The “worst scenario of famine” takes place in Gaza, warned the integrated classification of the food security phase (IPC) in an alert of July 29, adding that “access to food and other essential items and services has dropped to unprecedented levels”. Famine, malnutrition and widespread diseases lead to an increase in death -related deaths, the IPC, an organization affiliated with the United Nations, added, calling for “immediate action” to be taken to put an end to “catastrophic human suffering”.
“This is an incredibly important health disaster at the moment in Gaza, short -term and long -term,” said Dr. Deborah Frank, a pediatric professor at the Chobanian public health school and Avedisian, the clinic of Grow Clinic for the children of the Boston Medical Center and the Children’s Children’s Children’s Founder. “It’s repairable, but it is not a quick or easy solution. You must have qualified people, and you must have supplies. ”
According to the IPC, more than 20,000 children in Gaza were treated for acute malnutrition from April to mid-July, and more than 3,000 of them were seriously unwelcome. The Gaza Ministry of Health said on July 28 that nearly 150 people have died of malnutrition since the start of the War of Israel-Gaza in October 2023, including at least 88 children.
A desperate environment
At the end of April, Dr. Aqsa Durrani, doctor and epidemiologist with public health orientation in humanitarian emergency intervention, returned to the United States after spending two months in Gaza with doctors without borders, also known as doctors without borders. She was there on March 2, when Israel reprinted a blockade on the Gaza Strip, preventing the entry of food, fuel, drugs and other humanitarian aids. As she left, doctors, nurses and patients at the trauma hospital where she worked ate one meal a day-a little rice, she says, or perhaps lenses; Certainly no substantial protein or a large amount of vegetables. “We have spent many of our days trying to work with organizations to see where we could find more food sources and more nutritional sources for our patients,” she says. “It was impossible. I had mothers and children sharing part of a meal every day. ”
Learn more:: The Malnutrition Crisis in Gaza will survive war, warn the experts
Famine has triggered the “psychological torment”, recalls Durrani: “I asked mothers to come to me and take me aside and say:” Do you have anything else you can give to my child? ” The conditions have aggravated since his departure, and his colleagues tell him that they are now taking a meal every two or three days. “They perform surgeries while they are hungry, then go home with hungry children,” she said. “It’s quite painful.”
How the famine affects children
The impact of famine varies from one child to the other and from one person to another, explains Abyan Ahmed, a world adviser in humanitarian nutrition for Care, an international humanitarian organization fighting against poverty and global hunger. Factors such as immune health and body fat play a role; If someone is already undernourished, his health will deteriorate quickly, after a few days without food. Children and adults who have a normal weight, or more and more, in the meantime, may not undergo the hardest effects of famine for weeks, even months, especially if they are able to take intermittent meals.
When there is very limited access to food, the body turns into survival mode, first closing non -vital functions: the digestive system slows down, the reproductive system (ovaries and testicles) can shrink and the growth and development stand. Once the body has used all its carbohydrates stored, it will start to burn fat reserves and search for energy from organs, muscles and bones. The heart rate slows down; Blood pressure drops; The body temperature decreases. “The body is eaten to try to stay alive,” explains Frank. The broken bones are common for children in this state. Malnutrition also weakens children’s immune systems, increasing the risk of infections such as pneumonia, diarrhea, measles and sepsis. Although people can and die of famine, deaths are often caused by an infection, she adds.
In the short term, children suffering from malnutrition suffer mentally and behavior and physically. “They are irritable, they are lethargic and are apathetic,” explains Frank. “They seem miserable, and that’s exactly what they feel. In fact, when you slowly feed a child suffering from malnutrition, what we are talking about is a sign of smile: when they come to the point where they can smile, you are going up.”
Frank worked with children with malnutrition who, at the start, were deaf or blind. “They were not so insensitive when they were hungry,” she recalls. “Then you feed them, and indeed, this child can hear and see. As they feel better, they start to interact and act much more normal ”, but this recovery can take weeks or months.
Health effects in adults
Malnutrition affects adults in the same way as children. “When we reflect on the functioning of the body, the first stages of famine will be the same for men and women,” explains Don Thushara Galbadage, associate professor at the Harris College of Nursing and Health Sciences of Texas Christian University. During the first weeks, “they will experience fatigue, they will have muscle loss and muscle waste, and they will have altered cognition. And if it goes longer, some of their organ systems can work badly and stop. ” “We have seen, from case studies on famine, which it takes up to 60 days before the body stops completely if the person has access to water,” explains Ahmed. “If you don’t have access to the water, you can die as quickly as three to five days.”
People experiencing famine are often unable to concentrate and do not have energy to perform basic tasks, like getting out of bed or taking care of their children. “If a mother is badly nourished, all these tasks become incredibly difficult to do,” explains Ahmed. “This leads to problems of depression and mental health, which also affects malnutrition – because if you have mental problems, you cannot take care of yourself and eat properly, even if food is available.” In addition, she says, many women are exceeded and afflicted by the sound of their children who cry from hunger.
Pregnant or breastfeeding women are particularly vulnerable to the effects of famine. Research suggests that pregnant women in these situations are often incapable of gaining weight and that the risk of miscarriage and mortinity increases. In a study, birth weight decreased by 9% during a famine, the placental weight decreased by 15% and the length at birth decreased by 2.5%.
“During the third quarter, a lot of growth occurs for the fetus, and when a mother is hungry, she has life implications for the child,” explains Ruth Gibson, postdoctoral scholarship in the health policy of the University of Stanford who specializes in global health, emphasizing the improvement of maternal health and children in geopolitical regions. “This includes things such as epigenetic changes – it is therefore essentially when the expression of genes is modified – cardiovascular risks, chronic diseases and metabolic syndrome.”
How the famine interferes with the healing of the wounds
At Trauma Field Hospital in Gaza where Durrani has worked, she mainly treated patients injured by air strikes. Some had been burned by the resulting fires that torn the region – and for their injuries to heal, they needed appropriate nutrition. If a child needs an amputation, for example, his surgical incisions may not cure because his body does not have enough protein to rebuild the fabric. In general, when injuries do not heal properly, the risk of infection increases. “Very early on, I had a baby die who developed an infection because of his nutritional state,” said Durrani. “If you think of a community that is affected by relentless air strikes – it’s really just a layer of cruelty to add famine.”
A life of consequences
The effects of famine can persist long after people have found access to food. “What we cannot see are the generational and intergenerational impacts” of the current famine, says Gibson.
Research suggests that children who suffer from malnutrition are more likely to have good health, including an increased risk of diabetes, heart disease and obesity, as well as muscle -skeletal deficiencies – and development delays that persist throughout their lives. They are also at risk increased by anxiety, depression, post-traumatic stress disorders and mental illnesses such as schizophrenia.
“Not only does this reduced their cognitive development, but malnutrition has been associated with a bad level of education, with bad Qi scores, with a lack of income in life later, and not being able to keep jobs due to behavioral problems,” explains Ahmed. “This triggers the person to this cycle of poverty, which then gives birth to more malnutrition in their family.”
Tackling the chronic problems associated with malnutrition requires a systematic approach that is probably not possible in Gaza in the near future, says Ahmed. For the moment, it is crucial to ensure that as many people as possible have access to therapeutic nutritional support to help repress the immediate effects of famine.
“The priority at the moment is to keep so many people alive and make them flourish and bring them back to a normal immune system,” explains Frank, which can take a few months in optimal conditions. “But it will take long -term work for children who survive, to reduce the chances of school failure, psychiatric disorders and cardiovascular disease as they become adolescents and young adults.”
An imminent threat: REALIMENTATION SYNDRY
When a child or an adult has adapted to the consumption of very little food, he cannot suddenly start to eat a normal quantity, even if the supplies become available. This could lead to a condition called refeeding syndrome, which causes a gap of fluids and electrolytes which can trigger cardiac arrhythmia, organs dysfunction and death. “At a less catastrophic level, you can get horrible diarrhea and vomiting, which brings back hydration,” explains Frank. “It’s not just about giving someone a box of cereals and saying,” Go ahead. ” You must be careful.
He can take doctors who work with children with malnutrition up to 10 days to establish a safe and coherent weight gain, says Frank. As a general rule, doctors provide children with a small part of the calories they really need according to their weight, while monitoring their physiology and their stomach tolerance for a few days. “You are gradually being built over time, first of all in normal calorie needs, then the needs of catching up,” she says. “People who take care of these children need to know exactly what they do. The idea you can parachute food boxes on the heads of babies and then expect them to grow – that doesn’t work like that.”
