Generations of Gaza’s population have been below the breadline since Israel came into being as a state. Frances Coppola explains.

“Famine, what famine? There’s no famine in Gaza. Look at all the food we are letting in.” So cries the Israeli government and its spokespersons.

Last week, the respected Integrated Food Security Phase Classification agreed with them. Back in March, it warned that famine was imminent in the north of Gaza and was likely to spread throughout the rest of the Gaza Strip within a few months. But in its latest report, it says that the conditions for famine are not met. Why the change? Well, it appears that Israel has been letting more food into Gaza, particularly the north. Enough food to ward off famine – but not enough to prevent chronic childhood malnutrition.

Malnutrition in Gaza is endemic and multi-generational.

Chronic malnutrition attracts little attention from the Western press. Some babies and children die from it: infant mortality is typically high in malnourished populations. But most survive. They are shorter (“stunted”) and thinner (“wasted”) than they should be, and they suffer from avoidable health problems such as iron deficiency anaemia. But they aren’t the hollow-eyed skeletons that make good atrocity pics. To Western eyes, Gazan children look normal, if small. But Gazan adults are small too. It’s genetic, innit. Nothing to look at here.

But Gazan adults are small because they are stunted and wasted from childhood malnutrition. And their children are small not merely because they are suffering malnutrition themselves, but because their parents did. Malnutrition in Gaza is endemic and multi-generational. 

As long ago as the 1960s, studies showed that a significant minority of children in Gazan refugee camps were malnourished, some severely. One study found that children were particularly at risk of malnutrition around the time of weaning, which in Gaza at that time was typically 6 -18 months of age. But older children were also malnourished. A second study examined 4,007 children aged between two and five years old and discovered that over a quarter of them were malnourished and 10% were suffering from “nutritional dwarfism” – they were stunted.

These studies pre-date the 1967 war. Gaza was under Egyptian control at that time, so the malnutrition the children were suffering from cannot be attributed to the Israeli occupation. But it can nevertheless be laid at Israel’s door. These studies were conducted within 20 years of the 1948 Nakba (Arabic for catastrophe) following the creation of the state of Israel which displaced Palestinians from their homes and drove many into refugee camps in the Gaza Strip. The children studied were born to those refugees. And it was not only in Gaza that children of Nakba refugees were malnourished. A third study found that 10% of Palestinian children in refugee camps in Lebanon were stunted. 

The first study found that families with malnourished children were disproportionately likely to be completely dependent on food aid distributed by the United Nations Relief and Works Agency (UNRWA). It’s not clear why, but the most likely explanation is that these families were headed by women, elderly men, or men with disabilities, who were unable to earn enough income to feed the children. You’d think a United Nations agency would ensure that these vulnerable families received enough food of sufficient quality to prevent malnutrition, wouldn’t you?

It appears that UNRWA, starved of funds, withdrew the food aid on which these children depended. Deprived of aid, they slowly starved

On its website, UNRWA says this:

“UNRWA began mass distributions of rations in 1950, providing a basket of more than ten basic items, including sugar, flour, rice, cheese, fuel and soap. As contributions allowed, clothes, shoes, bedding and domestic items were included. Over time, the number and size of rations decreased, due to funding shortages and a growing realisation that not all Palestine refugees needed the same forms of support.”

It appears that UNRWA, starved of funds, withdrew the food aid on which these children depended. Deprived of aid, they slowly starved.

In 1978, UNRWA introduced a hardship relief programme for the poorest families. But it fed far fewer children than the number who needed food. Ten years later, malnutrition rates had not improved. However, in 1987, the Palestinian government embarked on a programme of supplementary feeding and nutritional education. The results were remarkable. By 1989, the proportion of malnourished children had fallen considerably.

Sadly, the improvement was short-lived. In 2000, as the Palestinian uprising known as the Second Intifada raged, Israel closed the Gaza border and imposed a tight blockade. Unemployment in Gaza rose to 85%. Families became unable to afford food. By 2002, malnutrition was higher than in the 1960s. A survey commissioned by Care International found that that 13.3% of Gazan children under five were suffering from acute malnutrition (also known as starvation) and 17.5% from chronic malnutrition.

Israel relaxed the blockade in 2004-5, but then tightened it again in 2006 after Hamas won Palestinian elections. The brief respite was not long enough to improve the health of chronically malnourished Palestinian children. A study using survey data collected in 2006-7 found that 30% of children in the north governorate of Gaza and 8-10% of children in the rest of Gaza were stunted.

The study highlighted “food insecurity” as the primary cause of stunting. The UN’s Food and Agriculture Organisation (FAO) says a person is “food insecure” when they “lack regular access to enough safe and nutritious food for normal growth and development and an active and healthy life.” In 2006-7, a significant proportion of children in Gaza were experiencing food insecurity severe enough to stunt their growth.

Then came Hamas’s takeover of Gaza. Israel responded with a near-total blockade. In communications with the US State Department obtained by Wikileaks, Israeli officials said the aim was to “keep Gaza’s economy in a state of near collapse”. But they didn’t want a humanitarian crisis, so they calculated the minimum calorific needs of Palestinians to establish the minimum amount of  food to allow into the enclave – though reports from the time suggest that food deliveries often did not meet this baseline.

By 2023, the stunting rate had risen to 20%, and nearly 60% of children were anaemic.

Once again, childhood malnutrition skyrocketed. In 2009, a survey by the World Health Organisation found that half of children in Gaza City were anaemic and 15% were stunted. The blockade was relaxed from 2014 onwards, which relieved acute malnutrition (starvation). But chronic malnutrition continued to rise. By 2023, the stunting rate had risen to 20%, and nearly 60% of children were anaemic. This is the correct baseline for the 2023 siege, and the reason why Gazans have so little resilience to the current food shortages. They are already malnourished, and have been for a long time.

Israel successfully prevented famine in 2007-12, and it is currently doing so again. But it won’t prevent malnutrition. For Israel, malnutrition has for many years now been a weapon of war.

Frances Coppola

Frances is a writer and commentator on banking, finance and economics. Her blog Coppola Comment is widely read and her writing has featured on the Financial Times, City AM, The …

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