As famine looms in Gaza, children are getting weak and losing their ability to move

Six-year-old Fadi Al-Zant is acutely malnourished, his ribs protruding under leathery skin, his eyes sunken as he lays in bed at the Kamal Adwan Hospital in northern Gaza, where famine is bearing down.

Fadi’s spindly legs can no longer support him enough to walk.

Photographs of Fadi from before the war show a smiling, healthy-looking child, standing in blue denims next to his taller twin with his hair brushed. A short video clip shows him dancing at a wedding with a little girl.

Fadi suffers from cystic fibrosis. Before the conflict, he was taking medicine that his family can no longer find and eating a carefully balanced variety of food no longer available in the Palestinian enclave, according to his mother Shimaa Al-Zant.

“His condition is getting worse. He is getting weaker. He keeps losing his ability to do things,” she said in a video obtained by Reuters from a freelancer. “He can no longer stand. When I help him stand up, he falls straight away.”

More than five months into Israel’s ground and air bombing campaign, there are widespread shortages of food, medicines and clean water in Gaza, doctors and aid agencies say.

The Kamal Adwan Hospital, caring for Fadi, had also treated most of the 27 children the health ministry in Gaza says died of malnutrition and dehydration in recent weeks.

Others died in Gaza City’s Al-Shifa Hospital, also in the north, the ministry said, and in the southernmost city of Rafah, where the UN relief agency says over one million Palestinians have sought refuge from Israel’s offensive.

Reuters saw ten badly malnourished children during a visit last week to the Al-Awda Health Centre in Rafah, arranged with nursing staff who gave the news agency unimpeded access to the ward.

Without urgent action, famine will hit between now and May in northern Gaza, where 300,000 people are trapped by fighting, the world’s hunger watchdog, the Integrated Food Security Phase Classification (IPC), said in a review on Monday.

The review’s most likely scenario said “extremely critical levels of acute malnutrition and mortality” were imminent for more than two thirds of the people in the north. The IPC is made up of UN agencies and global aid groups.

READ: Thousands of children suffering serious complications due to lack of milk in northern Gaza

Israel’s COGAT, the military body that handles aid transfers to Gaza, did not specifically respond to Reuters questions about the deaths of children from hunger and dehydration. It said Israel put no limits on the amount of aid that can enter. Egypt, the UN and aid groups have reported differently, claiming Israel is hindering aid deliveries and limiting the items allowed into the Strip.

UN reports frequent rejections by Israeli forces of vital supplies into Gaza for vague reasons. Source: The Egyptian Red Crescent and aid workers

The White House referred Reuters to comments from National Security advisor Jake Sullivan, who said responsibility to address impending famine “starts, first and foremost, with Israel.”

USAID chief Samantha Power said the IPC assessment marked “a horrific milestone” and called on Israel to open more land routes.

In response to a question from Reuters about the IPC report, senior Hamas official Sami Abu Zuhri said Israel’s Prime Minister Binyamin Netenyahu was “defying the world and pursuing the killing of the Palestinian people in Gaza by bombs and starvation.”

UN aid agencies have said “overwhelming obstacles” to moving aid to the north of Gaza will only be overcome with a ceasefire and the opening of border crossings closed by Israel after 7 October.

Displaced

In better times, Fadi’s favourite food was chicken shawarma, his mother said, and he ate a lot of fruit and drank a lot of milk.

When the war began, she said, the family fled their home in Al-Nasr district of Gaza City, which suffered widespread damage from bombardment. They were displaced four times before arriving in Beit Lahia, she added.

Fadi’s condition began to deteriorate about two months ago and he was admitted to Kamal Adwan Hospital, Al-Zant said. Creon – the medicine that people with cystic fibrosis need to supplement pancreatic enzymes that help digest food – was not available. Sometimes, Fadi had diarrhoea ten times in one night.

Before the war, he weighed 30 kilogrammes (66 lb). Now he weighs just 12 kilogrammes (26 lb), his mother said.

“He used to eat well. His treatment was available. His face was full. He was a child that did not seem ill. He went to kindergarten with his brother,” she said.

Gaza’s Ministry of Health says lack of medication contributed to the deterioration of the conditions of the children who died.

As well as for children like Fadi who have pre-exisiting medical conditions, risks are rapidly rising for many others in Gaza, UN.agencies say.

The UN children’s agency UNICEF said on Friday that nearly one in three children under two years old in northern Gaza suffer from acute malnutrition, twice as many as in January.

In shelters and health centres visited by UNICEF and its partners, 4.5 per cent of children had severe wasting, the most life-threatening form of malnutrition, it said.

“Unless fighting stops and aid agencies have full access throughout Gaza then hundreds if not thousands more children could die of hunger,” UNICEF Executive Director Catherine Russell said today in a joint statement with the World Food Programme (WFP).

If Israel goes ahead with a promised offensive in Rafah, 1.1 million people in Gaza, half the population, are expected to face an extreme lack of food, in which starvation and death are present in households, the IPC report said.

Human Rights Watch (HRW) said in late February that Israel was obstructing the provision of basic services as well as the entry and distribution of fuel and lifesaving aid in Gaza. It said this was “collective punishment”, considered a war crime under international humanitarian law.

Rafah

At Al-Awda Health Centre in Rafah, more than a dozen women sat or stood tending their malnourished children.

Most of the children in the ward already had medical problems before the war, their relatives said, though pictures that the parents of two of them had showed them looking notably healthier than now.

On 4 March, 12-year-old Yazan Al-Kafarna, who had cerebral palsy, died in southern Gaza.

The ward nurse, Amira Abu Juwaiyad, said the hospital was unable to get enough milk for babies and that 10-15 cases were coming in daily under “catastrophic” conditions. Abu Juwaiyad did not say how much milk was available prior to the war.

Umm Mesbah Heji sat cradling her five-year-old daughter Israa, who is quadriplegic and epileptic.

Israa’s medications are no longer available and she has lost a lot of weight. Before the war, Heji used to feed her eggs and milk for breakfast, liver for lunch and rice for dinner, she said. Sometimes, she gave her yoghurt and fruit.

“I know she’s hungry. The food she eats isn’t available,” she said, adding that every day “I die one hundred times” feeling sad for her daughter.

Diarrhoea

Disease is aggravating the dire lack of food. Dehydration from diarrhoea, which the World Health Organisation (WHO) says is rampant in the mass tent cities where displaced people cram together without proper sewage or clean water, hastens malnutrition.

One effect of acute hunger is to reduce immunity against such gastric diseases.

The WHO said last month that 90 per cent of children under five in Gaza were affected by one or more infectious diseases with 70 per cent having had diarrhoea in the previous two weeks – a 23-fold increase over cases before the war.

Kerstin Hanson, a US doctor working on nutrition with international charity Doctors Without Borders (MSF), described the physical onset of malnutrition and dehydration.

Children grow lethargic and less responsive. Their skin loses its puffiness so that if pushed out of shape it may stay in that position. The eyes get sunken. The body emaciates.

Even for children who were healthy before the conflict, sustained malnutrition can stunt physical and brain development.

As acute malnutrition takes hold, a child’s body stops growing, Hanson said. Then it shuts down everything except vital functions. “Your heart and lungs will keep functioning, but … maybe there isn’t enough energy to keep your immune system functioning,” she said.

After that, the body would “kind of start eating itself”, using muscle, fat and anywhere else it could find energy to keep breathing and pumping blood. Eventually, it would just shut down.

Even when malnutrition does not reach that dangerous stage, its effects on development might be impossible to reverse if it is sustained, Hanson said. Children may never recover lost centimetres of growth.

READ: Gaza in state of ‘man-made famine’ by Israel: EU foreign policy chief

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