It’s a tragic sign of the times when little introductory narrative is needed to set the near-apocalyptic scene that exists in Gaza today. The world watches from a distance as Israel’s onslaught continues and the civilian death toll escalates to unimaginable levels. Now, the nightmare that Palestinian survivors are currently enduring is about to take on another dimension.
The prediction made one year ago of a man-made famine is about to be realised, though in truth, Gazans have suffered food insecurity for decades. Despite a heavy dependency on international agencies for humanitarian assistance, access to food and safe water supplies has repeatedly been denied due to blockades imposed by Israel.1United Nations Office for the Coordination of Humanitarian Affairs (2022) Situation Report. The Gaza Strip. The humanitarian impact of 15 years of Blockade—June 2022. UNICEF. Accessed 2 November 2024.As is the trend in such crises, women and children are particularly affected by malnutrition. Anaemia and other manifestations of nutrient deficiency have led to adverse effects on maternal, foetal and child health. Miscarriage and birth defect rates are high. Suboptimal nutritional status also impairs immune function and the ability of mother and child to recover from disease.2Horino, M. et al. (2024) Food insecurity, dietary inadequacy, and malnutrition in the Gaza Strip: a cross-sectional nutritional assessment of refugee children entering the first grade of UNRWA schools and their households before the conflict of 2023–24. The Lancet. Accessed 2 November 2024.,3Global Nutrition Cluster (2024) Nutrition Vulnerability and Situation Analysis; Gaza. Accessed 2 November 2024.
This dire baseline has only amplified the number of civilian losses caused by violence. The proportion of deaths in Gaza attributed to trauma-related injury versus that from malnutrition is hard to define; in many cases, it’s part of the same story. Malnutrition significantly affects the ability to recover from internal injuries, limb loss, and surgery, thereby increasing the risk of infection, sepsis and death.
Obtaining accurate quantitative information on injury, disease and deaths is essential. It draws global attention and allows humanitarian organisations to focus their resources. The tricky bit of course is that over- or under-inflation of rates can occur for political gain. Regardless, even Israeli officials admit that the Palestinian Ministry of Health are the only governmental body actively collating decent morbidity and mortality data.4Prothero, M. (2024) Israeli Intelligence Has Deemed Hamas-Run Health Ministry’s Death Toll Figures Generally Accurate. Accessed 2 November 2024. There are pro-Israel lobbyists who are still quick to dismiss those figures, citing that a third of the 38,000 deaths declared earlier this summer were unverifiable. However, the reality of real-time assessment in this war zone is that many of the dead are still buried under rubble. Formal ID is impossible: collected statistics unavoidably include household losses reported by family members. Any remaining deniers of data coming out of Gaza should consider satellite image analysis performed by the City University of New York and Oregon State University. Almost 98,000 buildings had been destroyed as of 29 November 2023, most of which were in the Gaza Strip area and in densely populated residential areas.5Bailey, D. et al. (2023) “Nearly 100,000 Gaza buildings may be damaged, satellite images show.” Accessed 2 November 2024. The World Health Organisation and United Nations have also found mortality rates quoted by the Palestinian Ministry of Health to be reliable during earlier critical periods in Gaza’s history.
Malnutrition prevalence from (neutral) aid agency field and clinic data also paints a progressively disturbing picture. In March, nutrition monitoring by UNICEF and others highlighted that around 1 in 20 children attending health centres and in shelters were at a life-threatening stage of severe wasting. In addition, over 30 percent of children under 2 years of age were classified as acutely malnourished; double that of three months earlier.6Ammar, A. & Cooper, K. (2024) “Acute malnutrition has doubled in one month in the north of Gaza strip.” UNICEF. Accessed 2 November 2024. By June, major nutritional concerns were no longer primarily restricted to the north. Almost 3,000 children in southern Gaza were in need of intervention to manage the effects of moderate to severe malnutrition yet were prevented from attending clinics due to ongoing conflict.7Ammar, A. & Ingram, T. (2024) “Almost 3,000 malnourished children at risk of “dying before their families’ eyes” as Rafah offensive disconnects them from treatment.” Accessed 2 November 2024. Spring and late summer saw some alleviation of food insecurity, as more convoys were able to cross the border and distribute supplies. Then September marked the month with the lowest cross-border transfer and distribution of food and bottled water.
The UN continues to monitor the situation closely. Is Gaza now ‘officially’ in famine? To meet the Integrated Food Security Phase Classification (IPC) definition, at least 20 percent of the population should have significant lack of access to food; acute malnutrition prevalence should be at least 30 percent; and mortality should be at or above 2 deaths per 10,000 people daily. At the time of writing, forty-three thousand are dead. The majority of the surviving population are now displaced, and one in five are facing “catastrophic levels of denied access to nutrition” (another IPC classification). Three-quarters of all crop fields have been destroyed. Access to food and safe water supplies, medical care and the availability of proper sanitation continues to be impossible in most situations. As the UN have stressed, Gaza sits on the very brink of famine.8United Nations (2024) “Over 1.8 million in Gaza face extreme hunger.” Accessed 2 November 2024. Without an immediate ceasefire, this will be a forgone conclusion.
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