A group of United Nations-affiliated experts has warned that the people of the Gaza Strip are at imminent risk of famine, with more than 90% of its 2.2 million inhabitants facing “severe food insecurity” and a quarter of the population who experiences “catastrophic conditions”. hunger levels.”
Even before the war between Israel and Hamas, nearly 70% of Gazans depended on humanitarian assistance for food because the territory has been under an Israeli and Egyptian blockade since 2007. Now, only 20 to 30% of what they the population in need can leave the border with Gaza, according to the World Food Programme. Lack of electricity and fuel and the inability to travel safely have exacerbated the challenges of producing food or distributing it to people. Most people go a day or more without eating, the panel said.
As in the vast majority of other food crises that 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 have been pushed into malnutrition.
In interviews, nutrition experts and doctors described what can happen when people can’t get food.
Children often fail first
Children, pregnant and breastfeeding women, people with medical conditions and the elderly generally succumb first to acute malnutrition. How long they can survive under conditions of extreme hunger will vary.
“It depends on the age of the person,” Zita Weise Prinzo said, senior nutritionist at the World Health Organization. “It depends on their state of health. It depends on whether they have access to liquids or some type of food, even if it doesn’t cover all their nutritional needs.”
UNICEF, the humanitarian organization that focuses on children, is particularly concerned about newborns, said Anuradha Narayan, the agency’s senior advisor for child nutrition in emergencies. Before the war, about 60 percent of Gaza’s babies were fed formula. Their families now have little or no access to food supplies for them.
“We know there are many families who are probably not able to feed their babies formula,” she said.
For the families who have found the formula, the challenge is obtaining clean water to produce it; It is estimated that 1.6 liters of drinking water per capita is currently available in Gaza (compared to the minimum of 15 liters per day recommended by the WHO).
The progression to severe malnutrition is rapid
Ms. Narayan said the agency estimates that between 7,000 and 8,000 children are so severely malnourished that they are at risk of death without immediate treatment, but the active conflict in Gaza is making it difficult for humanitarian agencies to assess the situation.
“We expect these numbers to increase dramatically over 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 become ill and progress to severe malnutrition and wasting within a few days.
For Gaza, he said, “it’s harder to predict, but if there’s almost no food to feed young children, and diseases are involved, I would say it could be exactly the same thing. You go from being reasonably OK to being at some level of malnutrition, maybe not severely wasted, but wasted nonetheless, in the space of a few days. Especially for young people, under the age of 2, this will certainly 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 severe food shortages. An adult may be able to survive for a long period with only intermittent access to calories or only on foods that offer limited nutrients, he said. In a situation like that of Gaza, where food availability is still sporadic, most adults would be able to survive for a certain period, but this would not be enough for children to prevent the progression towards malnutrition.
What happens in the body
A malnourished body first burns its fat reserves, explains Heather Stobaugh, nutrition and emergencies expert at the humanitarian agency Action Against Hunger, until these are depleted. Then, “the body will resort to using muscles and eventually vital organs will begin to deteriorate,” she said. “In the most severe forms of malnutrition, the immune system is weakened and vital organs begin to shrink: the heart, lungs and so on.”
“When a child or adult gets to this point,” he added, “their body is literally wasting away.”
Ms. Weise Prinzo said that people in this state minimize energy expenditure. “They stop any movement that is not necessary for immediate survival, but also within the organs there are changes in the functioning of the heart and liver,” she said. “They really try to make do, but eventually one or the other of the systems starts to fail.”
At this point, a starving person exhibits a variety of physical impairments, including extreme fatigue, an inability to regulate temperature, and emotional deterioration.
“We say ‘acute malnutrition’ and acute means it could occur in a short period of time,” Dr. Stobaugh said. “It doesn’t always have to be months of slow degradation.”
Malnutrition and disease create a sad cycle
A malnourished person is vulnerable to disease due to a weakened immune system and due to conflict conditions, where clean water and sanitation facilities are lacking and people often live in crowded shelters.
A malnourished body’s defenses – the epithelial cells, which make up the surface of the skin and barrier tissues in places like the intestine – break down and white blood cells do not function properly.
“Then, when you get sick, the body uses all the protein and energy reserves you have, trying to fight the infection, and that cycle of infection and malnutrition is what rapidly causes wasting,” Ms. Narayan. This process is faster in children, she said.
Dr Zlotkin said the disease spreads rapidly in situations like the current one in Gaza, where 90% of people have been displaced and are taking shelter in tents or other temporary structures, and there are few adequate latrines or washing facilities. Pneumonia and gastrointestinal infections are the leading cause of death for malnourished people.
“There are epidemics of diseases such as extreme diarrhea combined with the absence of health services, food and clean water,” Dr. Stobaugh said. “This sort of perfect storm of adverse environmental and health conditions will exacerbate the rate at which a body will become malnourished and ultimately can find itself on the brink of death quite quickly.”