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.

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 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.

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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. Photogr
aph: 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.

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Israel has had ample warning of what will happen if it continues its campaign of destroying everything necessary to sustain life

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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

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