We are about to witness in Gaza the most intense famine since the second world war
Gaza’s
health crisis has its own dreadful momentum. Even if the shooting ends
today and the aid trucks begin to roll, the dying will carry on for some
time
Gaza
is already the most intense starvation catastrophe of recent decades.
The death toll from hunger and disease may soon surpass the body count
from bombs and bullets.
The Famine Review Committee reported this week that Gaza is facing “imminent famine”.
The
Integrated Phase Classification (IPC) system, set up 20 years ago,
provides the most authoritative assessments of humanitarian crises. Its
figures for Gaza are the worst ever by any metric. It estimates that
677,000 people, or 32% of all Gazans, are in “catastrophic” conditions
today and a further 41% are in “emergency” conditions. It expects fully
half of Gazans, more than 1 million people, to be in “catastrophe” or
“famine” within weeks.
A parallel report from
the Famine Early Warning System Network of the US Agency for
International Development sounds the same alarm. It is the clearest
warning that the network has given at any time in its 40-year history.
A
rule of thumb is that “catastrophe” or “famine” conditions mean a daily
death rate from from hunger or disease of two people out of 10,000.
About half are children under five years old. The arithmetic is simple.
For a population of 1 million, that is 200 deaths per day, 6,000 per
month.
By way of comparison, the worst famine
on the IPC record books struck Somalia in 2011, through a combination of
war, drought and a shutoff in aid. At its nadir, 490,000 people were in
“catastrophe” conditions with a larger number in “emergency”
conditions. An estimated 258,000 people perished over 18 months.
The
only other occasion when IPC data showed famine was in South Sudan in
2017. Civil war plunged half the country’s 10 million people into a food
emergency, with 90,000 suffering famine. About 1,500 people starved to
death in the two districts devastated by famine, but four years of wider
food emergency claimed about 190,000 lives.
The
“famine” threshold is arbitrary. In the next-worst stage, that of
“emergency” conditions, children are already dying of starvation. When
experts first drew up a prototype “famine scale”, they had a lower bar
for declaring famine, roughly equivalent to the IPC’s “emergency”, and
included “severe” and “extreme” famine categories that correspond to the
IPC’s “famine” conditions. They also included a measure of magnitude –
total numbers affected and dying – and later considered duration too.
Some food emergencies last years, with the death toll slowly
accumulating, without ever crossing the IPC’s “famine” threshold.
Even when the numbers of people needlessly dying dwindle, the scars of famine will endure
Famine
was never declared for Yemen. But food emergency affecting millions
over years of war caused as many as 250,000 starvation deaths. In the
Tigray region of Ethiopia, the story is similar.
We
are about to witness most intense famine since the second world war. It
won’t be the biggest, because starvation is confined to the 2.2 million
residents of the Gaza Strip.
Our picture of
starvation is a stick-thin child wasting away, whose eyes seem swollen
as her skin shrinks to her bones. Some children suffer kwashiorkor,
acute malnutrition marked by a tell-tale swollen belly.
As
the body starves, its immune system begins to fail. The malnourished
fall prey to waterborne infections and suffer diarrhoea, which causes
devastating dehydration. Other communicable diseases – which today could
include Covid – also ravage communities. The most common cause of death
in a famine is disease, not starvation as such.
“Starvation”
is defined in international criminal law as depriving people of objects
indispensable to survival. That includes not just food but also
medicine, clean water, sanitation, shelter, cooking fuel and maternal
care for children.
Palestinian children wait for food on 16 February in Rafah, Gaza. Photograph: Fatima Shbair/AP
When
people are driven from their homes into overcrowded camps, when water
supplies are scarce or unclean, when toilets are nonexistent or
unsanitary, when injuries are left untreated, disease outbreaks become
more common and more deadly.
Lacking shelter
and exposed to cold and rain in winter, and heat and dust in summer,
people succumb to hunger and disease more quickly. Without electricity
or cooking fuel, mothers cannot prepare meals that young children can
readily digest.
Epidemiologists in London and
Baltimore have generated projections for the likely death toll in Gaza
from all causes over the months to August. If epidemics are included,
their “status quo” scenario projects a range of 48,210 to 193,180
deaths, while under the “with escalation” scenario those figures range
even higher.
Gaza’s health crisis has its own
dreadful momentum. Even if the shooting ends today and the aid trucks
begin to roll, the dying will carry on for some time.
And even when the numbers of people needlessly dying dwindle, the scars of famine will endure.
Little
children who survive starvation face lifelong deprivation. They tend to
grow up to be shorter than their peers and suffer reduced intellectual
capacity. The World Health
Organization warns of an “inter-generational cycle of malnutrition”
whereby infants with low birth weight or undernourished girls grow into
smaller and less healthy mothers. The damage caused by the 1944 Dutch
hunger winter can still be observed generations on.
Famine
is a social trauma too. It tears apart communities and destroys
livelihoods. People are forced into the utmost indignities, breaking
taboos in what they can eat and how they can get the necessities of
life. Mothers have to ration the food they give to their children. They
turn away hungry neighbours from their door. Families sell their most
treasured heirlooms for a pittance to buy a meal.
Israel has had ample warning of what will happen if it continues its campaign of destroying everything necessary to sustain life
What solace is it to tell parents who have buried their child that it was not their fault? Survivors’ anguish lasts a lifetime.
Such
is the lingering sense of shame that people cannot speak openly about
famine, sometimes for generations. It took almost 150 years before
Ireland began publicly to commemorate the great hunger of the 1840s.
All of this is known. And in Gaza there is no margin of doubt.
In
most famines, there’s a margin of uncertainty in predictions, because
people may be able to find unexpected sources of food or money. In parts
of rural Africa, grandmothers may know about edible wild roots and
berries or migrant workers may find creative ways of sending cash to
their families. In Gaza, Israel
knows every calorie that’s available. In 2008, the coordinator of
government activities in the territories calculated every aspect of
Gaza’s food production and consumption, in minute detail, and extracted
the “red lines” needed to keep Palestinians on what it called a “diet”,
just short of starvation.
Until 7 October 2023,
Israel was, according to its own analysis, just on the right side of
the international laws prohibiting starvation. About 500 truckloads of
essentials entered every day to complement local farms, fisheries and
livestock. In recent months, less than one-third of that number has been
allowed to enter, while local food production has been reduced to
almost zero.
Israel has had ample warning of
what will happen if it continues its campaign of destroying everything
necessary to sustain life. The IPC’s Famine Review Committee report on
21 December authoritatively warned of starvation if Israel did not cease
destruction and failed to allow humanitarian aid at scale. Israel’s own
judge nominated to sit at the international court of justice, Aharon
Barak, voted with the court’s majority in favour of “immediate and
effective measures to enable the provision of urgently needed basic
services and humanitarian assistance”.
Israel
has not changed course. The supplies entering Gaza are woefully short of
the minimum calories Israel specified before the war. American airdrops
of supplies and an emergency port are a pitiful pretence of a
substitute.
Famine is unfolding in Gaza today. We should not have to wait until we count the graves of children to speak its name.
Alex de Waal is a writer
on humanitarian issues, conflict and peace, and an expert on the Horn of
Africa. He is executive director of the World Peace Foundation and a
research professor at the Fletcher School of Law and Diplomacy, Tufts
University in Massachusetts