Gazans are fighting over the last cans of food, malnourished mothers are struggling to make milk for their thinning babies, and doctors have begun counting down the days before the slow deaths by starvation begin to happen en masse.
“Within one week, we will see a severe starvation,” Dr. Ahmad Al-Farra, head of pediatrics and obstetrics at Nasser Hospital, told NBC News.
The besieged enclave is under its longest blockade of humanitarian aid since the war began on Oct. 7, 2023, as Israel’s total ban on the entry of all goods, including food, fuel and medical supplies, enters its third month. Despite international outrage, Israel has not only kept the gates shut for the past 63 days, but the security Cabinet is voting Sunday night to expand its offensive in Gaza.
For weeks, families were surviving on very little — fewer meals and smaller spoonfuls — and each day has brought a new low of deprivation.
Parents are now watching their vulnerable children starve, with warehouses now empty and community kitchens forced shut. In a place where 80% of the population relies on aid, according to the United Nations, those aid agencies no longer have much to supply. What little food is left in the markets is sold at exorbitant prices.
Ossama Al-Raqab was lying in the pediatric ward of Nasser Hospital, unable to sit up properly. The 5-year-old suffers from cystic fibrosis and is so starved that he can barely lift his gaunt head. His cheeks have sunk into the hollows of his face, his ribs are protruding and his scrawny limbs are little more than bone. His facial muscles have wasted away so much, he can no longer close his mouth.
“Mommy, Mommy, I want to go back,” he whimpers, unable to speak for long.
His mother, Mona Al-Raqab, sits next to him, showing a picture of her once healthy and smiling son, at a time when his diet included eggs, avocados, cashews and almonds. “He needs food and food that contains protein and fat,” she says. “But these things are not available now, and if they are, they are expensive.”
Young Ossama is among the thousands of people already being treated for malnutrition, and for months, doctors like Al-Farra have been warning that the hunger will one day turn fatal.
That warning is now a reality.
“We are talking about 57 deaths from starvation for pediatrics,” Al-Farra told NBC News, adding the cases were not only expected to rise in number, but also severity. “We are talking about increased cases of malnutrition and anemia.”
More than 52,000 people have been killed in Gaza since the war began, local health officials say, where less than half of the remaining 59 hostages taken from southern Israel are believed to still be alive in captivity. About 1,200 were killed in Israel and 250 kidnapped during the Oct. 7, 2023 attacks, led by Hamas, that sparked this major escalation of a decadeslong conflict.
Israel imposed the current blockade on March 2 after it ended a two-month ceasefire and resumed its military operations, justifying the blockade as necessary for pressuring Hamas into releasing the hostages. Israel, which has been accused of violating international humanitarian law by using starvation as a weapon of war, has defended its blockade by saying enough aid entered the strip during the ceasefire and accused Hamas of hijacking its delivery.
Those who survive malnutrition in Gaza also have to survive Israel’s ongoing bombardment. But in Gaza’s barely functioning health care system, even the most critical injuries are not getting treated and the simplest injuries are turning fatal without blood supply, which is also being depleted by hunger.
Even when there is an available donor, Al-Farra said, “unfortunately a lot of them already have anemia,” which disqualifies them from donation.
The blockade’s resumption has resulted in a sharp increase in acute malnutrition among children, according to UNICEF, which said the number of such cases doubled in March from the previous month. More than 9,000 children have been admitted or treated for acute malnutrition since the start of the year, it said.
With bakeries shut, farming land destroyed or taken over by Israeli forces, and fishing restricted, “humanitarian aid has provided the only lifeline for children, and now it is close to running out,” UNICEF Executive Director Catherine Russell said in a statement Friday.
Starvation begins with the most vulnerable, and newborns and children already suffering other conditions are especially prone.
Siwar Ashour, a 5-month-old child from Al-Nuseirat refugee camp, has lost half of her weight, her mother, Najwa Aram, 23, told NBC News.
“I can’t even afford milk. I beg for clothes for her,” Ashour says, crying. Ashour said her daughter first contracted intestinal flu, which worsened with the lack of clean water and food.
“Every day his condition worsens,” Al-Raqab says, looking at her son, Ossama, who was so frail he now appeared swallowed by the clothes that once fit him. “I want him to be like a normal child, play with children and go out and finish kindergarten.”
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