What comes after the famine in Gaza?

A few weeks ago, Suleiman Ziyad, a young health care worker in northern Gaza, told me that his family was on the verge of starvation. On some days, he and his uncle Abdul Karim would walk in search of food from 3 a.m I am Until the afternoon. Ziad told me: “We swore not to return home without finding flour.” “People were willing to risk their lives for one bag.” According to the World Health Organization, nearly forty percent of the population went days at a time without eating. Sometimes Abdul Karim would vomit from hunger and fatigue. His wife, who was pregnant with twins, was suffering from severe anemia.

The most recent food shortages in Gaza began in March, when Israel ended the ceasefire and imposed an eleven-week blockade on all aid. After that, the Gaza Humanitarian Foundation, supported by Israel and the United States, began distributing limited amounts of aid; About three thousand Palestinians were killed while seeking food. This month, a United Nations study was published in The scalpel I mentioned More than fifty-four thousand children suffer from malnutrition in Gaza. “Every family has been affected so far,” John Kahler, a pediatrician and co-founder of MedGlobal, a humanitarian organization working in Gaza, told me. About one in five babies is born premature or underweight. MedGlobal cared for one infant, Rafif, who weighed just four pounds when born. Her mother was so malnourished that she could not breastfeed; The child was constantly crying, began to lose weight, and developed ulcers and infections. On August 18 she died.

“We are living one day at a time,” Iyad Amawi, a father of four who works as an aid coordinator in Gaza, told me in September. “We have 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 – rose to thirty-five dollars, when it was possible to find it in the first place. Amawy often saw children suffering from malnutrition and lacking the strength to play. He expressed concern that the months of famine had already caused irreparable damage. “We are losing the next generation,” he added. “They will suffer all their lives from this.”

Now that a ceasefire has been reached, aid is starting to flow. Under the terms of the ceasefire agreement, six hundred trucks are supposed to enter Gaza daily. United Nations Relief and Works Agency for Palestine Refugees in the Near East Reports It has stored enough food for three months for every person in the region. There is reason to hope that the immediate hunger crisis will end, despite all the permanent devastation in Gaza. “As this famine is entirely man-made, it can be stopped and reversed,” the Famine Review Commission, an international body that monitors food insecurity around the world, wrote in August.

However, many experts have warned that it is not possible to undo all the consequences of famine. “People don’t realize that you don’t just recover from hunger,” says Dana Simons, a historian and author of the book “Hunger.”On Hunger: Violence and Desire in America, from Famine to Ozimbicism“For those with severe malnutrition, simply starting to eat normal meals again can cause illness — and even death. Famine survivors are at risk for chronic disease and mental health conditions for decades after they regain access to food. “It stunted the development of an entire generation,” Nathaniel Raymond, director of the Human Research Laboratory at Yale University, told me. At the Stanford Center for Innovation in Global Health, the terms are even clearer. “Can this be reversed?” she said. “The answer is that it cannot be.”

Much of what we know about the famine’s toll comes from the Warsaw ghetto, where the Nazis forcibly resettled about half a million Jews starting in 1940. German authorities in occupied Poland restricted sentences to “less than the minimum to sustain life”; The ration card issued in October 1941 allocated most Jews approximately three hundred calories per day. Deaths eventually rose to five hundred per day. Under these horrific conditions, twenty-eight Jewish doctors sent to the ghetto, led by a dermatologist named Israel Milikowsky, recruited seventy adults and forty children to research what they called pure starvation, meaning those infected had no additional infections or diseases. As physician Leonard Tushnet wrote, in 1966, researchers—who were starving—conducted “a comprehensive and careful study of the effects of starvation.” The study continued until deportations to the Treblinka extermination camp, where many of the researchers would eventually die, began in 1942. They hastily compiled the charts and graphs into a manuscript, which was then buried in a steel urn. It was restored after the war and published in Polish in 1946.

In the 1940s, the way the body dealt with hunger remained a mystery. Doctors used equipment smuggled into the ghetto to measure capillary circulation, examine bone marrow under a microscope, and record electrocardiograms. Merry Fitzpatrick, a malnutrition and famine researcher at Tufts University, told me the quality of their scientific work was “astonishing.” Muscles withered, skin took on the texture of cigarette paper, and swelling frequently affected the legs, scrotum, labia, heart, and lungs, they wrote. In the cemetery’s shed, doctors performed more than three thousand autopsies on corpses, which showed that hunger softens the bones and atrophies vital organs. Hungry children stopped playing and seemed lazy or indifferent; Cognitive development appears to stop or even decline. Some looked like “skin-covered skeletons.”

One of the most important findings of the study is that the body has advanced ways to provide energy and maintain tissues and vital functions. Glucose reserves in the blood, liver and muscles decrease rapidly. The body then switches to burning fat in three different ways. Some fat molecules can be used to form glucose. Some can be used to create ketones, an alternative energy source for some tissues, including the brain; Some can be broken down directly within the mitochondria to form adenosine triphosphate, or ATP, the primary energy source for our cells.