Malnourished kids arrive daily at a Gaza hospital as Netanyahu denies hunger
Her family showed The Associated Press a photo of Ro'a's body at the hospital, and it was confirmed by the doctor who received her remains. Several days after she died, Israeli Prime Minister Benjamin Netanyahu on Sunday told local media, 'There is no hunger. There was no hunger. There was a shortage, and there was certainly no policy of starvation.'
In the face of international outcry, Netanyahu has pushed back, saying reports of starvation are 'lies' promoted by Hamas.
However, U.N. spokesman Stephane Dujarric this week warned that starvation and malnutrition in Gaza are at the highest levels since the war began.
The U.N. says nearly 12,000 children under 5 were found to have acute malnutrition in July — including more than 2,500 with severe malnutrition, the most dangerous level. The World Health Organization says the numbers are likely an undercount.
The past two weeks, Israel has allowed around triple the amount of food into Gaza than had been entering since late May. That followed 2 1/2 months when Israel barred all food, medicine and other supplies, saying it was to pressure Hamas to release hostages taken during its 2023 attack that launched the war. The new influx has brought more food within reach for some of the population and lowered some prices in marketplaces, though it remains far more expensive than prewar levels and unaffordable for many.
While better food access might help much of Gaza's population, 'it won't help the children who are severely malnourished,' said Alex DeWaal, executive director of the World Peace Foundation at Tufts University, who has worked on famine and humanitarian issues for more than 40 years.
When a person is severely malnourished, vital micronutrients are depleted and bodily functions deteriorate. Simply feeding the person can cause harm, known as 'refeeding syndrome,' potentially leading to seizures, coma or death. Instead, micronutrients must first be replenished with supplements and therapeutic milk in a hospital.
'We're talking about thousands of kids who need to be in hospital if they're going to have a chance of survival,' DeWaal said. 'If this approach of increasing the food supply had been undertaken two months ago, probably many of those kids would not have gotten into this situation.'
Any improvement is also threatened by a planned new Israeli offensive that Netanyahu says will capture Gaza City and the tent camps where most of the territory's population is located. That will prompt a huge new wave of displacement and disrupt food delivery, U.N. and aid officials warn.
Preexisting conditions
The Gaza Health Ministry says 42 children died of malnutrition-related causes since July 1, along with 129 adults. It says 106 children have died of malnutrition during the entire war. The ministry, part of the Hamas-run government, is staffed by medical professionals and its figures on casualties are seen by the U.N. and other experts as the most reliable.
The Israeli military Tuesday pointed to the fact that some children who died had preexisting conditions, arguing their deaths were 'unrelated to their nutritional status.' It said a review by its experts had concluded there are 'no signs of a widespread malnutrition phenomenon' in Gaza.
At his press briefing Sunday, Netanyahu spoke in front of a screen reading 'Fake Starving Children' over photos of skeletal children with preexisting conditions. He accused Hamas of starving the remaining Israeli hostages and repeated claims the militant group is diverting large amounts of aid, a claim the U.N. denies.
Doctors in Gaza acknowledge that some of those dying or starving have chronic conditions, including cerebral palsy, rickets or genetic disorders, some of which make children more vulnerable to malnutrition. However, those conditions are manageable when food and proper medical treatments are available, they say.
'The worsening shortages of food led to these cases' swift deterioration,' said Dr. Yasser Abu Ghali, head of Nasser's pediatrics unit. 'Malnutrition was the main factor in their deaths.'
Of 13 emaciated children whose cases the AP has seen since late July, five had no preexisting conditions — including three who died — according to doctors.
Abu Ghali spoke next to the body of Jamal al-Najjar, a 5-year-old who died Tuesday of malnutrition and was born with rickets, which hinders the ability to metabolize vitamins, weakening bones.
In the past months, the boy's weight fell from 16 kilograms to 7 (35 pounds to 15), said his father, Fadi al-Najjar, whose lean face showed his own hunger.
Asked about Netanyahu's claim there was no hunger in Gaza, he pointed at Jamal's protruding rib cage. 'Of course there's famine,' he said. 'Does a 5-year-old child's chest normally come to look like this?'
Skin and bones
Dr. Ahmed al-Farra, Nasser's general director of pediatrics, said the facility receives 10-20 children with severe malnutrition a day, and the numbers are rising.
On Sunday, a severely malnourished 2-year-old, Shamm Qudeih, cried in pain in her hospital bed. Her arms, legs and ribs were skeletal, her belly inflated.
'She has lost all fat and muscle,' al-Farra said. She weighed 4 kilograms (9 pounds), a third of a 2-year-old's normal weight.
Doctors suspect Shamm suffers from a rare genetic condition called glycogen storage disease, which changes how the body uses and stores glycogen, a form of sugar, and can impact muscle and bone development. But they can't test for it in Gaza, al-Farra said.
Normally, the condition can be managed through a high-carbohydrate diet.
Her family applied a year ago for medical evacuation, joining a list of thousands the WHO says need urgent treatment abroad. For months, Israel slowed evacuations to a near standstill or halted them for long stretches. But it appears to be stepping up permissions, with more than 60 allowed to leave in the first week of August, according to the U.N.
Permission for Shamm to leave Gaza finally came this week, and on Wednesday, she was heading to a hospital in Italy.
A child died in her family's tent
Ro'a was one of four dead children who suffered from malnutrition brought to Nasser over the course of just over two weeks, doctors say.
Her mother, Fatma Mashi, said she first noticed Ro'a losing weight last year, but she thought it was because she was teething. When she took Ro'a to Nasser Hospital in October, the child was severely malnourished, according to al-Farra, who said Ro'a had no preexisting conditions.
At the time, in the last months of 2024, Israel had reduced aid entry to some of the lowest levels of the war.
The family was also displaced multiple times by Israeli military operations. Each move interrupted Ro'a's treatment as it took time to find a clinic to get nutritional supplements, Mashi said. The family was reduced to one meal a day — often boiled macaroni — but 'whatever she ate, it didn't change anything in her,' Mashi said.
Two weeks ago, they moved into the tent camps of Muwasi on Gaza's southern coast. Ro'a's decline accelerated.
'I could tell it was only a matter of two or three more days,' Mashi said in the family's tent Friday, the day after she had died.
Mashi and her husband Amin both looked gaunt, their cheeks and eyes hollow. Their five surviving children – including a baby born this year -- are thin, but not nearly as emaciated as Ro'a.
DeWaal said it's not unusual in famines for one family member to be far worse than others. 'Most often it will be a kid who is 18 months or 2 years' who is most vulnerable, he said, while older siblings are 'more robust.'
But any number of things can set one child into a spiral of malnutrition, such as an infection or troubles after weaning.
'A very small thing can push them over.'
___
Keath reported from Cairo. AP journalists Abdel-Karim Hana and Wafaa Shurafa contributed from Deir al-Balah, Gaza Strip.
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During the dark times, when I was suffering, the only thing that made me happy was going to work. Coming to the VA was my solace, and the veterans were my healers. I think the medical students and residents that work with me now are a little shocked. Because I'm not only a physician for my patients; I'm also their buddy. I go in and give each guy a huge hug, and we share war stories. I open up my life to my patients. We have a bond as combat veterans, and I make that connection before we even talk about why they're there. They tell me about pretty much everything in their lives. And I make notes about the details like what unit they were in or their grandson's soccer team, so I can remember at the next visit. It's so important, because even though I'm a rehab doc, 95% of my patients don't have any other doctors, so we provide the primary care. I wasn't the most compliant patient myself when I was recovering. My physical fitness level wasn't good. One of my recreational therapists finally said, 'Hey, Dr Lee. You're my boss, but you're pretty pathetic. You need to get moving.' So, I started getting involved in sports. I realized that sports are part of us. It doesn't matter what type of disability you have. You see it in little kids; competition is in our DNA. So, why not use that to rehab ourselves? I started using adaptive sports as part of the rehab for our guys in chairs. Fortunately, I had great support from my bosses, and now we have the largest local sports program in the VA system. It became my sub-specialty, the legacy that I leave in this world as I go. When the wheelchair guys play sports, sometimes their tires pop. It sounds like a gunshot or a bomb blowing up. It can be a trigger. Some veterans go into a full-blown flashback. When that happens, I go over there and just hug them, hold them. I keep talking, 'Hey, you know what? It was a tire popping. I'm right here. You know me. Hold my hand. Come on back.' Is that the correct way to deal with PTSD? I don't know. But I do know they need human contact. I know touch is important. Often, when I talk to a veteran patient, my hand is on their shoulder. If I'm standing at a distance while they're talking, and they start to cry, I close that distance. I say, 'My hand is here, if you want to hold it as you go through this,' because I remember when I was a patient and a doctor would hold out his hand and tell me not to give up hope. Before my injury, I used to tell my patients to take it day by day. Then, there I was at Walter Reed telling myself 'day by day.' I realized how easy it had been for me to say those words and how hard they are to accept. Who am I to tell these guys what to do? Now, I put it as a question. 'I want to tell you that we have to work day by day, but how do you feel about it?' They say, 'I really want to walk.' And I say, 'We're going to shoot for that, but in case it doesn't happen, I want you to work on other things too.' And we make a promise to each other. Open Road, New Horizon My legs are still covered in burns and shrapnel scars. They look horrible. I remember when I would take my kids to a swimming pool, all the moms would start pulling their kids out of the pool. They thought I had some terrible disease. While I'm not paralyzed, I don't have a lot of sensation below my hip, except for deep pains. My ankles give out. I can't turn doorknobs, so I changed all our doors at home from knobs to handles. I still have flashbacks every three or four months. Suddenly, I'm in Iraq, and it's really scary. When I come back, my heart's racing. I'm angry. But it's less and less. And now when there's a trigger like a loud noise, I know how to control it. My family has been through all of this with me. It was tough on my kids. They were scared of me after I came back from the war, because I wasn't the same person. I didn't realize how damaging that was. But things got better, and they are both physicians now, so maybe this experience will help them. Like many veterans, I celebrate my Alive Day every year — September 12, the day I could have died. But I came back. Kenneth Lee, MD, is the chief of the Spinal Cord Injury Division at Zablocki VA Medical Center in Milwaukee, Wisconsin, and a tenured professor in the Department of Physical Medicine and Rehabilitation at the Medical College of Wisconsin.
