Malnutrition and Mortality in Gaza, One Year Later. Who’s Counting the Dead?

by E. Mark Windle / November 4th, 2024

It’s a tragic sign of the times when little introductory narrative is needed to set the near-apocalyptic scene that exists in Gaza today. The world watches from a distance as Israel’s onslaught continues and the civilian death toll escalates to unimaginable levels. Now, the nightmare that Palestinian survivors are currently enduring is about to take on another dimension.

The prediction made one year ago of a man-made famine is about to be realised, though in truth, Gazans have suffered food insecurity for decades. Despite a heavy dependency on international agencies for humanitarian assistance, access to food and safe water supplies has repeatedly been denied due to blockades imposed by Israel. As is the trend in such crises, women and children are particularly affected by malnutrition. Anaemia and other manifestations of nutrient deficiency have led to adverse effects on maternal and foetal health. Miscarriage and birth defect rates are high. Suboptimal nutritional status also impairs immune function and the ability of mother and child to recover from disease.

This dire baseline has only amplified the number of civilian losses caused by violence. The proportion of deaths in Gaza attributed to trauma-related injury versus that from malnutrition is hard to define; in many cases, it’s part of the same story. Malnutrition significantly affects the ability to recover from internal injuries, limb loss, and surgery, thereby increasing the risk of infection, sepsis and death.

Obtaining accurate quantitative information on injury, disease and deaths is essential. It draws global attention, and allows humanitarian organisations to focus their resources. The tricky bit of course is that over- or under-inflation of rates can occur for political gain. Regardless, even Israeli officials admit that the Palestinian Ministry of Health are the only governmental body actively collating decent morbidity and mortality data. There are pro-Israel lobbyists who are still quick to dismiss those figures, citing that a third of the 38,000 deaths declared earlier this summer were unverifiable. However, the reality of real-time assessment in this war zone is that many of the dead are still buried under rubble. Formal ID is impossible: collected statistics unavoidably include household losses reported by family members. Any remaining deniers of data coming out of Gaza should consider satellite image analysis performed by the City University of New York and Oregon State University. Almost 100,000 buildings had been destroyed in the first two months of the current crisis, most of which were in densely populated residential areas. The World Health Organisation and United Nations have also found mortality rates quoted by the Palestinian Ministry of Health to be reliable during earlier critical periods in Gaza’s history.

Malnutrition prevalence from (neutral) aid agency field and clinic data also paints a progressively disturbing picture. In March, nutrition monitoring by UNICEF and others highlighted that around 1 in 20 children attending health centres and in shelters were at a life-threatening stage of severe wasting. In addition, over 30 percent of children under 2 years of age were classified as acutely malnourished; double that of three months earlier. By June, major nutritional concerns were no longer primarily restricted to the north. Almost 3,000 children in southern Gaza were in need of intervention to manage the effects of moderate to severe malnutrition, yet were prevented from attending clinics due to ongoing conflict. Spring and late summer saw some alleviation of food insecurity, as more convoys were able to cross the border and distribute supplies. Then September marked the month with the lowest cross-border transfer and distribution of food and bottled water.

The UN continues to monitor the situation closely. Is Gaza now ‘officially’ in famine? To meet the Integrated Food Security Phase Classification (IPC) definition, at least 20 percent of the population should have significant lack of access to food; acute malnutrition prevalence should be at least 30 percent; and mortality should be at or above 2 deaths per 10,000 people daily. At the time of writing, forty-three thousand are dead. The vast majority of the surviving population are now displaced, and one in five are facing “catastrophic levels of denied access to nutrition” (another IPC classification). Three-quarters of all crop fields have been destroyed. Access to food and safe water supplies, medical care and the availability of proper sanitation continues to be impossible in most situations. As the UN have stressed, Gaza sits on the very brink of famine. Without an immediate ceasefire, this will be a forgone conclusion.FacebookTwitterRedditEmail

E. Mark Windle is a freelance writer, with a former 25-year career as a clinical dietitian specialising in burn injury and critical care nutrition. He has also worked as a senior writer for Story Terrace (London, UK), and as a ghostwriter for Sheridan Hill / Real Life Stories LLC (North Carolina, USA). Read other articles by E. Mark, or visit E. Mark's website.