As hunger grows in Gaza, warnings that starvation hits the most vulnerable first

As sion continues to supply strenuous denials, the day-by-day,  on-going number of people in Gaza either dead or dying from malnutrition suggests the famine in the territory is taking a deeper hold.

In the last two weeks since the world's foremost authority on food insecurity declared a famine in Gaza City, 70 people have died of hunger, according to local health authorities.

One of them was 17-year-old Ahmed Ali Al-Batniji.

"There are rashes that come on my body and my feet are swollen," he said, pulling off his shirt to reveal a tiny frame with protruding bones and a body hollowed out by hunger.

Gaza teen explains what it’s like to starve

Large patches of red mottled skin across Ahmed's back suggested his weakened circulation system was having difficulty pumping blood to his extremities.

"My life is hopeless. It's destroyed," he said in tears.

Before the war, Ahmed was healthy, although celiac disease made him gluten-intolerant and required him to avoid foods that could damage his digestive system. 

In normal circumstances, and even through the first year of the war, he said his condition was manageable.

But last March, Israel imposed a near-total blockade of food and humanitarian supplies coming into Gaza. The naturally gluten-free foods he relied on disappeared from markets and malnutrition set in.

"We used to eat chicken and fish, meat, eggs and milk," he said. "But they [Israel] closed the crossings and cut off the chicken. The only food I can eat now is rice — it's the only food that works for me."

It indicated roughly one in four Gazans, or 500,000 people, are enduring the most severe category of hunger, having almost nothing to eat, with a further one million people in what the IPC calls an "emergency" phase.

Over the month of August, Gaza's Health Ministry said 185 people, including 12 children, died of starvation. On Wednesday, it said there were six additional deaths within the last 24 hours.

For its part, Israel has denied the existence of famine and said its food blockade of Gaza was necessary to put pressure on Hamas — both to free the remaining Israeli hostages and to cut off the militant group's access to the food, aid and other supplies coming into the territory.

Western aid agencies have said Israel has overstated the amount of aid Hamas has stolen or been able to divert. 

In late May, the Israeli government partnered with the Gaza Humanitarian Foundation (GHF), an American non-profit group that uses private U.S. Security and logistics companies to get supplies into the region, bypassing the traditional aid distribution system headed by UN agencies.

Rights groups say the GHF model — which uses aid "hubs" in zones where the Israeli Defence Forces (IDF) operate — comes at a horrendous cost to Palestinian lives.

Médecins San Frontières (MSF) called the GHF distribution system a "death trap" and a "slaughter, masquerading as humanitarian aid" after more than 1,400 people were shot dead as they were trying to obtain food in just the first few weeks of its operations.

People are still risking their lives to get food at GHF sites, with 12 killed in the last day, according to the Gaza Health Ministry.

It's not always evident who is firing, but many Palestinians blame GHF security guards or the accompanying IDF soldiers, while Israel accuses Hamas of doing the shooting.

GHF also denies accusations its practices have contributed to starvation in Gaza. In a social media post, the NGO said its model is "meeting the specific needs and requests of the Palestinian people, and it's working," having delivered more than 2.4 million boxes of food.

Israel launched its assault on Gaza in October 2023, after Hamas fighters attacked southern Israel, killing around 1,200 people and taking 251 hostage. The ensuing campaign has since killed more than 63,000 people in the territory and wounded another 160,000, according to local health officials.

According to one of the world's foremost experts in hunger and famine, the idea that Hamas would somehow be weakened by curtailing food deliveries into Gaza was nonsensical from the start.

"You cannot target starvation," said Alex de Waal, the executive director of the World Peace Foundation and a research professor at the Fletcher School of Law and Diplomacy at Tufts University.

"The armed men will be the last to go hungry. You actually know that the targeting of your starvation will hit the poorest and most vulnerable first."

Amid the IPC's famine declaration and growing worldwide outrage, Israel has been letting more aid trucks into the enclave. COGAT, the Israeli agency responsible, says 320 humanitarian aid trucks entered on Sept. 1 — but that's still substantially less than the 600 per day that were crossing in during the short-lived ceasefire last spring.

Since Palestinians continue to risk their lives to get supplies from GHF sites, it's evident more food is needed — because there are often no other alternatives, de Waal said.

"The Gaza Humanitarian Foundation is like feeding time at the zoo," he said. "It's the big and strong who get it."

"The chief of the general staff emphasized the IDF's commitment to preventing famine and doing everything in its power to continue enabling humanitarian aid to reach the civilian population directly, rather than Hamas," it said.

COGAT issued another statement Wednesday, saying that in advance of an expected IDF military offensive in Gaza City, it is increasing its humanitarian response in southern Gaza, so it can "receive the population," should people flee.

"The entry of food, medical equipment and shelter supplies has been increased," it said.

"His face and his hands were like ice," said Hana'a Fayez Al-Batniji. 

She and her husband put their son onto a cart and wheeled him to Gaza City's Al-Shifa Hospital, where doctors said there was little they could do.

"If there is no food, there is no immune system," said Dr. Mohammed Al-Deeb, 40, an internal medicine physician who examined Ahmed.

Al-Deeb said while he can provide malnourished patients nutritional supplements, it's only a temporary fix. "If he is absent from the only food he can eat … he will die."

Even with the additional aid trucks now entering Gaza, Al-Deeb said the number of malnutrition cases he sees continues to increase, "day by day by day, where their immune system is completely destroyed."

After Ahmed's futile hospital visit, his mom said she took the teen back to the family's shelter, where he died later that same day.

"In the last week, there was nothing he could put in his mouth — he ate like a bird," Al-Batniji recalled.

"There was no gluten-free food available; vegetables were cut off," she said. "May God have mercy on his soul. He's a martyr of hunger, a martyr of the siege." 

Some of the country's most senior politicians have hinted that starvation could be justified amid the nearly two-year war, even as the Israeli government vehemently denies famine in Gaza.

Far-right Israeli Finance Minister Bezalel Smotrich was widely condemned in early August after saying, "nobody will let us cause two million civilians to die of hunger, even though it might be justified and moral, until our hostages are returned."

And in a radio interview, another top minister, Amichay Eliyahu, said "there is no nation that feeds its enemies," and Israel's government is "rushing toward Gaza being wiped out."

At the same time, Israel's efforts to discredit famine accusations have included smearing those who've died by suggesting underlying health problems were more relevant than the lack of food. 

The government has also posted videos of people in Gaza eating pizza and shopping in stores with full shelves. "This is not how a place with projected famine looks like," reads a caption under a video posted by COGAT.

In both cases, the Israeli claims are deeply misleading, said Francesco Checchi, an epidemiologist with the London School of Hygiene and Tropical Medicine.

"It's not the case that people are dying from their pre-existing conditions," he said. "There is a whole group of individuals in the community who have pre-existing conditions, who are going to be the very first to feel the effects of a famine and die for it."

And showing stores with food on the shelves doesn't explain the disparities in food distribution, he said. 

"I think there is absolutely a famine going on in Gaza; in pockets of the strip, particularly in Gaza City, the situation is a lot worse than elsewhere," said Checchi.

"There are inequities in every population. There are people who still have a bit of cash, who still have some things to sell — and they'll be able to eat while others will be in completely dire straits."

Israel has yet to respond to a Hamas-accepted proposal seeking to halt the war and release at least some of the remaining 50 hostages still held in Gaza, 20 of whom are thought to still be alive.

Instead, the government of Prime Minister Benjamin Netanyahu is signalling its next steps is more war and combat — with the IDF warning Gaza City's estimated one million residents to leave in advance of the coming offensive. 

Alex de Waal, the food security expert, says such an invasion would surely tip most of those into the worst famine category.

"Bearing in mind that the driver of distress and mortality in this situation is not just lack of food, it's those intolerable living conditions," he said. "It would be calamitous."

Foreign correspondent

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