What ‘starvation' really means, for the human body and for Gaza

Al Jazeera

3 days ago

Aid agencies say the limited amount of aid Israel has allowed into Gaza in the last week is unlikely to avert the famine experts have warned about for months.
While at first most of the starvation-related deaths were among children and infants, increasingly, older people are succumbing to the hunger that Israel has imposed upon the enclave since March.
On Sunday, six more adults died from malnutrition, bringing the number of adults to die from hunger in Gaza to 82 over the last five weeks, when such deaths were first recorded.
Ninety-three children have also been killed by Israel through the man-made malnutrition it has imposed upon the enclave since its war began.
So, how does starvation happen? Are we seeing the whole picture?
Here's what we know.
What does starving to death feel like?
'It's awful,' Dr James Smith, an emergency doctor who has volunteered twice in Gaza, said.
In the early stages, after being deprived of food for days, the body begins to break down muscle and other tissues.
'It's one of the most undignified and barbaric ways to kill. Starvation is always something that is done by one person to another. It's intended to be protracted and to maximise suffering,' he said.
Soon, metabolism slows, the ability to regulate temperature is lost, kidney function becomes impaired and, critically in Gaza, the immune system begins to falter and the body's ability to heal from injury is reduced.
Once the body's reserves are used up, it loses the ability to channel nutrients to vital organs and tissues. As a result, essential organs like the heart and lungs become less effective. Muscles shrink and people feel weak.
Eventually, as the body's protein stores are ravaged, the body's tissues are broken down, with death not far away.
How long does it take the human body to die of starvation?
While scientific research on the subject has been limited for ethical reasons, it's estimated that a typically well-nourished and otherwise healthy adult could survive without food for between 45 and 61 days.
However, after 22 months of war, few people in Gaza could be described as well nourished or healthy, leaving them susceptible to malnutrition and the many infectious diseases prevalent in the enclave.
'With starvation, the body loses the ability to launch an immune response to diseases or injuries it could normally deal with, such as gastroenteritis, trauma or a respiratory infection, so it's often malnutrition plus an infection that kills,' Dr Smith continued.
Who are the people who are most at risk of starving to death?
The old, the young, those already ill and, cruelly, those who are alone.
'A child will die earlier from starvation. The loss of muscle and fat occurs almost immediately. Equally, those in older age groups will also die quicker,' Dr Ghassan Abu-Sittah, a Palestinian British surgeon who spent 43 days working in Gaza, said.
'However, it isn't just age. There are social differences, too,' he continued.
'There are currently thousands of orphans roaming Gaza. There is no one to feed them or risk their lives to get food for them, so they're also more likely to die,' he said.
Who are the people who are dying of hunger in Gaza?
There is overwhelming evidence that, through the various blockades Israel has imposed on Gaza, the threat of death by starvation has spread from the vulnerable to everyone in Gaza.
In February 2024, five months into Israel's war on Gaza, the World Health Organization estimated that one in six children under the age of two, especially in Gaza's north – at the time under Israeli siege – were acutely malnourished.
As of August 2025, 82 adults have starved to death over the last five weeks.
Israel has been limiting Gaza's food for years. How has that affected the people there?
Israel has been controlling the amount of food it allows into Gaza for decades, suggesting it already knows precisely how much is needed to avert, or cause, starvation in Gaza.
In 2007, following Hamas's takeover of the enclave, Israel instituted its first blockade on Gaza's population, reducing the aid it allowed into the enclave while still giving public assurances that it was not starving people.
However, documents uncovered after a legal battle between an Israeli NGO and the government confirmed that, between 2007 to 2010, Israel deliberately reduced the food it allowed into Gaza to 'minimal subsistence' levels.
'Generationally, the damage [of malnutrition] is lasting,' Dr Abu-Sittah said, citing the lasting impact of starvation on brain function, and the prevalence of other ailments, such as diabetes, high blood pressure and heart disease among survivors.
Dr Smith pointed out the increased frequency with which malnourished mothers give birth to underweight babies, the effects of which 'cascade through the generations'.
Can famine in Gaza still be avoided?
It's unlikely.
Just under a week ago, the United Nations-backed Integrated Food Security Phase Classification (IPC) issued its gravest warning yet: that a worst-case famine scenario was unfolding in Gaza.
However, other observers feel famine has already arrived in Gaza.
'There are three rigid criteria for a famine to be officially declared,' Dr Jones explained.
The first two: widespread extreme food shortages and high levels of acute malnutrition, had already been met, he said. Data to confirm the third – the extent of malnutrition-related mortality – is difficult to confirm, he added.
'Some of those most at risk of dying from malnutrition probably don't have the ability to reach a hospital where deaths are typically recorded,' he said.
'Similarly, while many children in Gaza now show signs of malnutrition, they're also at high risk of being killed by Israeli shells and gunfire, which will be recorded as their primary cause of death.
'However, whatever term we use to describe the situation, people are still being killed by starvation throughout Gaza, as the world looks on,' he said.
'This is worse than famine. This is the most grotesque spectacle of suffering.'