A few weeks ago, Soliman Zyad, a young health-care worker in northern Gaza, told me that his family was near starvation. On some days, he and his uncle AbdulKareem walked in search of food from 3 A.M. until the afternoon. “We swore we would not return home without finding flour,” Zyad told me. “People were ready to risk their lives for a single sack.” Almost forty per cent of the population was going days at a time without eating, according to the World Health Organization. Sometimes AbdulKareem would vomit from hunger and fatigue. His wife, pregnant with twins, was severely anemic.
The latest food shortage in Gaza began in March, when Israel ended a ceasefire and imposed a blockade on all aid that lasted eleven weeks. After that, the Gaza Humanitarian Foundation, which was backed by Israel and the U.S., began distributing limited amounts of aid; around three thousand Palestinians were killed while seeking food. This month, a United Nations study published in The Lancet reported that more than fifty-four thousand children are malnourished in Gaza. “Every family, by now, has been affected,” John Kahler, a pediatrician and a co-founder of MedGlobal, a humanitarian organization that operates in Gaza, told me. About one in five babies was born premature or underweight. MedGlobal cared for one infant, Rafeef, who weighed just four pounds at birth. Her mother was too malnourished to breast-feed; the baby cried constantly, began losing weight, and developed ulcers and infections. On August 18th, she died.
“We live day by day,” Eyad Amawi, a father of four who works as an aid coördinator in Gaza, told me in September. “We have just enough to survive, but not enough to carry out our normal activities.” On the black market, the price of a kilogram of flour—about ten cents before October 7, 2023—had risen to thirty-five dollars, when it could be found at all. Amawi often saw malnourished children who lacked the strength to play. He worried that months of famine had already inflicted irreversible damage. “We are losing the next generation,” he said. “They will suffer for all their lives from this.”
Now that a ceasefire is in place, aid is trickling in. Under the terms of the ceasefire agreement, six hundred trucks a day are meant to enter Gaza. The United Nations Relief and Works Agency for Palestine Refugees in the Near East reports that it has stockpiled three months of food for everyone in the territory. There is reason to hope that, for all the lasting destruction in Gaza, the immediate crisis of hunger will come to an end. “As this famine is entirely man-made, it can be halted and reversed,” the Famine Review Committee, an international body that monitors food insecurity worldwide, wrote in August.
Yet numerous experts warned that not all consequences of famine can be undone. “People don’t realize that one doesn’t just recover from starvation,” Dana Simmons, a historian and the author of “On Hunger: Violence and Craving in America, from Starvation to Ozempic,” said. For the severely malnourished, simply starting to eat normal meals again can cause sickness—even death. And survivors of starvation are at risk of chronic diseases and mental-health conditions for decades after they regain access to food. “You’ve stunted a generation,” Nathaniel Raymond, the director of the Humanitarian Research Lab at Yale, told me. Ruth Gibson, a scholar at Stanford’s Center for Innovation in Global Health, spoke in even starker terms. “Can this be reversed?” she said. “The answer is, it can’t be.”
Much of what we know about the toll of starvation comes from the Warsaw Ghetto, where the Nazis forcibly resettled about half a million Jews starting in 1940. German authorities in occupied Poland restricted provisions to “less than the minimum to preserve life”; a ration card from October, 1941, allotted most Jews roughly three hundred daily calories. Deaths eventually climbed to five hundred per day. Under these horrific conditions, twenty-eight Jewish doctors who had been sent to the Ghetto, led by a dermatologist named Izrael Milejkowski, recruited seventy adults and forty children for research into what they called pure starvation, meaning that those afflicted had no additional infections or diseases. As the physician Leonard Tushnet wrote, in 1966, the researchers—who were themselves going hungry—conducted “an exhaustive and precise study of the effects of starvation.” The study continued until deportations to the Treblinka extermination camp, where many of the researchers would ultimately perish, began, in 1942. They hurriedly compiled their charts and graphs into a manuscript, which was then buried in a steel jar. It was recovered after the war and published, in Polish, in 1946.
In the forties, exactly how the body dealt with starvation remained a mystery. The doctors used equipment that had been smuggled into the Ghetto to measure capillary circulation, examine bone marrow under microscopes, and record electrocardiograms. The quality of their scientific work was “amazing,” Merry Fitzpatrick, a scholar of malnutrition and famine at Tufts University, told me. They wrote that muscle melted away, skin acquired the texture of cigarette paper, and swelling often afflicted the legs, scrotum, labia, heart, and lungs. In a cemetery shed, the doctors performed more than three thousand autopsies, which revealed that starvation softened the bones and atrophied vital organs. Starving children stopped playing and appeared sluggish or apathetic; cognitive development seemed to halt or even regress. Some looked like “skin-covered skeletons.”
A nurse attends to two starving children at a hospital in the Warsaw Ghetto, in 1942.Photograph from United States Holocaust Memorial Museum / Maladie de Famine / American Joint Distribution Committee
One of the study’s most important findings was that the body has sophisticated ways of saving energy and sparing critical tissues and functions. Reserves of glucose in the blood, liver, and muscle quickly run low. Then the body shifts to burning fat in three different ways. Some of the fat molecules can be used to create glucose; some can be used to create ketones, an alternative energy source for certain tissues, including the brain; and some can be directly broken down inside the mitochondria to create adenosine triphosphate, or ATP, the primary energy source for our cells.
