As of August 8, 197 people, including 96 children, have died of famine in Gaza as a result of Israel’s blockade and military offensive, according to Gaza health authorities.
have said some 100,000 Palestinian women and children are facing severe malnutrition, and a third of the population of 2.1 million hasn’t eaten in days.
Gaza isn’t the only place where conflicts are driving catastrophic hunger. In Sudan, 3.2 million children under the age of 5 will suffer from acute malnutrition in the next year. People under siege in El Fasher, in North Dafur, .
In Nigeria, where , malnutrition has led to the deaths of 625 children . Haiti, Mali and Yemen are among other countries experiencing catastrophic hunger.
But treating hunger crises can be more difficult than it seems, and requires more than just a regular supply of healthy food. Health experts have warned that refeeding programs for malnourished people can have fatal complications if done without proper care.
“If you reintroduce things quickly, you get a very rapid change of electrolytes and that can cause sudden death,” said Marko Kerac, a pediatrician and clinical researcher at the London School of Hygiene and Tropical Medicine in the UK.
That’s why a return to proper nutrition needs to be carefully managed, Kerac told DW.
What is refeeding syndrome and why is it dangerous?
Refeeding syndrome can occur if some malnourished people resume normal eating too quickly.
People with kidney failure, eating disorders, depression and alcohol issues are most susceptible to refeeding syndrome.
The problem arises after the malnourished body has adapted to reduced nutrition. By slowing its metabolism and organ function to deal with catastrophic hunger, the body is ill equipped to deal with a sudden flood of nutrients.
“When you’re really [nutritionally] compromised … when you’re really sick, that’s when the risk of refeeding syndrome happens,” said Kerac.
The sudden arrival of vitamins and electrolytes like potassium, phosphorus and magnesium can disrupt critical organ processes and lead to arrhythmia — an irregular heartbeat — which can be fatal.
What happens to the body during starvation?
Starvation begins when people don’t get enough calories to keep up with the body’s energy demands.
The loss of adequate nutrition denies the body essential materials needed to produce hormones and enzymes that keep the body functioning. To compensate for the calorie deficit, the body slows down metabolic processes and organ activity.
In the first two days without food, the body’s carbohydrate stores are depleted. After three days, the body starts converting vital fats and proteins into emergency fuel. This is when people begin to experience muscle wasting, severe fatigue and a weakened immune system.
Death from starvation occurs most commonly due to an infection the body is too weak to fight, or from organ failure.
What do experts say needs to happen?
The first step is to introduce food or nutrition slowly, what Kerac calls “stabilization feeds.” This can include things like special milk formulations and ready-to-use therapeutic foods (RUTFs).
Aid organizations supply RUTFs like Plumpy’Nut, a fortified peanut paste, to help prevent refeeding syndrome in .
“[RUTFs] are paradoxically quite light in nutrients, but are specially formulated. They have low sodium, higher potassium, higher phosphate,” said Kerac.
RUTFs are designed to deliver essential nutrition specifically for severely malnourished children at a dosage that doesn’t overload their bodies and risk refeeding syndrome. A child given three sachets of Plumpy’Nut a day could recover from severe acute malnutrition in eight weeks.
“RUTFs [can] prevent refeeding syndrome in settings where you cannot monitor for refeeding syndrome,” said Wieger Voskuijl and Hanaa Benjeddi, pediatricians at the Amsterdam University Medical Center who have delivered medical services in conflict zones and refugee camps.
Researchers have also looked to other RUTF products that can be prepared closer to African and Asian sites, where rates of are highest.
These products include ones made from chickpeas, mung beans, maize and lentils, foods grown locally that could potentially help to reduce production costs and allergy risk.
Safe resumption of aid in famine regions ‘needs international pressure’
Food crisis experts have predicted “” if action is not taken to alleviate hunger in these regions.
The crucial part of supplying food aid to is delivering food and RUTFs in the right way by allowing aid services into regions like Gaza and Sudan, Voskuijl and Benjeddi told DW.
“The crux and the issue is that preventing refeeding syndrome is almost impossible in settings with high demand and a low amount of health care workers or aid workers,” they said.
Voskuijl and Benjeddi said governments in famine-hit regions need to prioritize safe conditions for aid agencies to resume their work and prevent a humanitarian crisis.
“And that needs international pressure. If we look at , but also , these are two governments that are denying such access to malnourished children and pregnant women.”
Edited by: Fred Schwaller
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