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Gaza’s hunger and famine could hurt children for a lifetime

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Gaza’s children are going hungry. More than 25 have reportedly died of complications linked to malnutrition, according to the World Health Organization. Hundreds of thousands more face starvation as Israel continues its siege.

Doctors and nutrition experts say the children who survive the lack of nourishment — and the ongoing bombing, infectious diseases and psychological trauma — are further condemned to face a lifetime of health woes. Malnutrition will rob them of the ability to fully develop their brains and bodies. Many will be shorter and physically weaker as a result.

“At the simplest level, if you have impaired nutrition and growth, your brain stops growing,” said Zulfiqar Bhutta, a physician and the chair of global child health at the Hospital for Sick Children in Toronto.

In the short term, even less sustenance will be available for the children of Gaza: This week, an Israeli airstrike that killed seven aid workers led several assistance organizations to announce they would suspend operations.

When Asim al-Najjar was born on Dec. 21 in Gaza City, he weighed more than eight pounds, above average for a newborn baby boy.

Asim al-Najjar, receiving treatment in northern Gaza, weighs less at three months old than he did the day he was born.
(The Washington Post)

But, at more than three months, deprived of milk and nutrients for much of his short life in hunger-stricken Gaza, his weight has dropped to just over six pounds, the infant’s father, Mohammad, said.

Asim’s mother, Hala, was no longer able to breastfeed her baby because she wasn’t eating enough. They survive on animal feed, Mohammad said. They haven’t been able to find enough infant formula.

Humanitarian officials have sounded alarms about an “imminent” famine in Gaza, urging the Israeli government, which approves what comes through Gaza’s border checkpoints, to allow more food to enter.

Israel denies it is limiting aid, blaming the United Nations for not doing enough to deliver help — or saying that the food is being sent to Hamas. Israel has also accused the aid community of exaggerating the extent of the crisis. Israeli protesters have blocked and prevented aid convoys from entering Gaza.

The toll of hunger on the human body is evident from adults to children. The younger the person, the greater the impact.

People get energy primarily by turning carbohydrates into glucose, which is processed in the liver and distributed throughout the body, especially to the brain.

After exhausting its glucose reservoir, the body starts getting energy from fat.

But if the body is not getting sufficient sustenance, it then burns protein from muscles to get energy, eventually becoming unable to deliver essential nutrients to vital organs and tissues. For children, this happens more quickly because they have fewer reserves and need more energy to grow.

As a consequence, muscles start shrinking and organs stop functioning properly, the body can’t regulate temperature, skin goes pale and gums may start bleeding. The immune system loses its ability to repair wounds and fight infections such as those causing diarrhea, which can create a vicious cycle that further deprives the body of nutrients.

The digestive system is one of the first to shut down, resulting in decreased production of stomach acid, chronic inflammation, shrinking of the stomach, and a loss of appetite. If food becomes available again, it will need to be introduced slowly, ideally in a hospital setting.

The heart shrinks, which decreases blood flow, slows the heart rate and lowers blood pressure. Eventually, the heart can fail.

Breathing slows and lung capacity wanes. Eventually, respiratory function can fail.

As the brain is deprived of energy and essential nutrients, apathy, exhaustion and irritability ensue. Children need more energy than adults to develop their brains, making them more vulnerable to a lack of nutrients, as well as hampering their ability to learn later in life.

Previous famines or extreme hunger crises, including those in Ethiopia, Sudan and Yemen, have sparked a mass exodus of refugees into neighboring countries, where aid workers can distribute food. In Gaza, most people are blocked from leaving, and aid workers can rarely reach those in need, particularly in the north, which is all but cut off from the rest of the world.

That’s a violation of social norms set during conflicts over the past few decades, according to Alex de Waal, executive director of the World Peace Foundation at Tufts University and author of “Mass Starvation: The History and Future of Famine.”

The lack of aid has left children like 11-year-old Nour al-Huda Mohammad marooned, wasting away in a hospital bed without enough food or medicine. Nour’s mother, Amira, said her daughter has lost more than eight pounds since the war began.

“We have been living on scraps of food,” Amira said. “And recently even scraps are no longer available.”

Nour al-Huda Mohammad, 11, receives treatment in Kamal Adwan Hospital in northern Gaza. (Family photo)

Nour, who came to northern Gaza’s Kamal Adwan Hospital for treatment in mid-March, has cystic fibrosis, making her even more vulnerable to the horrors of malnourishment. Her skin began to peel off — “just like fish scales,” her mother said — a side effect of dehydration.

Hussam Abu Safiya, the head of Kamal Adwan, said the hospital treats approximately 50 children per week for severe dehydration and malnutrition. He said mothers often come in saying their child hasn’t had a full meal in days.

The hospital lacks food and clean water for patients and staff. Abu Safiya said most workers, including himself, have lost about 30 percent of their body weight.

Ahmed Qannan, a boy suffering from malnutrition, receives treatment at a health-care center in Rafah on March 4. (Mohammed Salem/Reuters)

Gazans are not getting enough nutrition

More than 90 percent of young children and pregnant and breastfeeding women in Gaza are subsisting on two or fewer food groups, such as bread, per day. They previously had access to more protein, fresh fruits and vegetables, and milk, said Anuradha Narayan, senior nutrition adviser at UNICEF.

Types of food eaten in Gaza

UNICEF has been unable to deliver to northern Gaza enough ready-to-use therapeutic food, a peanut butter paste chock-full of needed vitamins and minerals that can treat acute malnourishment, she said. And the limited medical system to treat and distribute it further hampers efforts to treat children.

A lack of nutrients has affected pregnant mothers. Nada Abu Mattar, whose third child is due in mid-April, has been diagnosed with anemia — typically caused by lower levels of iron — which can lead to life-threatening heavy bleeding during childbirth.

Nada Abu Mattar, who lives in Gaza’s Jabalya camp and is expecting a child this month, says she has only gained six pounds during her pregnancy. (Family photo)

Abu Mattar, 36, said she hasn’t had meat, eggs or milk in three months. She and her family live off flour from aid shipments and “cheeseweed,” a regional herb that sprouts from the ground when it rains. She said that eight months into her pregnancy, she has gained only about six pounds.

Medical professionals on the ground have warned that newborn babies could die because of low birth weight.

Those babies who survive face severe risks tied to malnutrition.

Micronutrients are fundamental for development. For instance, without enough vitamin A — found in eggs, fish and vegetables — children in Gaza risk developing poor eyesight.

A lack of zinc makes it hard for children to put on weight.

Insufficient iron, most easily absorbed from meat, saps energy and affects the ability to concentrate.

Children who don’t consume micronutrients will develop weaker immune systems, leaving them more susceptible to infections that could cause diarrhea, pneumonia and fevers.

Malnourishment can also stunt physical growth in the long term.

Even after war, hunger leaves a social toll

The children of Gaza will carry the marks of starvation as they grow into adulthood, limiting educational and workforce opportunities.

Desperation for food has led to gruesome deaths: More than 100 people were killed as thousands swarmed an aid truck convoy in February. Palestinian authorities say Israeli forces shot at hungry civilians; Israeli officials say most people were killed in a stampede. Last week, Gazan authorities said a dozen people drowned trying to reach airdropped aid deliveries that landed in the water.

And the horrors of social decay — as parents make choices about whom to feed or what to sell to survive — will endure.

“Unlike shooting or bombing, if killing stops, the dying won’t stop. It’ll still continue for some time,” de Waal said. “Starvation in war like this is a massacre in slow motion.”

Displaced Palestinians gather to collect food donated by a charitable youth group on the second day of the holy month of Ramadan in Rafah on March 12. (Loay Ayyoub for The Washington Post)

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