Patients' physical state flags severe malnutrition, say doctors in Gaza

Shortly after Mohammed Adeel Khaleel, a spinal surgeon from Texas, arrived at a hospital in Gaza City in early August, a 17-year-old was admitted with gunshot injuries to both legs and one hand. He sustained them while trying to collect food at an aid-distribution centre.

While in the emergency room, Khaleel observed the boy's ribs jutting out from his malnourished body, exposing his severe malnutrition. After the medical team at Al-Ahli Hospital stabilised the patient, the teen raised his heavily bandaged hand and gestured to his barren mouth, Khaleel, who is on his third volunteer stint in Gaza, recounted.

'It's beyond imagination'

Expressing his shock during an interview, he said, “The level of hunger is really what's heartbreaking. You know, we saw malnutrition before, back in November, already starting to happen. But now the level is just, it's beyond imagination.”

Also read: Israeli strikes kill 25 in Gaza; famine declared in Gaza City

On Friday, August 22, the Integrated Food Security Phase Classification (IPC), a leading body working on worldwide hunger emergencies, announced for the first time that certain areas of Gaza are experiencing famine and cautioned that the situation is worsening. For several months, United Nations agencies, aid organisations, and specialists have been alerting that Israel’s blockade and continued military actions were driving the region to the edge.

On the day after the famine was declared, eight individuals in Gaza succumbed to causes linked to malnutrition, raising the total number of such fatalities during the conflict to 281, according to the Gazan health ministry, which operates under Hamas and includes medical experts.

One in 6 kids under age 5 suffering

An American medical nonprofit operating in the region reports that one in six children under the age of five is suffering from severe malnutrition.

Based on observations made by its personnel in four of Gaza’s five governorates, the US's MedGlobal said that acute malnutrition currently affects one in six children under the age of five in Gaza. All of Gaza's young children could starve if nothing is done, the group warned.

Israel protests famine announcement

Israel has objected to the announcement of famine, saying it was an “outright lie”. It also pointed to its own efforts in recent times to ensure more food reached the region after easing a two-and-a-half-month complete blockade in May.

Also read: Israel warns of opening 'gates of hell' in Gaza if Hamas refuses to drop arms

It has countercharged Hamas with diverting aid—a claim the UN contests, stating that Israel’s restrictions and a collapse of law and order severely hinder the process of delivering of food to those in greatest need.

Speaking to The Associated Press ahead of the announcement, Khaleel said that signs of deprivation were clearly showing.

“Just the degree of weight loss, post-operative complications and starvation that we're seeing. That wouldn't surprise me at all if it was called famine,” the doctor, who travelled to Gaza as an independent volunteer via the World Health Organisation, said.

At Gaza City's Shifa Hospital earlier in the week, nutrition director Dr Mohammad Kuheil guided an AP journalist to the bedside of a frail 15-year-old girl. Aya Sbeteh sustained injuries from an airstrike. However, her healing process has been hindered by weakness resulting from food deprivation, which her family claims has decreased her weight by over a third.

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“All we have are grains like lentils, sometimes,” said her father, Yousef Sbeteh, 44. “Even flour is unaffordable." The sick, wounded and young are most vulnerable.

Karam Akoumeh, another patient, was lying with sunken cheekbones and thin skin stretched over his rib cage like plastic wrap. According to his family, he was shot while out collecting flour, gravely damaging his intestines and jeopardising his digestive system.

Now he is one of 20 people at Shifa brought in for abdominal injuries and increasingly malnourished because of a shortage of intravenous nutritional supplements, the doctor said.

Akoumeh's father, Atef, said hunger has been compounded by lack of supplements and it has reduced Karam's weight from 62 kilograms (kg) to just 35 kg.

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“I checked throughout all Gaza's hospitals for it (the supplements), but I have not found any,” he said.

According to Israeli officials, some of the people who allegedly perished from starvation had underlying medical issues. However, physicians and other specialists say that is to be expected because starvation initially targets the most vulnerable, such as infants and young children.

Doctors and others see signs of hunger everywhere outside the hospital. The shortage of nutrients is equally dire, both medical experts and civilians say.

“There are no protein sources, only plant-based protein from legumes. Meat and chicken are not available. Dairy products are not available, and fruits are also unavailable,” said Dr Kuheil.

On Friday, Palestinians displaced from elsewhere recounted a desperate search for food in Gaza City.

'We eat once in a day'

“We’re starving. We eat once a day. Will we be more hungry than we are now? There’s nothing left,” said Dalia Shamali, whose family has been repeatedly displaced from their home in nearby Shijaiyah.

She said most of their money has been exhausted over the last two years as they moved from one part of Gaza to another after the Israeli military issued evacuation orders. With Israel allowing more food in recently, the price of flour and other food items has been dropping, but still, Shamali’s family can’t afford them.

In its announcement Friday, the IPC said famine in Gaza City is likely to spread across the territory without a ceasefire and a flood of humanitarian aid.

Some of the IPC's conclusions were echoed in a report by a group that organises medical missions to Gaza, which described a “catastrophic rise in severe malnutrition” among children and pregnant women.

Though Khaleel said he would leave it to the experts to measure exactly what constitutes famine. He knows what he saw in three weeks of treating patients in Gaza, most of the time at the hospital in Gaza City.

Healthcare professionals remove patients' garments to attend to their wounds, exposing a significant reduction in muscle and fat due to starvation, which causes the skin to be pulled taut over visible bones.

“These patients, a number of them that we're seeing are just exposed ribs, severely skinny extremities," he said. “And you know that they're just not getting calories in.”

(With Agency inputs)