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Malnutrition Relief or Empty Calories? Gaza Food Aid Composition, Distribution and Effectiveness

E. Mark Windle

E. Mark Windle 18 February 2026.

Last year’s nutrition-related headlines in Gaza were hardly in short supply. In the spring of 2025, there was a three-month complete aid blockade on a background of chronically restricted border access. By August, over 54,600 children were acutely malnourished, 40% of pregnant and breastfeeding women were severely malnourished, and a famine was officially declared.

Last year’s malnutrition-related headlines in Gaza were hardly in short supply. In the spring of 2025, there was a three-month complete aid blockade on a background of chronically restricted border access. By August, over 54,600 children were acutely malnourished, 40% of pregnant and breastfeeding women were severely malnourished, and a famine was officially declared.

The opening line from United Nations spokesperson Stéphane Dujarric this January gave a hint of cautious optimism—for the first time since October 2023, the UN and partners had enough stock “to meet 100 percent of the minimum caloric standard”. Over the new year period alone, 10,000 metric tonnes of goods were sent into Gaza via the Karim Shalom, Karem Abu Salam and Zikim crossings. 1

Of course, ‘stock’ doesn’t quite equate to internal distribution. This is particularly true  in the context of ongoing conflict (a ceasefire has been called in name only), and Israel’s determination to suspend the operations of numerous NGOs in Gaza and West Bank.

The UN’s announcement was encouraging but the challenges are real. Importantly, the UN also stressed that the delivery of food, clothing and shelter must remain unimpeded to prevent exacerbation of the current crisis. It’s one thing to have enough stock. It’s another to ensure that it actually reaches those who need it. Then there’s further consideration regarding food aid: that of intrinsic quality and appropriateness. Donors may entrust such matters to NGOs, but are food parcels practically, nutritionally and culturally fit for purpose?

Sphere guidelines

While not the only set of internationally recognised standards for agencies to plan aid delivery, the Sphere Handbook:  Humanitarian Charter and Minimum Standards in Humanitarian Response is a widely used reference point. 2 Guidance is offered in the four main areas of crisis response: water supply including sanitation and hygiene promotion (WASH); shelter, health, and nutrition.

The nutrition standards stress the need to continuously monitor aspects of malnutrition incidence, food security status, and the availability of local markets and health facilities. As a starting point, where food rations are designed to supply all dietary energy in the absence of any other available food, then they should also contain full daily amounts required of macronutrients (protein, fat and carbohydrate) and micronutrients (vitamins, minerals and trace elements). For a total energy target of 2,100kcal per day—the Sphere Handbook assumption of a typical adult’s daily requirement—protein content should represent a minimum of 10-12% of total calories, or 52.5 – 63g per day.

Where communities are able to obtain some food locally, Sphere guidelines suggest a pro rata approach to calorie (energy) and individual nutrient provision. If the nature of typically available food is known, the parcel should be designed to “complement these foods by filling nutrient gaps”. 2

Types of food aid

Aid may be presented in the form of single or multiple bulk food parcels, ready to use therapeutic / supplementary foods, voucher and subsidised systems, and food fortified with micronutrients. On-site kitchens can also prepare and serve soup, hot meals and fortified bread. The severely malnourished and those with specific dietary needs to manage a chronic medical condition may require specialised oral feeds. Some of these individuals are best managed in clinical settings, though Israel’s destruction of Gaza’s healthcare infrastructure has ruled that option out for many.

The following illustrates some of large-scale food distribution approaches and population reach in Gaza:

World Food Programme “food baskets”: these boxes may contain cereals (like wheat, maize, or rice), pulses (such as lentils and beans), vegetable oil, and iodized salt. WFP prioritises food purchasing from local suppliers and often uses staple foods fortified with micronutrients. 3  Within a month of the October 2025 ceasefire announcement, WFP delivered food packages designed to last 10 days to 1 million people in Gaza from the organisation’s 44 hubs. Fresh bread was also delivered to 700,000 people through 17 approved bakeries. 4

Relief kitchens: US NGO World Central Kitchen (WCK) scaled up its activity in Gaza in 2025, shifting from an emergency response to a widely established community-led activity. Despite frequent security incidents, WCK’s six main relief kitchens and its partner facilities were able to cook between 650,000 and 1 million hot meals every day during the latter half of 2025. 5, 6

Cash / vouchers– nearly 200,000 people in Gaza received emergency digital cash payments from the WFP in October 2025 for the purposes of purchasing food and essential goods from local markets. 4

Ready-to-use Therapeutic Foods (RUTF) – nutrient dense RUTF are presented as a paste, spread or biscuit bar in foil wrapping and do not require refrigeration or water for reconstitution. Most are based on peanut butter, vegetable oil, skimmed milk powder, sugar and fortified with vitamins and minerals. Among the most widely used is Plumpy’Nut, manufactured by Nutriset (and others under special licence arrangements). Each 92g sachet provides 500kcal.

As its indication for use is in the treatment of severe acute malnutrition in children, Plumpy’Nut is classed as a prescribed medicine. Nutriset also manufacture less nutrient dense supplementary ready-to-use products for the prevention of malnutrition or for the management of moderate acute malnutrition. UNICEF and WFP have been the main supplier to hospitals and community clinics in Gaza. Other NGOs such as Médecins San Frontières, CESVI Fondazione and Action Against Hunger have also been involved in the use of RUTF. 7-9

Political and conflict factors affecting food manufacture and distribution

Ensuring nutritional needs are met is a humanitarian priority. However, a number of barriers influence the manufacture, supply, composition and delivery of food aid intended for Gaza.

External politics: Cuts made by Trump and the Elon Musk-associated Department of Government Efficiency (DOGE) to the funding approval abilities of USAID affected a number of supply chain contracts, including those of RUTF companies. US-based peanut paste manufacturers like MANA Nutrition and Edesia Nutrition were given federal instructions to halt work on active orders. Contracts were voided and existing warehouse stock carrying the USAID logo and other US references was rendered useless, as RUTF manufacturers were informed that it should not be distributed. 10

Border crossing closures and goods blockade: Gaza’s high population density has meant a constant and heavy reliance on the external supply of goods, including food, power and water. Obvious difficulties for aid organisations have been border closures and Israel’s goods blockade. At times blockade has been complete and sustained, as in the spring of last year that ultimately led to the famine a few months later. Chronic partial blockades have also placed severe and illogical constraints on goods supply. Previously, Israeli authorities placed peanut butter paste (and by extension, RUTF) on the restricted list, categorising it as a “luxury” item. 11

Transportation risks across land: Truck convoys have faced precarious journeys even before entering Gaza. Protest groups against the supply of aid while Israeli hostages were still being held captive by Hamas attempted to sabotage operations. Tsav 9, Forum Tikva and Warrior Mothers carried out a number of demonstrations at the crossings of Kerem Shalom, Nitzana and Tarqumiyah.12-14 These often turned violent, with truck drivers stoned, and food and clothing supplies taken or destroyed. In one instance, trucks were torched by a teenage gang from the Israeli settlement at Evyatar. The passiveness of local Israeli police and inadequate protection for trucks travelling to border gates were reported by senior security commissioners to have been the result of an order from Itamar Ben-Gvir, Minister of National Security. 15

Once inside Gaza, goods are usually taken to warehouses or designated storage areas, and from there, to distribution sites or other places where communities gather. The Gaza Ministry of Health repeatedly reported a number of attacks on aid workers travelling to and from storage hubs. In 2024, a small convoy of World Central Kitchen cars travelling between a warehouse and a food distribution area was targeted by missiles fired from an Israeli drone. Seven workers were killed: the IDF later admitted a serious violation of standard military operating procedures and had dismissed a number of its senior officers and commanders. 16 Within the first 12 months of the latest escalation in conflict, over 320 aid workers were estimated been killed by Israeli snipers, open fire and airstrikes. 17

Airdrops and maritime transfer: Because of persistent dangers posed by a lack of truck protection in and outside Gaza, attempts to deliver goods by air or sea have been made with very limited success. Airdrops are costly and inefficient. Parcels can land in the sea or present a danger to civilians on land. In active conflict zones, parachuted pallets may have to be dropped from heights between 300 and 5,000 metres. The US also implemented a floating pier and causeway concept. Goods would be unloaded from incoming ships, then transferred by smaller boats to a 500-metre coastal pier on the beach.

From the outset the project was perceived by many as a Biden administration publicity stunt. 18,19 Homes in the al-Zahra neighbourhood were bulldozed to create a buffer zone for pier access. Accusations were also made that the IDF—in cooperation with US forces— used the pier for a hostage rescue mission at Nuseirat refugee camp: one which left over 200 Palestinians dead. US forces denied it had been used for military purposes, despite the fact that there was video footage of military equipment on the pier. 20 In the end, bad weather and expense ensured the exercise was short-lived. At construction and maintenance costs of 230 million US dollars, the floating pier assisted in the equivalent of one day’s aid. 21

Practical and cultural considerations for package composition

Where the intention is to include fresh food such as meat, fish, dairy products and fruit and vegetables, perishability is limiting factor when transportation times are long, border openings unpredictable and where there are numerous links in the supply chain. The prolonged nature of conflict in Gaza now means local sourcing is near impossible. Exclusion zones, destroyed infrastructure and people displacement has almost completely limited access to agricultural land. Even back in the summer of 2025, the UN Food and Agriculture Organisation (FAO) reported that only 9% of cropland was physically available. Additionally, a mere 1.5% of land had soil that escaped contamination by white phosphorous and debris from bombing. 22, 23

Since the inclusion of fresh produce in food programmes remains a major problem for agencies, emphasis is often placed on commodities requiring little temperature or storage control. ‘Dry’ staples like cereals, flour and rice, and packets of biscuits, energy dense halva bars, and tinned fruit and vegetables are among items typically featured in aid packages.

Best practice, as highlighted by the Sphere guidelines, is to ensure food supply is culturally appropriate. WFP food basket contents are selected to be familiar to recipients by actively monitoring market availability, purchasing habits, and community or religious food traditions. 3 Certified and tinned shelf-stable halal products, including meat sourced from Australia and India, have been transported via Jordan through a number of distribution programmes. The WFP, alongside Muslim organisations such as the Global Rahmah Foundation and iF Charity have been involved in purchasing, processing and canning of halal and Qurbani meat for Gaza. 24, 25

Nutritional diversity, compromise and bad practice

The body requires sufficient amounts of protein, fat and carbohydrate for optimal physiological function. Around half of all calories should be derived from dietary carbohydrate, the body’s preferred energy source which helps to fuel metabolic processes and muscle and brain function. Of equal importance is dietary protein for its essential role in wound repairing, immune function, muscle building, metabolic reactions and nutrient transport in the body.  

Well intended but disproportionate use of certain foods can lead to an imbalance in nutritional diversity, especially in prolonged periods of dependency. Flour, rice and couscous are often core components of multi-item packages. However, sometimes these parcels can be “carbohydrate-heavy” and lack in significant amounts of protein. Cost and the perishable nature of some protein-rich foods can be prohibitive. There are workarounds, such as using lentils, chickpeas, beans and other plant sources. Options for animal sources of protein include tinned meat and fish, and ultra-heat-treated milk.

Vitamins, minerals, trace elements are required in small amounts only, but their presence in the diet is essential for cellular reactions that produce energy, the manufacture of hormones and enzymes, and immune function optimisation. Muscle wasting and weight loss are classic features of malnutrition, though sequelae can also include single or multiple micronutrient deficiencies. In Gaza, chronic food insecurity has led to a persistently high prevalence of iron-deficiency anaemia among young children, pregnant mothers and the severely malnourished. 26, 27

An example of how not to supply food aid is ably demonstrated the Gaza Humanitarian Foundation (GHF) throughout the five months of its existence in 2025. The controversial US-Israeli backed venture was fraught with a number of concerns, not least with regard to hundreds of incidences of shooting and killing of civilians at or near its distribution hubs.28 As far as the GHF packages were concerned, each box contained a total of 42,500 kcal; calculated to be sufficient to feed just over 5 people for half a week. Academics highlighted deficits in the wider nutrient profile: including iron, vitamin C, calcium, zinc and some B vitamins which could exacerbate existing levels of anaemia and scurvy.  29There was also a fundamental flaw—with hubs centralised to no more than four at best throughout the whole of Gaza, civilians were faced with very long journeys on foot, often made by children who would struggle with boxes weighing almost 20kg.

Water: the essential ‘nutrient’

In the absence of drinking water, adult survival rarely extends beyond four or five days: babies and young infants within half that time, and less when on a background of malnutrition, diarrhoea and disease. Most adults are likely to need around 2 to 2.5 litres per day at baseline, though requirements increased where fluid loss increases such as in hot environments, or with diarrhoea. For washing, cooking, cleaning and personal hygiene purposes, WHO recommendations are 15 litres per person daily. The tragic reality is that over two billion people in the world do not have access to clean water, whether due to climate, conflict, politics or poverty. 30

Since the beginning of the Nakba in the late 1940s, Gaza has depended on external supplies of potable water. The only source of flowing surface water and the groundwater basin have long been contaminated with sewage. Clean water was derived from desalination plants (now mostly damaged by airstrikes) and mainline pipes connected to Israel’s National Water Carrier network, a supply heavily controlled and weaponised by Israeli authorities.

If potable water is scarce, incorporation in aid parcels of cereals, rice, powdered milk and other foods that require cooking or reconstitution is a failed concept. Where bottled water is not included as part of an agency’s strategy, there should be coordination with others who do supply it or be knowledge that it is obtainable and affordable in local markets. The reality in Gaza is that there is often heavy reliance on private suppliers of bottled or tanked water enterprises which can be costly and of low quality.

The most logical way to meet population demand for clean, safe water is through a combination of importing, restoration of desalination plants and repair of disrupted pipe networks. Despite numerous challenges, Oxfam reported in January 2026 that they had worked with partners to restore wells in Gaza City and Khan Younis. Around 156,000 people in these locations now had a sustainable water supply. Plans to work on pumping stations also anticipated to benefit a further 175,000. 31

*

Humanitarian aid requires careful design and delivery. A range of indicators are used to justify and assess efficiency and success. The amount of food delivered has been expressed as the number of trucks entering Gaza; food pallets distributed, and even calories provided. Ultimate proof of success will be found through tracking food security and nutritional status over time. There are tentative signs that organised efforts are working once again. The Famine Review Committee report that there are no areas of the Strip currently in famine. Malnutrition rates decreased slightly in October last year. This is all relative of course. The situation on the ground remains dire, with food insecurity at high levels in 77% of the population. Projections to April 2026 suggest that 100,000 children and 37,000 pregnant and breastfeeding women will continue with acute malnutrition, its associated morbidity and mortality. 32, 33

The UN’s January report is encouraging, but to significantly improve nutrition and the lives of the people of Gaza, a very long road lies ahead.

References

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  2. Sphere Association. The Sphere Handbook: Humanitarian Charter and Minimum Standards in Humanitarian Response. Fourth Edition [Internet]. Geneva, Switzerland: Sphere Association; 2018. Available from: https://handbook.spherestandards.org/en/sphere/#ch001
  3. WFP Staff. All you need to know about the WFP food basket.  World Food Programme [Internet]. 2025 Jan 8 [cited 2026 Jan 15]. Available from: https://www.wfp.org/stories/wfp-food-basket/
  4. One Million People in Gaza Receive WHP Food Boxes but More Crossings Needed for Continued Scale-Up. World Food Programme [Internet]. 2025 Nov 4 [cited 2026 Jan 16]. Available from: https://wfpusa.org/news/one-million-people-gaza-receive-wfp-food-boxes/
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  29. Nguyden K, Murray A. What is inside the GHF food aid box being distributed in Gaza? BBC Verify [Internet]. 2025 Jul 26 [cited 2025 Dec 23]. Available from: https://www.bbc.co.uk/news/articles/cd787er1qz4o
  30. WHO and UNICEF Joint Monitoring Programme (JMP) Report. Progress on Drinking Water, Sanitation and Hygiene: 2017 Update and Sustainable Development Goal Baselines [Internet]. WHO and UNICEF; 2017 [cited 2024 Nov 20]. Available from: https://www.dropbox.com/scl/fi/qtllzjcbwrfcml75cdiwq/Section-1-Highlights-June-20-revised-July-10-docx?rlkey=jhabslybug8t7d75mvshan6o6&e=1&dl=0.
  31. 100 days into ceasefire Gaza still deliberately deprived of water as aid groups forced to scavenge under illegal blockade. Oxfam [Internet]. 2026 Jan 14 [cited 2026 Jan 31]. Available from: https://www.oxfam.org/en/press-releases/100-days-ceasefire-gaza-still-deliberately-deprived-water-aid-groups-forced-scavenge
  32. UN agencies welcome news that famine has been pushed back in the Gaza Strip, but warn fragile gains could be reversed without increased and sustained support. World Health Orghanization [Internet]. 2025 Dec 19 [cited 2026 Jan 31]. Available from: https://www.who.int/news/item/19-12-2025-un-agencies-welcome-news-that-famine-has-been-pushed-back-in-the-gaza-strip-but-warn-fragile-gains-could-be-reversed-without-increased-and-sustained-support
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