Gaza: The Impacts of Famine Will Last Generations

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Global leaders and policymakers continue to hesitate on the question of famine in Gaza. Some have called Gaza’s hunger crisis a famine—notably, the heads of the U.S. Agency for International Development (USAID) and the UN World Food Programme, as well as the International Criminal Court (ICC)—while others continue to hedge, and no formal declaration of famine has been made in Gaza. Though the technical determination of famine is important, it also distracts from the ultimate point—whether famine is declared in Gaza or not, the current hunger and malnutrition crises will affect Gazans for generations.

Q1: What is the current state of food security in Gaza?

A1: Conditions of hunger and safety continue to deteriorate across Gazan communities. In its latest report, published on May 31, 2024, the U.S.-based Famine Early Warning Systems Network (FEWS NET) stated that it is possible that famine began in northern Gaza in April of this year. FEWS NET projected that famine will persist through at least July without significant changes in the delivery of food assistance. This analysis does not amount to a formal famine declaration, though several top policymakers have stated that famine is present in Gaza, including USAID administrator Samantha Power, director of the UN World Food Programme Cindy McCain, and ICC prosecutor Karim A.A. Khan. The last Integrated Food Security Phase Classification (IPC) report on Gaza drew a similar conclusion, and a new IPC report is expected imminently.

Just nine months after the October 7 Hamas attack on Israel and the declaration of the “complete siege” of Gaza, the Palestinian death toll in Gaza has surpassed 37,000 people. The deliberate curtailment of food, water, energy, and humanitarian assistance entering Gaza leaves more than 1.1 million people facing catastrophic living conditions. With the recent incursion into Rafah, about 1 million Palestinians—many of whom had initially fled south to Rafah throughout the early stages of the conflict—must continue to seek safety elsewhere out of fear for their well-being and severe disruption to humanitarian assistance. Previously, the Rafah and Kerem Shalom Crossings in southern Gaza served as the main access points for the flow of commercial and humanitarian supplies into the region. However, since the start of military operations in Rafah in early May, aid entering through southern crossings has dropped to some of the lowest levels seen throughout the war, and the United Nations assesses that aid entering all of Gaza has declined by two-thirds. Aid facilities working in Rafah have also been forced to shutter their operations. The United Nations, for example, suspended food distribution in Rafah because of supply shortages and increasing security concerns.

The international community has increasingly recognized the severity of the food crisis in Gaza. In May, the ICC requested an arrest warrant for Israeli prime minister Benjamin Netanyahu for criminal responsibility for war crimes that included the “starvation of civilians as a method of warfare.” While Israeli officials have insisted that plans to increase aid to Gaza remain a priority, more than a dozen aid agencies assert that the humanitarian response is “on the verge of collapse.” A May ruling by the International Court of Justice joins a growing number of voices calling for Israel to halt its military offensive in Rafah. To date, these calls have not been heeded.

While the Famine Review Committee—a team of independent food security and nutrition experts assembled to review famine classifications—has yet to reach a definitive conclusion on famine in Gaza, it is important to consider that the cumulative harm and loss of life associated with protracted periods of near-famine conditions can be as high, if not higher, than for acute conditions of famine. A significant amount of evidence already exists for the acute effects of malnutrition on the children of Gaza. In addition to the casualties of violence and the hundreds of thousands of children that have been internally displaced, in northern Gaza perhaps as many as 4 in every 10,000 children are dying of starvation per day.

Q2: What are the immediate health consequences of food insecurity and famine?

A2: For children, severe acute malnutrition (SAM)—defined as severe wasting associated with insufficient energy and/or nutrient intake—can result in myriad serious negative health outcomes, including the following:

  • Growth restriction (stunting)
  • Metabolic dysfunction
  • Hormonal imbalances
  • Immune system suppression
  • Organ system damage (e.g., impaired brain development and cardiac function)

Clinically, SAM is assessed based on diagnostic features that include wasting, which occurs when a child is significantly underweight for their height. Globally, more than 45 million children show signs of wasting, with SAM affecting about 19 million children under the age of five. Today, according to the World Health Organization, SAM accounts for an estimated 400,000 deaths among children under the age of five annually, with many of these deaths coming as the result of additional complications related to the diseases, infections, and chronic inflammation associated with starvation itself.

For the undernourished children of Gaza who survive the war, the consequence of the conflict won’t end when the fighting ceases, however.

Q3: How long will the consequences of famine last?

A3: Generations.

Though SAM can be treated through nutritional intervention, SAM can result in irreversible conditions. At an individual level, exposure to malnutrition in childhood can lead to increased noncommunicable disease burden and decreased immune function throughout later life. Additionally, developmental delays associated with malnutrition can result in permanently impaired cognitive ability and motor skills, increased risk of behavioral issues, and significantly reduced educational achievement. In isolation, the damage inflicted by malnutrition robs individuals of their health, well-being, and economic potential. Collectively, the damage within populations facing severe food insecurity poses significant challenges for the social and economic health of the communities and countries they live in. This inverse relationship between malnutrition and progress perpetuates a vicious cycle. Societal conditions of poverty and food insecurity lead to increased rates of malnutrition, which in turn hampers community development, which then increases the risk of widespread malnutrition.

The impacts of this nutritional trap are not limited to the social transmission of lost human potential, however. Malnutrition during periods of particular developmental vulnerability, like gestation or early life, can also manifest in permanent biological changes that are encoded at a genetic level. The Dutch Famine of 1944–1945, sometimes referred to as the Dutch Hunger Winter, offers insight into these generational effects of famine. In the waning months of World War II, Nazi Germany cut off all food supply to regions of the western Netherlands, resulting in the rapid onset of famine that lasted just six months, from November 1944 to May 1945. The extreme deprivation experienced in those months resulted in more than 20,000 deaths by starvation. At the same time, continued obstetric medical care and meticulous record keeping allowed for the collection of some of the most robust data on the developmental consequences of acute hunger. Subsequent studies revealed that prenatal exposure to a severely calorie-deprived environment resulted in epigenetic changes for those in gestation during the famine and was associated with a number of negative physical and mental health outcomes for those same individuals in later life. Consequences included increased risk of type 2 diabetes, increased breast cancer prevalence among women, and higher rates of anxiety and depression among men.

Like those who lived through the Dutch Hunger Winter, those exposed to hunger during war in Gaza and elsewhere will face these enduring physiological effects of malnutrition, compounded by the immediate violent consequences of war.

Q4: What other long-term consequences will the children of Gaza and other conflict-affected populations face?

A4: While facing both the acute and chronic threats of malnutrition, children in Gaza are also forced to contend with the profound physical, psychological, and social toll of the extreme violence experienced during the conflict; in April, UNICEF estimated that a child is killed or injured every ten minutes in Gaza.

While precise figures have been contested, the United Nations Office for the Coordination of Humanitarian Affairs reports that 7,797 children have been killed to date, making up 32 percent of the total identified death toll. This number could likely be an underestimate, however, as more than 10,000 Palestinian fatalities are so far unidentified. Other estimates suggest that as many as 26,000 Palestinian children have been killed or wounded in the war. Given the nature of the conflict, many of the wounds that Palestinian children bear are life altering. High rates of pediatric amputations, risk of traumatic brain injuries, and hazardous environmental exposure portend prolonged suffering and disability for many. Still, the children of Gaza and their communities will face further, less visible challenges.

Early childhood adversity—such as violence, social disruption, and forced displacement—increases the incidence of anxiety, depression, and stress disorders in the immediacy, as well as the risk of poor physical and mental health over a lifetime. Like the experience of malnutrition, exposure to war early in life can result in permanent physiological and epigenetic changes that reverberate across future generations. The toxic stress that results from frequent activation of the human stress response, either over extended periods of time or by intense periods of hardship, disrupts healthy development. This will result in a particularly outsized burden for Gaza once the war ends, as decades of political instability and social grievance had already resulted in widespread insecurity now worsened by the current conflict. Even prior to the current conflict, more than half of children had post-traumatic stress disorder (PTSD), and about 60 percent reported engaging in self-harm due to depression, fear, and grief. These figures, like the number of children visited by malnutrition, injury, and death, will only grow worse as the conflict continues.

Q5: What more should be done to prevent the lasting harm of famine and war?

A5: While calls for an immediate ceasefire that would allow for rapidly increased access to life-saving humanitarian assistance continue to grow, it is clear that irreparable and generational harm has already occurred in Gaza. Nearly half of Gaza’s population is under the age of 18. As children are both disproportionately affected by armed conflict and malnutrition and are simultaneously overrepresented in the Gazan population, the impacts to physical and mental health will have particularly severe and extensive ramifications for the well-being of Gazan communities. Like children, pregnant and breastfeeding women are also extremely vulnerable to the effects of severe food insecurity. Across northern Gaza, 95 percent of pregnant and breastfeeding women report critically inadequate dietary intakes (consuming two or fewer food groups per day). It is therefore all but certain that the chronic health consequences created by this war will be felt for decades and inherited by those yet to be born.

The evidence for intergenerational health consequences of conflict and famine exposure offers a clear warning to a global community still grappling with widespread food crises. Such conditions have broad implications for geopolitical security. Without significant support, the ingrained physiological and psychological damage caused by hunger and violence will likely stunt Gaza’s future economic development. And around the world, the humanitarian conditions created by the war suggest emerging threats, with Director of National Intelligence Avril Haines stating that “…it is likely that the Gaza conflict will have a generational impact on terrorism.”

Addressing food insecurity should include holistic and long-term strategies that address the destructive and self-perpetuating association between conflict and hunger. It should also include the prioritization of assistance that supports resilient food systems that can withstand external shocks. Without a renewed and deliberate emphasis on proactively preventing global hunger rather than reactively addressing its deadly outcomes, the generations-spanning consequences of food insecurity will persist. This renewed emphasis would include observing the clear directives of intergovernmental bodies and a robust adherence to Resolution 2417 (2018) of the United Nations Security Council, which condemns the weaponization of food in conflict and the denial of life-saving humanitarian assistance, as well as supporting political settlements in conflicted regions that explicitly address the conditions that lead to severe food insecurity.

Zane Swanson is a fellow with the Global Food and Water Security Program at the Center for Strategic and International Studies in Washington, D.C. Caitlin Welsh is the director of the Global Food and Water Security Program at CSIS.

Jon B. Alterman
Fellow, Global Food and Water Security Program
Caitlin Welsh
Director, Global Food and Water Security Program