Has Israel manufactured a famine in Gaza?

The markets are empty. The make-shift hospitals are bare. The water is contaminated. The aid trucks are nowhere in sight.

Gaza is being starved, and rights groups say, deliberately. 

At least 57 children have starved to death since 2 March, and 71,000 children under the age of five are expected to be acutely malnourished over the next eleven months.

In the ongoing war on Gaza, which genocide scholars and international human rights organisations have unanimously called a “genocide” against the Palestinian people, Israel also has been accused of implementing a policy of starvation in Gaza.

The crisis has escalated to such an extent over the past 11 weeks since Israel blocked aid to the enclave – opening it just this week in a dehumanising manner –  that nearly every single person in Gaza is facing prolonged food shortages, with close to a half a million people (or around one in five) are currently experiencing “catastrophic situation of hunger, acute malnutrition, starvation, illness and death”.

In its assessment in mid-May, the Integrated Food Security Phase Classification (IPC), a global initiative aimed at enhancing food security and nutrition analysis to inform decisions, wrote that over the next six months, the entirety of Gaza is expected to face what is referred to by experts as “crisis, or worse acute food insecurity”.

Around 22 percent of the population is already living in conditions akin to famine.

Like Gaza, parts of Sudan have also been facing acute food insecurity, including famine, over the past year, as a result of the ongoing conflict between the Sudanese army and the paramilitary Rapid Support Forces.

But what happens to the body when it enters “starvation” mode? What does it mean to live in conditions of famine?

And when a human being is facing starvation and the body begins to waste away, is it possible to ever reverse the devastating impact on the body?

Middle East Eye looks at the medical and legal dimensions of what it means to starve a population. 

What is starvation, and how is it defined? 

According to health professionals, starvation occurs in several stages.

The first stage can begin as quickly as a single missed meal. The second stage is activated when the body has to rely on stored fats for energy while not eating.

The third phase is when the body turns to bone and muscle for energy after releasing all stored fats.

When this deficit of nutrients impacts health, the body is considered malnourished. 

This can result in physical and psychological distress, and over a prolonged period, it can have severe impacts on the human body.

Once the body uses its energy reserves, known as glycogen, it moves to fats and then to muscles to keep the heart going. 

It is particularly damaging for children because it can impact their developing immune systems and make them susceptible to other diseases. 

Over and above the agonising pain triggered by hunger, the body shrinks, bones protrude, and the cheeks become gaunt and appear hollow.

This inevitably impacts the brain, with victims suffering from mood swings and immense irritability.

A body struggling with malnutrition and undernutrition can result in wasting and is also likely to impact the heart’s function. 

The body’s blood pressure will drop, and the pulse will slow.

At some point, the body either succumbs to an infection or the heart simply fails.

What is the current level of food insecurity in Gaza?

Between late April and early May, around 50 experts from 17 organisations conducted a study into the food insecurity and famine in Gaza.

The group coordinated by the IPC concluded that Gaza in its entirety was in phase four of acute food insecurity.

This means households across Gaza were facing huge food shortages that have either seen them suffer from high acute malnutrition and excess mortality, or resulted in them adopting desperate measures to survive.

On Wednesday, Feroze Sidhwa, an American trauma surgeon who spent five weeks in Gaza, told the UN Security Council that civilians in Gaza were now dying “not from the constant air strikes, but acute malnutrition, sepsis, exposure, and despair”.

“Between my two visits to Gaza, I witnessed a sharp decline in patients’ health driven not just by injury, but by worsening hunger and malnutrition that left their bodies weaker, their wounds slower to heal, and their survival far less certain,” Sidhwa said.

Marina Pomares, Médecins Sans Frontières’ medical coordinator in Deir al Balah, describes the level of malnutrition in Gaza as “very alarming”.

“We are seeing a lot of children who are coming to us who have not been eating for weeks. These children are going through [the] malnutrition process,” Pomares told MEE.

Pomares said there were also many adults, especially breastfeeding women, malnourished themselves, who were “giving the little food that they had to their children”.

Likewise, a World Health Organisation spokesperson told MEE that pregnant and breastfeeding mothers in Gaza “were also at high risk of malnutrition, with nearly 17,000 expected to require treatment for acute malnutrition over the next eleven months”.

Prolonged starvation can result in severe damage, including stunted growth, impaired cognitive development, and severely poor health.

Pomares said that with the right treatment, malnourished children, pregnant and breastfeeding women, could experience some improvement in their health.

However, she warned that if the treatment is not followed up with sufficient nutrient intake, the process would repeat itself and, potentially, as others have suggested, severely impact them for the rest of their lives.

What is the difference between food insecurity and famine?

Famine is a term used to describe “a societal catastrophe” that calls for an urgent and coordinated humanitarian response to avoid the mass loss of life. 

There is a set of technical requirements or thresholds that have to be crossed for famine to be declared.

These include: at least 20 percent of the population facing extreme food shortages; acute malnutrition rates exceeding 30 percent; and two out of 10,000 people dying from starvation daily.

In Gaza, UN human rights experts have sounded the alarm that certain sections of Gaza were already in a state of famine.

In July 2024, the IPC said Gaza was facing a “high risk” of famine, but wouldn’t go so far as to call it famine.

Likewise, in its most recent report in mid-May, it said Gaza was again on the cusp of famine.

Experts argue that whereas Israel has allowed the crisis to deepen, resulting in excruciating living conditions for the people of Gaza, it has looked to let in aid just before Gaza entered the catastrophic phase of famine. 

“Encouraged by the United States, Israel has tried to keep the Gazans from descending into ‘famine’ by turning the aid tap on whenever the data indicate it is about to cross that threshold. When it does this, and the IPC reports that the deterioration has been arrested, Israeli advocates claim that the famine story was made up all along. That’s wrong,” Alex de Waal, an expert on famine, Sudan and the Horn of Africa, writes.

“The IPC experts protest that even when the situation is an ’emergency’ (level four) or ‘catastrophe’ (level five for food insecurity), the level of distress is unacceptable. But for international policymakers, it seems that what counts is the ‘F-word’.

“They won’t say it out loud, but the implication is that hunger that doesn’t reach the famine threshold is somehow tolerable,” de Waal added.

The IPC did not reply to MEE’s request for comment.

Meanwhile, on 20 May, Akihiro Seita, director of health at United Nations Relief and Works Agency for Palestine Refugees in the Near East (Unrwa), reiterated that the crisis in Gaza could be resolved if the UN were allowed to resume its aid work there. 

Seita said that whereas medicine was likely to run out by the end of May, there was sufficient medicine and food in Jordan waiting to be taken into Gaza.

Seita said Unrwa staff in Gaza were thinking about only two things at this point: how to survive and how to die. 

What are the driving factors of food insecurity in Gaza?

According to the IPC, there are four key drivers of acute food insecurity in Gaza and several contributing factors adding to the crisis.

These include: the ongoing Israeli bombardment of Gaza, that has so far killed over 54,000 people, injured tens of thousands and destroyed crucial infrastructure; the restrictions placed by Israel in bringing in essential food, energy, medicine and clean water; the continuous displacement of people – around 1,9 million Palestinians have been made to leave their homes – and move multiple times as a result of evacuation orders and no-go areas; and crucially, the collapse of food systems as a result of the war on Gaza.

“The widespread destruction and degradation of productive assets, coupled with the ongoing blockade, have left extremely limited space for any form of domestic food production,” the IPC said in its report in mid-May.

In addition, the contributing factors of critical deficiencies in the availability of clean water, sanitation, and hygiene, which bear the marks of a two-decade-long blockade, and the prolonged shortage of healthy and nutritious foods, such as fresh fruit, vegetables, meat, and dairy products, have only exacerbated the risk of disease and other health consequences. 

Over the past 19 months, 75 percent of Palestinians with a reliance on food aid have been eating no more than two food groups per day, hindering nutrient and protein intake.

“Israel’s military has simultaneously destroyed Gaza’s agricultural production capacity and decimated Palestinians’ livelihood reserves. Gaza’s fragile food basket, bakeries, fishing boats, food storage warehouses, and emergency kitchens have all been targeted,” Mads Gilbert, James Smith and Dr Ghassan Abu-Sittah wrote in a joint opinion article in early May.

What is the legal position on starvation as a weapon of war?

Starving a population during a time of war has long been used as a tactic by warring parties to force surrender or to annihilate a population. 

However, International Humanitarian Law (IHL), specifically Article 54 in the Geneva Convention, is unequivocal in its prohibition of starvation as a war strategy. 

Article 54 also prohibits the destruction of objects or material indispensable to the survival of the civilian population, including denying access to humanitarian aid intended for civilians in need and deliberately impeding humanitarian aid. 

Israel has been repeatedly found in breach of Article 54 over the course of the past 19 months.

It has shut down Gaza’s access to electricity and water, and restricted the entry of essential energy, aid, food and medicinal supplies.

It has also killed Palestinians as they assembled to receive supplies, with one of the more infamous incidents being termed the “Flour Massacre”. 

As early as December 2023, human rights experts began accusing Israel of intentionally starving Palestinians as a part of a “genocidal” project across the Gaza Strip. 

By July 2024, around 33 children, mostly in northern Gaza, had died from symptoms associated with malnutrition, prompting UN experts to accuse Israel of weaponising food and aid as a form of collective punishment, which constituted starvation crimes, and therefore war crimes.

Several Israeli leaders, including Prime Minister Benjamin Netanyahu and his former Defence Minister Yoav Gallant, have been accused of alleged war crimes and crimes against humanity committed since the Hamas-led attacks on southern Israel on 7 October 2023.

Warrants are still out for their arrest.