Why children are starving so much faster than adults in Gaza

Telegraph

2 days ago

How is it that Palestinian children in Gaza are starving and emaciated, while the adults cradling them appear reasonably healthy?
The question is circulating widely on social media – often to imply that parents of starving children are hoarding food, or even that the images of starvation coming from Gaza are staged or fabricated.
But the answer is horribly simple, say doctors: children are smaller and have less energy reserves to draw on when food runs out. The result is that they starve - and die - much faster than adults.
'Without food, a child will be gone within a fortnight or so. An adult can last between 40 to 70 days,' Dr Andrew Prentice, Professor of international nutrition at the London School of Tropical Hygiene and Medicine in The Gambia told The Telegraph.
'Metabolically, the adults [in Gaza] will already be in real trouble too. They'll be on the way to losing a lot more weight, and themselves become skeletal, but it is just so much quicker in the children,' Prof Prentice added.
One in three people in Gaza - about 420,000 people - are going days at a time without food, while one in five are estimated to be at risk of starvation, according to the Integrated Food Security Phase Classification (IPC).
Between March and June, just 56,000 tonnes of food entered the territory, less than a quarter of Gaza's minimum needs and equivalent to around 810 calories per person per day: an intake and on par with what prisoners in Auschwitz were fed in World War Two, according to historical estimates.
At the time of writing, the total death toll from malnutrition since October 2023 is 154, amongst them 89 children, according to the Hamas-run health ministry.
More than half of those deaths – 86 – have occurred in the last 11 days.
Starvation takes time, but can accelerate very rapidly in children, experts say.
When a person eats less than they need, the body doesn't immediately start shutting down but wastes away gradually.
In the first 24 hours with little or no food, the body relies on a form of stored sugar called glycogen, which is kept in the liver.
Once that sugar runs out – usually within a day – the body begins to burn fat for energy.
In adults, this transition can take longer because they tend to have slower metabolisms and larger energy reserves.
But in babies and young children, the switch happens much faster. Their bodies burn through energy more rapidly. That's because, relative to their size, children require far more calories than adults just to stay alive.
A baby, for example, needs around four times as many calories per kilogram of body weight as an adult, according to Dr Prentice.
Their organs, especially the brain and heart, are still developing and consume a disproportionately large amount of energy.
This means that when food disappears, children reach critical levels of starvation much sooner than adults, because their bodies are far less equipped to withstand its absence.
Prof Prentice describes children as 'a bundle of metabolic activity' – their bodies are constantly working and need steady fuel to function.
Once a person's fat stores are used up, the body enters a dangerous phase: it starts breaking down muscle and organ tissue to make fuel.
At that point, the body is cannibalising itself to survive. Muscles shrink, and critical organs like the liver and kidneys start to deteriorate.
'That's when things start to become really serious,' says Prof Prentice.
Children are especially vulnerable because their bodies are made up of much less muscle than adults – only about 15 per cent, compared to 45 per cent – so they have less to fall back on when starvation sets in.
'If you have 45 percent muscle, it will take a lot more time to reach starvation. If you only have 15 percent, very quickly – in two or three weeks without enough food – your body reaches starvation mode,' said Alexandra Rutishauser-Perera, Director of Nutrition and Health at the NGO Action Against Hunger.
This advanced stage of malnutrition is what we are now seeing in Gaza, experts say.
At this point, any morsel of energy obtained through food is immediately diverted to the vital organs in a desperate attempt to keep them functioning—while virtually every other system in the body begins to shut down.
Muscles have significantly atrophied, leaving the arms and legs skeletal, with bones – ribs, shoulders, hips – clearly visible beneath thinning skin.
Faces appear gaunt, with sunken eyes and hollow cheeks.
The skin becomes dry, flaky, and discoloured, often bruising easily and healing slowly.
Hair turns brittle and dull, frequently falling out, while fine body hair may develop as the body struggles to retain heat.
Despite the visible wasting, fluid retention caused by a lack of protein can lead to swelling in the feet, ankles, or tummy.
Many Telegraph readers will remember similar images of small children with large, protruding bellies trickling out from Biafara in the 1960s and Ethiopia in the 1980s.
People feel constantly cold; with the thyroid suppressed and fat stores gone, the body no longer generates enough heat.
Movement becomes slow and exhausting, even basic tasks may be impossible, and mental fog, apathy, or confusion set in.
Some will start to hallucinate, say experts.
If death doesn't come from heart failure, it often results from infection – something as simple as a cold or skin wound – because the immune system has collapsed beyond repair.