with medical conditions, and older adults typically develop acute malnutrition first. How long they can survive under extreme starvation conditions varies.
“It depends on the age of the person,” said Zita Weise Prinzo, senior nutritionist at the World Health Organization. “It depends on their health condition. It depends on whether they have access to fluids or some type of food, even if it does not meet all of their nutritional needs.”
UNICEF, the humanitarian aid agency that focuses on children, is particularly worried about infants, said Anuradha Narayan, the organization's senior adviser on emergency child nutrition. Before the war, about 60 percent of Gaza's infants were formula-fed. Their families now have little or no access to food.
“We know there are many families who probably won’t be able to feed their children formula,” she said.
For families who have found formulas, the challenge is getting clean water to make it; There is currently an estimated 1.6 liters of drinking water available per person in Gaza (compared to the WHO recommended minimum of 15 liters per day).
Severe malnutrition quickly occurs
Ms. Narayan said the agency estimates that 7,000 to 8,000 children are so severely malnourished that their lives are in danger without immediate treatment, but the active conflict in Gaza made it difficult for aid agencies to assess the situation.
“We expect these numbers could increase quite dramatically over the next two to three weeks,” she said.
Ms. Narayan said that in her work in other food crises, such as in Ethiopia, it is common for a child to become ill and become severely malnourished and wasted within a few days.
For Gaza, she said, “It's harder to predict, but if there's almost no food to feed young children and disease comes along with that, I'd say it could be exactly the same thing.” Within a few days, you'll be feeling pretty good good condition to some degree of malnutrition, perhaps not too exhausted but still exhausted. This is certainly the case, especially for young people under the age of two.”
For people with some access to food, the trajectory would be different, said Dr. Stanley Zlotkin, professor of nutrition at the University of Toronto and an expert on the impact of critical food shortages. An adult could potentially survive for a long period of time if they only have intermittent access to calories or only eat foods that offer limited nutrients, he said. In a situation like that in Gaza, where food availability is still sporadic, most adults could survive for a while, but that would not be enough for children to prevent the progression of malnutrition.
What happens in the body?
A malnourished body initially burns fat reserves until they are depleted, says Heather Stobaugh, nutrition and emergencies expert at the charity Action Against Hunger. Then “the body will resort to using muscles, and eventually vital organs will begin to break down,” she said. “In the most severe forms of malnutrition, the immune system becomes weakened and vital organs actually begin to shrink – heart, lungs and so on.”
“When a child or adult reaches that point,” she added, “their body literally deteriorates.”
Ms. Weise Prinzo said that people in this state minimize energy consumption. “They stop any movement that is not necessary for immediate survival, but even within the organs there are changes in the way the heart and liver function,” she said. “They really try to cope, but at some point one system or another starts to fail.”
At this point, a starving person suffers a range of physical impairments, including extreme fatigue, an inability to regulate temperature, and emotional impairment.
“We say 'acute malnutrition' and acute means it can happen in a short period of time,” said Dr. Stobaugh. “It doesn’t always have to be months of slow decline.”
Malnutrition and disease lead to a grim cycle
A malnourished person is vulnerable to illness due to a weakened immune system and due to conflict conditions where there is a lack of clean water and sanitation and people often live in overcrowded shelters.
A malnourished body's defenses – epithelial cells that form the surface of the skin and barrier tissue in places such as the intestines – are destroyed and white blood cells malfunction.
“Then when you get sick, the body uses whatever protein and energy stores you have to fight the infection, and this cycle of infection and malnutrition quickly leads to emaciation,” Ms. Narayan said. This process is quicker in children, she said.
Dr. Zlotkin said the disease spreads quickly in situations like the current one in Gaza, where 90 percent of people have been displaced and are taking refuge in tents or other makeshift structures and there are few suitable latrines or washing facilities. Pneumonia and gastrointestinal infections are the main causes of death for malnourished people.
“There are outbreaks of disease such as extreme diarrhea combined with a lack of health care, no food and no clean water,” said Dr. Stobaugh. “This perfect storm of adverse environmental and health conditions will exacerbate the rate at which a body becomes malnourished and ultimately pushed to the brink of death quite quickly.”