After starvation in Gaza, Sudan, refeeding syndrome a risk – DW – 08/09/2025
As of August 8, 197 people, including 96 children, have died of famine in Gaza as a result of Israel's blockade and military offensive, according to Gaza health authorities.
UN-backed health monitors have said some 100,000 Palestinian women and children are facing severe malnutrition, and a third of the population of 2.1 million hasn't eaten in days.
Gaza isn't the only place where conflicts are driving catastrophic hunger. In Sudan, international agencies claim 3.2 million children under the age of 5 will suffer from acute malnutrition in the next year. People under siege in El Fasher, in North Dafur, have been starving for the past year.
In Nigeria, where funding from international donors has been cut, malnutrition has led to the deaths of 625 children in the first six months of 2025. Haiti, Mali and Yemen are among other countries experiencing catastrophic hunger.
But treating hunger crises can be more difficult than it seems, and requires more than just a regular supply of healthy food. Health experts have warned that refeeding programs for malnourished people can have fatal complications if done without proper care.
"If you reintroduce things quickly, you get a very rapid change of electrolytes and that can cause sudden death," said Marko Kerac, a pediatrician and clinical researcher at the London School of Hygiene and Tropical Medicine in the UK.
That's why a return to proper nutrition needs to be carefully managed, Kerac told DW.
To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video
Refeeding syndrome can occur if some malnourished people resume normal eating too quickly.
People with kidney failure, eating disorders, depression and alcohol issues are most susceptible to refeeding syndrome.
The problem arises after the malnourished body has adapted to reduced nutrition. By slowing its metabolism and organ function to deal with catastrophic hunger, the body is ill equipped to deal with a sudden flood of nutrients.
"When you're really [nutritionally] compromised … when you're really sick, that's when the risk of refeeding syndrome happens," said Kerac.
The sudden arrival of vitamins and electrolytes like potassium, phosphorus and magnesium can disrupt critical organ processes and lead to arrhythmia — an irregular heartbeat — which can be fatal.
Starvation begins when people don't get enough calories to keep up with the body's energy demands.
The loss of adequate nutrition denies the body essential materials needed to produce hormones and enzymes that keep the body functioning. To compensate for the calorie deficit, the body slows down metabolic processes and organ activity.
In the first two days without food, the body's carbohydrate stores are depleted. After three days, the body starts converting vital fats and proteins into emergency fuel. This is when people begin to experience muscle wasting, severe fatigue and a weakened immune system.
Death from starvation occurs most commonly due to an infection the body is too weak to fight, or from organ failure.
The first step is to introduce food or nutrition slowly, what Kerac calls "stabilization feeds." This can include things like special milk formulations and ready-to-use therapeutic foods (RUTFs).
Aid organizations supply RUTFs like Plumpy'Nut, a fortified peanut paste, to help prevent refeeding syndrome in famine regions.
"[RUTFs] are paradoxically quite light in nutrients, but are specially formulated. They have low sodium, higher potassium, higher phosphate," said Kerac.
RUTFs are designed to deliver essential nutrition specifically for severely malnourished children at a dosage that doesn't overload their bodies and risk refeeding syndrome. A child given three sachets of Plumpy'Nut a day could recover from severe acute malnutrition in eight weeks.
"RUTFs [can] prevent refeeding syndrome in settings where you cannot monitor for refeeding syndrome," said Wieger Voskuijl and Hanaa Benjeddi, pediatricians at the Amsterdam University Medical Center who have delivered medical services in conflict zones and refugee camps.
Researchers have also looked to other RUTF products that can be prepared closer to African and Asian sites, where rates of food insecurity are highest.
These products include ones made from chickpeas, mung beans, maize and lentils, foods grown locally that could potentially help to reduce production costs and allergy risk.
Food crisis experts have predicted "widespread death" if action is not taken to alleviate hunger in these regions.
The crucial part of supplying food aid to regions of catastrophic hunger is delivering food and RUTFs in the right way by allowing aid services into regions like Gaza and Sudan, Voskuijl and Benjeddi told DW.
"The crux and the issue is that preventing refeeding syndrome is almost impossible in settings with high demand and a low amount of health care workers or aid workers," they said.
Voskuijl and Benjeddi said governments in famine-hit regions need to prioritize safe conditions for aid agencies to resume their work and prevent a humanitarian crisis.
"And that needs international pressure. If we look at Gaza, but also Sudan, these are two governments that are denying such access to malnourished children and pregnant women."
Hashtags
Try Our AI Features
Explore what Daily8 AI can do for you:
Comments
No comments yet...
Related Articles
DW
4 hours ago
- DW
Japan: Two boxers die from brain injuries at Tokyo event – DW – 08/10/2025
The Japanese athletes, both 28 years old, were rushed into emergency surgery after competing in separate bouts on August 2. Two Japanese boxers have died within days of each other after sustaining brain injuries in separate bouts on the same fight card. The World Boxing Federation on Saturday confirmed the deaths, which occurred at Tokyo's iconic Korakuen Hall on August 2. The deaths have reignited urgent debate over boxing safety regulations in Japan — especially the duration of fights and ringside medical protocols. Shigetoshi Kotari, 28, collapsed shortly after completing a grueling 12-round tie against junior lightweight champion Yamato Hata on August 2. He was rushed into emergency surgery for a subdural hematoma, also known as a brain hemorrhage — a life-threatening condition where blood pools between the brain and skull — but died on Friday. The World Boxing Council confirmed Kotari's death was directly linked to injuries sustained during the bout. Just one day later, Hiromasa Urakawa, also 28, died after suffering the same type of brain injury during a knockout loss to Yoji Saito. The lightweight fighter was knocked out in the eighth and final round and underwent a craniotomy in a bid to save his life. The World Boxing Organization (WBO) paid tribute to Kotari on social media. "The boxing world mourns the tragic passing of Japanese fighter Shigetoshi Kotari, who succumbed to injuries sustained during his August 2nd title fight," the statement said. "A warrior in the ring. A fighter in spirit. Gone too soon." Kotari's gym also released a heartfelt statement on its website: "He gave everything — fighting through surgery and treatment at a Tokyo hospital after suffering an acute subdural hematoma. He never stopped battling." Following Urakawa's death, the WBO issued a separate message extending its "deepest condolences to the families, friends, and the Japanese boxing community, during this incredibly difficult time." Tsuyoshi Yasukochi, secretary-general of the Japan Boxing Commission (JBC), told local media on Saturday that it was likely "the first time in Japan two fighters underwent skull-opening surgery for injuries stemming from the same event." In response, the JBC announced that all Oriental and Pacific Boxing Federation title bouts will now be shortened from 12 rounds to 10. Urakawa's death marks the third boxing fatality worldwide from in-ring injuries this year. Last year, Irish boxer John Cooney died a week after being hospitalized following his Celtic super-featherweight title defeat to Nathan Howells in Belfast. He had suffered a severe brain injury during the bout. Calls for tighter oversight of boxing — both in Japan and internationally — have been gaining momentum following the fatalities. Advocates are demanding shorter fight durations, mandatory post-fight medical scans, and stricter enforcement of concussion protocols. To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video
DW
a day ago
- DW
After starvation in Gaza, Sudan, refeeding syndrome a risk – DW – 08/09/2025
Even if food aid reaches Gaza, Sudan and other famine zones, complications can arise in malnourished or starving people when they regain access to regular meals. Those complications can be fatal. As of August 8, 197 people, including 96 children, have died of famine in Gaza as a result of Israel's blockade and military offensive, according to Gaza health authorities. UN-backed health monitors have said some 100,000 Palestinian women and children are facing severe malnutrition, and a third of the population of 2.1 million hasn't eaten in days. Gaza isn't the only place where conflicts are driving catastrophic hunger. In Sudan, international agencies claim 3.2 million children under the age of 5 will suffer from acute malnutrition in the next year. People under siege in El Fasher, in North Dafur, have been starving for the past year. In Nigeria, where funding from international donors has been cut, malnutrition has led to the deaths of 625 children in the first six months of 2025. Haiti, Mali and Yemen are among other countries experiencing catastrophic hunger. But treating hunger crises can be more difficult than it seems, and requires more than just a regular supply of healthy food. Health experts have warned that refeeding programs for malnourished people can have fatal complications if done without proper care. "If you reintroduce things quickly, you get a very rapid change of electrolytes and that can cause sudden death," said Marko Kerac, a pediatrician and clinical researcher at the London School of Hygiene and Tropical Medicine in the UK. That's why a return to proper nutrition needs to be carefully managed, Kerac told DW. To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Refeeding syndrome can occur if some malnourished people resume normal eating too quickly. People with kidney failure, eating disorders, depression and alcohol issues are most susceptible to refeeding syndrome. The problem arises after the malnourished body has adapted to reduced nutrition. By slowing its metabolism and organ function to deal with catastrophic hunger, the body is ill equipped to deal with a sudden flood of nutrients. "When you're really [nutritionally] compromised … when you're really sick, that's when the risk of refeeding syndrome happens," said Kerac. The sudden arrival of vitamins and electrolytes like potassium, phosphorus and magnesium can disrupt critical organ processes and lead to arrhythmia — an irregular heartbeat — which can be fatal. Starvation begins when people don't get enough calories to keep up with the body's energy demands. The loss of adequate nutrition denies the body essential materials needed to produce hormones and enzymes that keep the body functioning. To compensate for the calorie deficit, the body slows down metabolic processes and organ activity. In the first two days without food, the body's carbohydrate stores are depleted. After three days, the body starts converting vital fats and proteins into emergency fuel. This is when people begin to experience muscle wasting, severe fatigue and a weakened immune system. Death from starvation occurs most commonly due to an infection the body is too weak to fight, or from organ failure. The first step is to introduce food or nutrition slowly, what Kerac calls "stabilization feeds." This can include things like special milk formulations and ready-to-use therapeutic foods (RUTFs). Aid organizations supply RUTFs like Plumpy'Nut, a fortified peanut paste, to help prevent refeeding syndrome in famine regions. "[RUTFs] are paradoxically quite light in nutrients, but are specially formulated. They have low sodium, higher potassium, higher phosphate," said Kerac. RUTFs are designed to deliver essential nutrition specifically for severely malnourished children at a dosage that doesn't overload their bodies and risk refeeding syndrome. A child given three sachets of Plumpy'Nut a day could recover from severe acute malnutrition in eight weeks. "RUTFs [can] prevent refeeding syndrome in settings where you cannot monitor for refeeding syndrome," said Wieger Voskuijl and Hanaa Benjeddi, pediatricians at the Amsterdam University Medical Center who have delivered medical services in conflict zones and refugee camps. Researchers have also looked to other RUTF products that can be prepared closer to African and Asian sites, where rates of food insecurity are highest. These products include ones made from chickpeas, mung beans, maize and lentils, foods grown locally that could potentially help to reduce production costs and allergy risk. Food crisis experts have predicted "widespread death" if action is not taken to alleviate hunger in these regions. The crucial part of supplying food aid to regions of catastrophic hunger is delivering food and RUTFs in the right way by allowing aid services into regions like Gaza and Sudan, Voskuijl and Benjeddi told DW. "The crux and the issue is that preventing refeeding syndrome is almost impossible in settings with high demand and a low amount of health care workers or aid workers," they said. Voskuijl and Benjeddi said governments in famine-hit regions need to prioritize safe conditions for aid agencies to resume their work and prevent a humanitarian crisis. "And that needs international pressure. If we look at Gaza, but also Sudan, these are two governments that are denying such access to malnourished children and pregnant women."
DW
4 days ago
- DW
US scientists discover trees host up to 1 trillion microbes – DW – 08/06/2025
Healthy trees contain more than one trillion different bacteria, fungi and viruses, a new study has found. These wood microbiomes could hold clues about forest health and climate change. A new study has discovered that trees contain a rich and diverse microbiome inside their tree trunks, much like humans do in our bodies. An average tree contains approximately one trillion microbe cells, according to data acquired from sampling the DNA of 150 trees and published today in the journal . It found that healthy trees contain distinct microbiomes specialized to different parts of the tree and rich in fungi, bacteria, and viruses. The authors believe these could play a vital role in tree health. "Our study shows that each tree species hosts its own distinct microbial community that has evolved alongside the tree," said study co-author Jon Gewirtzman at Yale University, US. Katie Field, a plant biologist at Sheffield University, UK, who was not involved in the research, said the study "helps reredefine how we see trees — not just as standalone organisms, but as complex, integrated ecosystems that include a vast network of microbial life." "In the same way that human microbiomes are important for our health, this work suggests we may need to start thinking similarly about trees. It opens a whole new frontier for environmental microbiology, forest science, and even biotechnology," Field told DW. Microbes are an important part of plant life. The discovery of a 'wood-wide web' — a network that connects fungal filaments and tree roots in underground soil — led to the idea that other organisms aid plant growth and defence against pathogens. But little is known about the microbes living inside healthy wood. "The three trillion trees on Earth represent the world's largest pool of biomass, much of which hosts unique ecosystems we've never studied," said Gewirtzman. The researchers set out to study the microbiomes of trees in the Yale-Myers Forest in Connecticut, US. They took multiple samples from 150 trees across 16 species, including oaks, maples, and pines. Soil samples were also taken. They then extracted DNA from the wood and soil and analysed the data for evidence of DNA from bacteria, fungi, and viruses. They found that trees contain huge numbers of different microbe species — roughly one microbe for every 20 plant cells. This translates to between 100 billion and one trillion microbial cells on average, which is still far fewer than the 39 trillion inside humans. "This study provides some of the clearest evidence to date that the wood of living trees hosts distinct and adapted microbiomes, different to those of the surrounding soil, leaves, or tree roots," said Field. To play this audio please enable JavaScript, and consider upgrading to a web browser that supports HTML5 audio Microbes weren't equally distributed through the tree — specialized microbial communities existed in different parts of wood. The inner heartwood and outer sapwood contained completely different microbial communities. Denser heartwood was dominated by microbes that don't need oxygen, while the sapwood contained more oxygen-requiring microbes. Different microbiomes were also found in different tree species. Maple trees, for example, contained high abundance of microbes that are adept at breaking down sugars. Further experiments showed that different communities changed gas concentrations inside these woods. To view this video please enable JavaScript, and consider upgrading to a web browser that supports HTML5 video Whether these specialized microbiomes affect the health of their tree hosts is unclear. More studies are needed to understand how microbiomes affect wider forest health, but the authors believe there is a link. "We know that certain microbes promote growth in certain model plants, including in major cereal crops and poplar trees, but there are thousands [of microbes] that we do not know the function of," Gewirtzman told DW via email. The study may also open new questions. For Field, this includes investigating the roles microbiomes play in tree aging, defence and decay. "There is also clear potential to explore whether managing or modifying wood microbiomes could help improve forest resilience or carbon cycling," said Field. Gewirtzman suggests it could also answer big picture questions about how climate change impacts trees, or whether tree microbiomes could be deployed for other purposes. "How will climate change affect these internal ecosystems and forest health? And can we harness these microbes for new forest management or biotechnology applications?" But Michael Köhler, a botanist at Martin Luther University Halle-Wittenberg, Germany, told DW it's far too early for Gewirtzman's group to start monitoring tree microbiomes to measure climate impacts and forest health. "We're investigating this at the moment — how climate change is affecting the microbiome of seeds and seedlings in grasslands," he told DW.
