'Famine', 'starvation': the challenges in defining Gaza's plight
But the difficulty of getting to the most affected areas in the Palestinian territory, besieged by Israel, means there are huge challenges in gathering the required data.
- What is a famine? -
The internationally-agreed definition for famine is outlined by the Integrated Food Security Phase Classification (IPC), an initiative of 21 organisations and institutions including UN agencies and aid groups.
The IPC definition has three elements.
Firstly, at least 20 percent of households must have an extreme lack of food and face starvation or destitution.
Second, acute malnutrition in children under five exceeds 30 percent.
And third, there is an excess mortality threshold of two in 10,000 people dying per day.
Once these criteria are met, governments and UN agencies can declare a famine.
- What is the situation in Gaza? -
Available indicators are alarming regarding the food situation in Gaza.
"A large proportion of the population of Gaza is starving", according to the World Health Organization's chief, Tedros Adhanom Ghebreyesus.
Food deliveries are "far below what is needed for the survival of the population", he said, calling it "man-made... mass starvation".
Doctors Without Borders (MSF) said on Friday that a quarter of all young children and pregnant or breastfeeding women screened at its clinics in Gaza last week were malnourished, blaming Israel's "deliberate use of starvation as a weapon".
Almost a third of people in Gaza are "not eating for days" and malnutrition is surging, the UN's World Food Programme (WFP) said Friday.
The head of Al-Shifa hospital in Gaza City on Tuesday said that 21 children had died across the Palestinian territory in the previous 72 hours "due to malnutrition and starvation".
The very few foodstuffs in the markets are inaccessible, with a kilogramme (two pounds) of flour reaching the exorbitant price of $100, while the Gaza Strip's agricultural land has been ravaged by the war.
According to NGOs, the 20 or so aid trucks that enter the territory each day -- vastly insufficient for more than two million hungry people -- are systematically looted.
"It's become a technical point to explain that we're in acute food insecurity, IPC4, which affects almost the entire population. It doesn't resonate with people," said Amande Bazerolle, in charge of MSF's emergency response in Gaza.
"Yet we're hurtling towards famine -- that's a certainty."
- What are the challenges in gathering data? -
NGOs and the WHO concede that gathering the evidence required for a famine declaration is extremely difficult.
"Currently we are unable to conduct the surveys that would allow us to formally classify famine," said Bazerolle.
She said it was "impossible" for them to screen children, take their measurements, or assess their weight-to-height ratio.
Jean-Raphael Poitou, Middle East programme director for the NGO Action Against Hunger, said the "continuous displacements" of Gazans ordered by the Israeli military, along with restrictions on movement in the most affected regions; "complicate things enormously".
Nabil Tabbal, incident manager at the WHO's emergency programme, said there were "challenges regarding data, regarding access to information".
- Can famine still be avoided? -
For France's foreign ministry, malnutrition and the "risk of famine" is the "result of the blockade imposed by Israel".
The Israeli military denies it is blocking humanitarian aid entering Gaza. On Tuesday it claimed that 950 truckloads of aid were inside the Strip waiting for collection and distribution by international organisations.
Israeli government spokesman David Mencer insisted there was "no famine caused by Israel. There is a man-made shortage engineered by Hamas."
Hamas has consistently denied that. The New York Times on Saturday reported that, according to two senior Israeli military officials and two other Israelis involved, "the Israeli military never found proof" supporting the official Israeli allegation.
NGOs have accused Israel of imposing drastic restrictions.
More than 100 NGOs -- including MSF, Caritas, Save the Children, Amnesty International, Medecins du Monde, Christian Aid and Oxfam -- have urged Israel to open all land crossings and "restore the full flow of food" into Gaza.
- What does a famine declaration tell us? -
A fresh Gaza IPC assessment is due very soon.
For some, the technical debates over a famine declaration seem futile given the urgency of the situation.
"Any famine declaration... comes too late," explained Jean-Martin Bauer, the WFP's director of food security and nutrition analysis.
In Somalia in 2011, when famine was formally declared, half of the total number of victims of the disaster had already died of starvation.
Israel launched its military campaign in Gaza after a deadly attack by Palestinian militant group Hamas on October 7, 2023.
The Israeli campaign has killed nearly 60,000 Palestinians, mostly civilians, according to the health ministry in the Hamas-run territory.
Hamas's October 2023 attack resulted in the deaths of 1,219 people, most of them civilians, according to an AFP tally based on official figures.
By Célia Lebur
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Daily Maverick
8 hours ago
- Daily Maverick
Rethinking HIV treatment with tailored solutions for improved patient engagement and outcomes
The health department has R622-million extra to prop up South Africa's HIV treatment programme in the wake of foreign aid cuts. But it's only about a fifth of the total gap. We look at how data can help drive decisions to make the most of this lifebuoy. Just over two weeks ago, Health Minister Aaron Motsoaledi announced that the Treasury had given R622-million of emergency funding to his department to prop up South Africa's HIV treatment programme, with about R590-million for provinces' HIV budgets and R32-million for the chronic medicine distribution system, which allows people to fetch their antiretroviral treatment from pick-up points other than clinics, closer to their homes. This extra budget is just over a fifth of the roughly R2.8-billion funding gap that the health department says the country needed after US President Donald Trump's administration pulled the plug on financial support for HIV in February. (The Pepfar/Aids relief budget for this financial year was just under R8-billion, but the health department calculated that it could fill the void with R2.8-billion if it trimmed extras and ruled out duplicate positions.) So, how to get the best bang for these limited bucks — especially with the health department wanting to get 1.1-million people with HIV on treatment before the end of the year and so reach the United Nations targets for ending Aids as a public health threat by 2030? By getting really serious about giving people more than one way of getting their repeat prescriptions for antiretroviral (ARV) medicine (so-called differentiated service delivery), said Kate Rees, the co-chairperson of the 12th South African Aids Conference to be held later this year, from Kigali last week, where she attended the 13th IAS Conference on HIV Science. At another Kigali session, Lynne Wilkinson, a public health expert working with the health department on public health approaches to help people stay on treatment, said: 'People who interrupt their antiretroviral treatment are increasingly common, but so are people who re-engage, or in other words start their treatment again after having stopped for a short period.' A big part of South Africa's problem in getting 95% of people who know they have HIV on ARVs (the second target of the UN's 95-95-95 set of cascading goals) is that people — sometimes repeatedly — stop and restart treatment. For the UN goals to be reached, South Africa needs to have 95% of people diagnosed with HIV on treatment. Right now, the health department says, we stand at 79%. But the way many health facilities are run makes the system too rigid to accommodate real life stop-and-start behaviour, says Rees. This not only means that extra time and money are spent every time someone seemingly drops out of line and then comes back in, but also makes people unwilling to get back on board because the process is so inconvenient and unwelcoming. Rees and Wilkinson were the co-authors of a study published in the Journal of the International Aids Society in 2024, whose results helped the health department update the steps health workers should follow when someone has missed an appointment for picking up their medicine or getting a health check-up — and could possibly have stopped treatment. 'We often have excellent guidelines in place, built on solid scientific evidence,' says Rees, 'but they're not necessarily implemented well on the ground.' To make sure we track the second 95 of the UN goals accurately, we need a health system that acknowledges people will come late to collect their treatment and sometimes miss appointments. This doesn't necessarily mean they've stopped their treatment; rather that how they take and collect their treatment changes over time. 'The standard ways in which the public health system works mostly doesn't provide the type of support these patients need, as the resources required to provide such support is not available,' says Yogan Pillay, the health department's former deputy director-general for HIV and now the head of HIV delivery at the Gates Foundation. 'But with AI-supported digital health solutions and the high penetration of mobile phones, such support now can — and should — be provided at low cost and without the need to hire additional human resources.' We dived into the numbers to see what the study showed — and what they can teach us about making the system for HIV treatment more flexible. Does late equal stopped? Not necessarily. Data from three health facilities in Johannesburg that the researchers tracked showed that of the 2,342 people who came back to care after missing a clinic appointment for collection medication or a health check, 72% — almost three-quarters — showed up within 28 days of the planned date. In fact, most (65%) weren't more than two weeks late. Of those who showed up at their clinic more than four weeks after they were due, 13% made it within 90 days (12 weeks). Only one in 14 people in the study came back later than this, a period by which the health department would have recorded them as having fallen out of care. (Some incomplete records meant the researchers could not work out by how much 8% of the sample had missed their appointment date.) The data for the study was collected in the second half of 2022, and at the time national guidelines said that a medicine parcel not collected within two weeks of the scheduled appointment had to be sent back to the depot. 'But it's important to distinguish between showing up late and interrupting treatment,' notes Rees. Just because someone was late for their appointment doesn't necessarily mean they stopped taking their medication. Many people in the study said they either still had pills on hand or managed to get some, despite not showing up for their scheduled collection. Pepfar definitions say that a window of up to 28 days (that is, four weeks) can be tolerated for late ARV pick-ups. Pepfar is the US HIV programme that funds projects in countries like South Africa, but most of them were cut in February. Research has also shown that for many people who have been on treatment for a long time already, viral loads (how much HIV they have in their blood) start to pass 1,000 copies/mL — the point at which someone could start being infectious again — about 28 days after treatment has truly stopped. Sending back a parcel of uncollected medicine after just two weeks — as was the case at the time of the study — would therefore add an unnecessary administration load and cost into the system. (Current health department guidelines, updated since the study and in part because of the results, say that a medicine pick-up point can hold on to someone's medicine for four weeks after their scheduled appointment.) Does late equal unwell? Not always. In fact, seven out of 10 people who collected their next batch of medication four weeks or more late had no worrying signs, such as possible symptoms of tuberculosis, high blood pressure, weight loss or a low CD4 cell count, when checked by a health worker. (A low CD4 count means that someone's immune system has become weaker, which is usually a sign of the virus replicating in their body.) Moreover, given the large number of people without worrying health signs in the group for whom data was available, it's possible that many of those in the group with incomplete data were well too. When the researchers looked at the patients' last viral load results on file (some more than 12 months ago at the time of returning to the clinic), 71% had fewer than 1,000 copies/mL in their blood. A viral count of fewer than 1,000 copies/mL tells a health worker that the medicine is keeping most of the virus from replicating. It is usually a sign of someone being diligent about taking their pills and managing their condition well. Yet clinic staff often assume that people who collect their medicine late are not good at taking their pills regularly, and so they get routed to extra counselling about staying on the programme. 'Most people don't need more adherence counselling; they need more convenience,' says Rees. Offering services that aren't necessary because of an inflexible process wastes resources, she says — something a system under pressure can ill afford. Rees says: 'With funding in crisis, we really have to prioritise [where money is spent].' Does late equal indifferent? Rarely. Close to three-quarters of people who turned up four weeks or more after their scheduled medicine collection date said they had missed their appointment because of travelling, work commitments or family obligations. Only about a quarter of the sample missed their appointment because they forgot, misplaced their clinic card or for some other reason that would suggest they weren't managing their condition well. Part of making cost-effective decisions about how to use budgets best is to offer 'differentiated care', meaning that not every patient coming back after a missed appointment is treated the same way, says Rees. Health workers should look at by how much the appointment date was missed, as well as a patient's health status to decide what service they need, she says. Giving people who've been managing their condition well enough medicine to last them six months at a time can go a long way, Wilkinson told Bhekisisa's Health Beat team in July. 'Getting 180 pills in one go reduces the number of clinic visits [only twice a year], which eases the workload on staff. But it also helps patients to stay on their treatment by cutting down on their transport costs and time off work,' Wilkinson said. Zambia, Malawi, Lesotho and Namibia have all rolled out six-month dispensing — and have already reached the UN's target of having 95% of people on medicine at a virally suppressed level. According to the health department, South Africa will start rolling out six-month dispensing in August. 'But not everyone wants this,' said Wilkinson, pointing out that experiences from other countries showed that 50 to 60% of people choose six-monthly pick-ups. It speaks to tailoring service delivery to patients' needs, says Rees, rather than enforcing a one-size-fits-all system when more than one size is needed. Says Rees: 'Facing funding constraints, we really need tailored service delivery to keep the [HIV treatment] programme where it is.' DM
TimesLIVE
a day ago
- TimesLIVE
'If the baby could speak, she would scream': the risky measures to feed small babies in Gaza
'I am terrified about the fate of the baby,' said her grandmother, Nemah Hamouda. 'We named her after her mother ... hoping she can survive and live long, but we are so afraid, we hear children and adults die every day of hunger.' Muntaha now weighs about 3.5kg, her family said, barely more than half of what a full-term baby her age would normally weigh. She suffers stomach problems like vomiting and diarrhoea after feeding. Health officials, aid workers and Gazan families told Reuters many families are feeding infants herbs and tea boiled in water, or grinding up bread or sesame. Humanitarian agencies also reported cases of parents boiling leaves in water, eating animal feed and grinding sand into flour. Feeding children solids too early can disrupt their nutrition, cause stomach problems, and risk choking, paediatric health experts say. 'It's a desperate move to compensate for the lack of food,' said Unicef spokesperson Salim Oweis. 'When mothers can't breastfeed or provide proper infant formula they resort to grinding chickpeas, bread, rice, anything that they can get their hands on to feed their children ... it is risking their health because these supplies are not made for infants to feed on.' BABY BOTTLES WITHOUT MILK Gaza's spiralling humanitarian crisis prompted the main world hunger monitoring body on Tuesday to say a worst-case scenario of famine is unfolding and immediate action is needed to avoid widespread death. Images of emaciated Palestinian children have shocked the world. Gazan health authorities have reported more people dying from hunger-related causes. The total so far stands at 154, among them 89 children, most of whom died in the last few weeks. With the international furore over Gaza's ordeal growing, Israel announced steps over the weekend to ease aid access. But the UN World Food Programme said on Tuesday it was still not getting the permissions it needed to deliver enough aid. Humanitarian agencies say there is almost no infant formula left in Gaza. The cans available in the market cost more than $100 — impossible to afford for families like Muntaha's, whose father has been jobless since the war closed his falafel business and displaced the family from their home. In the paediatric ward of Al-Aqsa Martyrs Hospital in the central Gaza city of Deir al-Balah, the infant formula supply is mostly depleted. One mother showed how she poured thick tahini sesame paste into a bottle and mixed it with water. 'I am using this instead of milk, to compensate her for milk, but she won't drink it,' said Azhar Imad, 31, the mother of four-month-old Joury. 'I also make her fenugreek, anise, caraway, any kind of herbs (mixed with water),' she said, panicked as she described how instead of nourishing her child, these attempts were making her sick. Medical staff at the hospital spoke of helplessness, watching as children's health deteriorated with no way to safely feed them. 'Now, children are being fed either water or ground hard legumes, and this is harmful for children in Gaza,' said doctor Khalil Daqran. 'If the hunger continues ... within three or four days, if the child doesn't get access to milk immediately, then they will die,' he said.
Mail & Guardian
2 days ago
- Mail & Guardian
Genocide: Israel intentionally starving children to death in Gaza
The world is witnessing the slow slaughter of Gaza's children through mass starvation. Image: Supplied A Palestinian mother clutches her skeletal child to her chest. The child's eyes are gaunt, almost popping out of her face and look you in the eye. You can't look away despite the shiver that runs down your spine. The child's spine is visible, jutting out of the malnourished little body. It's only skin on bones, the bones from the emaciated body of the child jut out almost breaking through the skin, the spine is tender as though it's about to crack. The Palestinian mother clutches the child closer to her chest. This unconditional tenderness of a mother's love strikes a chord with every mother in the world. What pain can be more brutal to the heart of a mother than to watch her child die before her own eyes, starve over a period of time, reduced to just skeletal bones, hearing the suffering pangs of hunger and thirst every minute, every hour, every day for months and slowly, agonisingly watching her baby perish to death. The image is striking, it pierces the human heart. Nothing is more repulsive to the human heart than the suffering, pain and killing of a child. This slaughter of children through mass starvation is being played out in real time and the world is witnessing this horror on their smartphones and TV screens. At least 103 Palestinians have died from starvation and dehydration, 80 one of them children, in the past week. Just in this year 2025, the Gaza Health Ministry records 28,672 registered cases of children suffering from malnutrition. And 260,000 children are in urgent and desperate need of nutrition. The infanticidal character of the genocide is deliberate. At the beginning of the genocide, on 10 November 2023, the Israeli defence minister, Yaov Gallant, expressed the government's genocidal intent when he said: 'There will be no food, no electricity, no fuel, everything is closed, we are fighting human animals and we act accordingly.' Israel has acted according to its expressed genocidal intent as the images of dead starving bodies of children haunt the collective conscience of the world. Israel has done exactly what it said it would do more than 20 months ago. Why is everyone then pretending to be shocked and expressing concern today about children starving to death? General Ghassan Alian said: 'Israel has imposed a total blockade on Gaza, no electricity, no water, just damage. You wanted hell, you will get hell.' This hate speech is racist and repulsive and exhibits the arrogance of the supremacist white settler mentality. Why do well fed rich white powerful men like Israeli leader Benjamin Netanyahu, United States President Donald Trump and Alian think that they are gods and can impose hell on poor people? Israeli Minister Itama Ben Gvir proclaimed: 'The food and aid depots should be bombed in order to create military and political pressure'. Avigdor Lieberman, former deputy prime minister and finance minister, said in August 2024: 'The only arrangement to be made with Gaza is to stop all transfers of humanitarian aid, equipment, fuel, electricity and water.' Member of the Israeli Knesset Revital 'Tally' Gottlieb said in October 2023: 'Without hunger and thirst among the Gaza population, we will not be able to recruit collaborators, we will not be able to recruit intelligence, and we will not be able to bribe people with food, drink, medicine in order to obtain intelligence.' These words point to the deliberate weaponisation of starvation as a means of gathering intelligence. Israeli Knesset member Moshe Saada in April 2025 said: 'Starve the Gazan's and impose a siege to the Max.' Israeli settler leader and former mayor Daniella Weiss said in January 2024: 'They will move. The Arabs will move. We don't give them food, we don't give the Arabs anything. They will have to leave'. These words express the strategic aim of the Zionist state, to ethnic cleanse and forcibly expel the people of Gaza, using starvation as a strategic weapon. This is clearly and concisely expressed by former Israeli General Giora Eiland in October 2023: 'The people of Gaza should be told that they have two choices, to stay and to starve or to leave.' For more than 20 months the leadership of the Israeli military and political establishment have verbalised using starvation as a weapon of war. Some believe that this racist policy of starving the occupied Palestinians only emerged after 7 October 2023. It is true that Israel has used the 7 October Hamas attacks to justify its genocide in Gaza and go in for the kill by starving Palestinians to death. But Israel's weaponisation of starvation did not begin then. In 1997, Israel's prime minister, Levi Eshkol, said: 'We will deprive Gaza of water and the Arabs will leave.' In 2007, Israelis actually calculated the minimum calories Palestinians needed to avoid famine and blocked food just above this line. Dav Weissglass, adviser to the then Israeli prime minister said: 'The idea is to put the Palestinians on a diet, but not to make them die of hunger.' The immunity that the world has given Israel historically and specifically after 7 October enabled Israel's impunity as it today deliberately starves Palestinian children to death. The genocidal green light has shifted Israel policy from using starvation to a point of just about avoiding famine to pursuing a policy that creates a famine and kills children. Even as Palestinian children are dying in large numbers, the Western powers have not even imposed sanctions on the Zionist state, allowing for further Israeli impunity and more suffering in Gaza. The United Nations report of 2022 found that one year before that, 65% of Gazan's were food insecure as a result of the unlawful siege Israel imposed with the tacit complicity of the Egyptian government as well as the US and Europe. At the beginning of the Israeli genocide in Gaza, Oxfam reported that only 2% of the usual amount of food was being delivered to Gaza. Oxfam's Sally Abi Khalil stated: 'There can be no justification for using starvation as a weapon of war.' The Zionist state of Israel has been determined in strategically using starvation as a weapon of war. Apart from banning the United Nations Relief and Works Agency for Palestine Refugees and its 400 aid distribution points, Israeli forces have also been targeting agricultural land in Gaza, food production factories and grocery stores through the war. This is a cold, calculated and callous strategy to starve the people of Gaza. Alex de Waal, author of Mass Starvation, The History and Future of Famine, says: 'While it may be possible to bomb a hospital by accident, it is not possible to create a famine by accident.' So when you see the skeletal bodies of Palestinian children, know for sure that they have been deliberately killed by Israel. The people of the world are calling for a ceasefire and an end to the Israeli barbarism in Gaza but the governments of the world are not acting. The US Israel's primary military and economic backer, has throughout the invasion of Gaza, green lighted the actions of the Israeli state and still refuses to leverage its financial and military aid to compel Israel to comply with international human rights and humanitarian law. Everyone knows that without a complete ceasefire, it is impossible for aid to reach all the people of Gaza who desperately need it. Despite the Israeli genocide, Palestinians are defiant, they do not accept to be subjugated, subordinates and slaves to Israeli colonial masters. The suffering triggers a memory in their historical consciousness as they remember their Prophet who was also sanctioned, sieged and starved in Shee'b Abi Talib. On the day of justice, when they are asked: 'For what crime was the innocent child starved to death and killed? one wonders what defence the Israeli killers will present. And those who are in power both in the Arab and Western World, how will they reply when they are asked: ' Why did you not come to the defence and aid of children who cried out 'rescue us from this oppressive regime who are baby killers and starving us to death'.' Inaction and silence is complicity to infanticide and genocide. Eric Clapton, who, in solidarity painted his guitar in Palestinian colours and blasted Israel for its killing of Palestinian children after losing his young child, wrote the song, Tears in Heaven, with heart wrenching lyrics that capture the anguish of a parent losing a child: 'Would you hold my hand if I saw in heaven, would you help me stand if I saw you in heaven, I know there won't be more tears in heaven.' Perhaps this is the only solace for the suffering Palestinian mother. Iqbal Suleman is a social justice lawyer and former head of the law clinic for Lawyers for Human Rights in Pretoria and Research Associate: Media Review Network.
