A group of experts affiliated with the United Nations has warned that the population of the Gaza Strip is in immediate danger of starvationwith more than 90 percent of its 2.2 million people facing “acute food insecurity” and a quarter of the population experiencing “catastrophic levels of hunger.”
Even before the war between Israel and Hamas, nearly 70 percent of Gazans depended on humanitarian food aid because the area has been under an Israeli and Egyptian blockade since 2007. Now, only 20 to 30 percent of of what the people there need are allowed at the border with Gaza, according to the World Food Programme. Lack of electricity and fuel and the inability to travel safely have compounded the challenges of producing food or getting it to people. Most people go a day or more without eating, the team of experts said.
As in the vast majority of other food crises, the panel, the famine review committee, has assessed in the 20 years since its creation, the situation in Gaza is not environmental but man-made. But Gaza is unusual in the speed with which people are being pushed into malnutrition.
In interviews, nutritionists and doctors described what can happen when people can’t get food.
Children often fail first
Children, pregnant and lactating women, people with medical conditions and the elderly usually succumb first to acute malnutrition. 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 state of health. It depends on whether they have access to fluids or some kind of food, even if it doesn’t cover all the nutrient needs.”
UNICEF, the child-focused aid agency, is particularly concerned about infants, said Anuradha Narayan, the agency’s senior adviser on child nutrition in emergencies. Before the war, about 60 percent of Gazan infants were breastfed. Their families now have little or no access to food for them.
“We know there are many families who probably can’t feed their children infant formula,” she said.
For families who have found formula, the challenge is getting clean water to make it. An estimated 1.6 liters of drinking water (against the minimum of 15 liters per day recommended by the WHO) is available per person in Gaza now.
Progression to severe malnutrition is rapid
Ms Narayan said the agency estimated that 7,000 to 8,000 children were so severely malnourished that they were at risk of death without immediate treatment, but the active conflict in Gaza was making it difficult for aid agencies to assess the situation.
“We expect those numbers may increase quite dramatically in the next two to three weeks,” he said.
Ms Narayan said that in her work in other food security crises, such as in Ethiopia, it was typical to see a child fall ill and progress to severe malnutrition and wasting within days.
On Gaza, he said: “It’s harder to predict, but if there’s almost no food to feed the young children and there’s disease involved, I’d say it could be exactly the same. From being pretty okay to some level of malnutrition, maybe not severely wasted, but still wasted, in the space of a few days. Especially for young people, under 2 years of age, this is certainly likely to be the case.”
The trajectory for people with some access to food would be different, said Dr. Stanley Zlotkin, a professor of nutrition at the University of Toronto and an expert on the effects of critical food shortages. An adult may be able to survive for a long time on only intermittent access to calories or only on foods that offer limited nutrients, he said. In a situation like that of Gaza, where there is still sporadic availability of some food, most adults could survive for some time, but this would not be enough for children to prevent the progression of malnutrition.
What happens to the body
A malnourished body first burns fat stores, said Heather Stobaugh, a nutrition and emergency specialist with the aid agency Action Against Hunger, until they are depleted. Then, “the body will resort to using muscles and eventually the vital organs will start to break down,” he said. “In the most severe forms of malnutrition, the immune system weakens and the vital organs actually start to shrink – the heart, the lungs and so on.”
“When a child or an adult reaches that point,” he added, “their body is literally lost.”
Ms Weise Prinzo said people in this situation minimize energy expenditure. “They stop any movement that is not necessary for immediate survival, but also within the organs, there are changes in the way the heart and liver work,” he said. “They’re really trying to make it work, but eventually one or the other of the systems starts to fail.”
At this point, a starving person has a number of physical degradations, including extreme fatigue, inability to regulate temperature, and emotional exhaustion.
“We say ‘acute malnutrition’ and acute means it could happen in a short period of time,” Dr. Stobaugh said. “It doesn’t always have to be months of slow degradation.”
Malnutrition and disease lead to a vicious circle
A malnourished person is vulnerable to disease because of a weakened immune system and because of the conflict conditions, where clean water and sanitation facilities are lacking and people often live in crowded shelters.
A malnourished body’s defenses—epithelial cells, which make up the skin’s surface and barrier tissues in places like the gut—break down and white blood cells malfunction.
“Then when you get sick, the body uses whatever protein and energy stores you have, trying to fight the infection, and that cycle of infection and malnutrition is what quickly causes wasting,” Ms Narayan said. This process is faster in children, he 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 housed in tents or other temporary structures and there are few adequate toilets or washing facilities. Pneumonia and gastrointestinal Infections are the leading causes of death for malnourished people.
“You have disease outbreaks like extreme diarrhea combined with no health care services, no food, no clean water,” Dr. Stobaugh said. “This kind of perfect storm of adverse environmental and health conditions will exacerbate the speed at which a body becomes malnourished and can eventually reach the brink of death very quickly.”