The long-term effects of hunger in Gaza

Economist

2 days ago

FOR two weeks, the world has claimed it is working to end the widespread hunger in Gaza. The UN is pleading with Israel to allow more lorries of aid into the territory. Arab and Western states are airdropping food. On August 5th Donald Trump said America would take a larger role in distributing aid, though he was vague about the details. 'I know Israel is going to help us with that in terms of distribution, and also money,' he said.
Yet on the ground, Gazans say little has changed. There is not enough food entering Gaza, nor is there law and order to allow its distribution. Airdrops are hard to reach. Convoys are looted soon after they cross the border. Finding food often requires making a risky trip to an aid centre, where hundreds of Palestinians have been killed in recent months, or paying exorbitant sums on the black market.
This is a calamity in its own right, one that will have long-term consequences for many Gazans, particularly children. But it is also a glimpse of Gaza's future. Even after the war ends, it will remain at the mercy of others for years to come.
Wedged between Israel and Egypt, the tiny territory was never self-sufficient. Its neighbours imposed an embargo after Hamas, a militant group, took power in 2007. The economy withered. Half of the workforce in the strip was unemployed and more than 60% of the population relied on some form of foreign aid to survive. The UN doled out cash assistance, ran a network of clinics that offered 3.5m consultations a year and operated schools that educated some 300,000 children.
Still, Gaza could meet at least some basic needs by itself. Two-fifths of its territory was farmland that supplied enough dairy, poultry, eggs and fruits and vegetables to meet most local demand. Small factories produced everything from packaged food to furniture. The Hamas-run government was inept, but it provided law and order. After nearly two years of war, almost none of that remains.
The UN's World Food Programme (WFP) says that Gaza's 2m people need 62,000 tonnes of food a month. That is a bare-bones calculation: it would provide enough staple foods but no meat, fruits and vegetables or other perishables. By its own tally, Israel has allowed far less in. It imposed a total siege on the territory from March 2nd until May 19th, with no food permitted to enter.
Then Israel allowed the UN to resume limited aid deliveries to northern Gaza. It also helped establish the Gaza Humanitarian Foundation (GHF), a shadowy outfit that distributes food at four points in southern and central Gaza. In more than two months of operation, it has handed out less than 0.7 meals per Gazan per day—and that assumes each box of aid, stocked with a hotch-potch of dried and canned goods, really provides as many meals as the GHF claims it does. All told, Israel permitted 98,674 tonnes of food aid to cross the border in the five months through July, an average of 19,734 tonnes a month—just 32% of what the WFP says is necessary.
Although the volume of aid has increased in recent days, it is still insufficient. 'We're trying to get 80 to 100 trucks in, every single day,' says Valerie Guarnieri of the WFP. 'It's not a high bar, but a realistic bar of what we can achieve.' On August 4th, though, Israel allowed only 41 of the agency's lorries to enter a staging area on the Gaza border, and it let drivers collect just 29 of them.
Getting into Gaza is only the first challenge. Distribution is a nightmare. Since May 19th the UN has collected 2,604 lorryloads of aid from Gaza's borders. Just 300 reached their intended destination. The rest were intercepted en route, either by desperate civilians or by armed men. Aid workers are nonchalant about civilians raiding aid lorries, which they euphemistically call 'self-distribution': they reckon the food still reaches people who need it. 'There's a real crescendo of desperation,' says Ms Guarnieri. 'People have no confidence food is going to come the next day.'
But the roaring black market suggests that much of it is stolen. Gaza's chamber of commerce publishes a regular survey of food prices (see chart). A 25kg sack of flour, which cost 35 shekels ($10) before the war, went for 625 shekels on August 5th. A kilo of tomatoes fetched 100 shekels, 50 times its pre-war value. Such prices are far beyond the reach of most Gazans. Those with a bit of money often haggle for tiny quantities: a shopper might bring home a single potato for his family, for example.
Israel's ostensible goal in throttling the supply of aid was to prevent Hamas from pilfering any of it. Earlier this month the group released a propaganda video of Evyatar David, an Israeli hostage still held in Gaza. He was emaciated, and spent much of the video recounting how little he had to eat: a few lentils or beans one day, nothing the next. At one point a militant handed Mr David a can of beans from behind the camera. Many viewers noted that the captor's hand looked rather chubby. As much of Gaza starves, Hamas, it seems, is still managing to feed its fighters.
The consequences of Israel's policy instead fall hardest on children—sometimes even before birth. 'One in three pregnancies are now high-risk. One in five babies that we've seen are born premature or underweight,' says Leila Baker of the UN's family-planning agency. Compare that with before the war, when 8% of Gazan babies were born underweight (at less than 2.5kg). There were 222 stillbirths between January and June, a ten-fold increase from levels seen before the war.
The Integrated Food Security Phase Classification (IPC), a UN-backed outfit that tracks hunger, said last month that 20,000 children were hospitalised for acute malnutrition between April and mid-July. Even before they reach that point, their immune systems crumble. Moderately malnourished children catch infections far more easily than well-fed ones, and become more seriously ill when they do, rapidly losing body weight.
The body takes a 'big hit' when food intake falls to just 70-80% of normal, says Marko Kerac, a paediatrician at the London School of Hygiene and Tropical Medicine who has treated children in famine-stricken places. Most children in Gaza are eating a lot less than that. In July the World Health Organisation reported an outbreak of Guillain-Barré syndrome, a rare autoimmune disease that may have links to hunger. Gaza's health ministry says cases are multiplying, including among children.
Give us our daily bread
Nor is calorie intake the only concern. Although flour and salt in Gaza are fortified with some vitamins and minerals, such as iodine, they are consumed in limited amounts—especially now, since many bakeries have been closed for months, owing to a lack of flour and fuel. In February, during the ceasefire, Israel allowed 15,000 tonnes of fruits and vegetables and 11,000 tonnes of meat and fish into Gaza. Since March it has allowed just 136 tonnes of meat. All of this means there is widespread deficiency of essential nutrients that help children's brains develop.
Every child in Gaza, in other words, will remain at lifelong risk of poor health because of today's malnutrition. There is consistent evidence for this from studies of populations that have lived through famine: during the second world war, the 1960s famine in China and, more recently, places like Ethiopia. Children who have suffered acute malnourishment have higher rates of heart disease, diabetes and other chronic diseases as adults. They are also at risk of worse cognitive development.
A flood of aid cannot undo the damage, but it can prevent it from getting worse. It will have to be sustained. The devastation wrought by Israel's war has left Gazans with no alternative but to rely on aid.
In February the UN estimated that the war had caused $30bn in physical damage and $19bn in economic disruption, including lost labour, forgone income and increased costs. Reconstruction would require $53bn. At this point, that is little more than a guess. The real cost is impossible to calculate. But it will be enormous.
The first task will be simply clearing the rubble. A UN assessment in April, based on satellite imagery, estimated that there were 53m tonnes of rubble strewn across Gaza—30 times as much debris as was removed from Manhattan after the September 11th attacks. Clearing it could be the work of decades. The seven-week war between Israel and Hamas in 2014, the longest and deadliest before the current one, produced 2.5m tonnes of debris. It took two years to remove.
Rebuilding a productive economy will be no less difficult. Take agriculture. The UN's agriculture agency says that 80% of Gaza's farmland and 84% of its greenhouses have been damaged in the war. Livestock have been all but wiped out.
A satellite assessment last summer found that 68% of Gaza's roads had been damaged (that figure is no doubt higher today). The two main north-south roads—one along the coast, the other farther inland—are both impassable in places. Even if farmers can start planting crops for small harvests after the war, it will be hard to bring their produce to market. The picture is equally bleak in other sectors: schools, hospitals and factories have all been largely reduced to rubble.
The Geneva Conventions are clear that civilians have the right to flee a war zone. Exercising that right in Gaza is fraught: Palestinians have a well-grounded fear that Israel will never allow them to return. Powerful members of Binyamin Netanyahu's government do not hide their desire to ethnically cleanse the territory and rebuild the Jewish settlements dismantled in 2005. Still, the dire conditions have led some people to think the unthinkable: a survey conducted in May by a leading Palestinian pollster found that 43% of Gazans are willing to emigrate at the end of the war.
Mr Netanyahu may not follow through on his talk of reoccupying Gaza, which he hinted at in media leaks earlier this month. His far-right allies may not fulfil their dream of rebuilding the Jewish settlements dismantled in 2005. In a sense, though, the ideologues in his cabinet have already achieved their goal. Israel's conduct of the war has left Gazans with a grim choice: leave the territory, or remain in a place rendered all but uninhabitable. ■