E. Mark Windle 18 November 2023.
The history of the conflict between Israel and Hamas is a complex and protracted one. As the latest escalation continues with airstrikes and ground invasions in Gaza, various political parties, the public and media across the globe debate the definition of Israel’s right to defend itself and the questionable tactics of the Israel Defence Forces. But however the argument plays out, there’s a huge elephant in the room.
Accurate figures are always difficult to quantify in war. But based on data collated by authorities on both sides since October 7th, a best guess indicates a death toll of approximately 11,000 Palestinians and 1,500 Israelis to date. According to the World Health Organisation, the seven-fold increase in Palestinian deaths also reflects a disproportionately high percentage of women and child fatalities. And those who have managed to make the perilous journey south via the evacuation corridor, only 500 or so have been permitted to cross the border at Rafah, largely on the basis of dual nationality, foreign national status or because of significant injury. For those remaining in Gaza, the journey isn’t over by a long shot.
Other than the immediate violent trauma of war, significant daily health challenges are being faced throughout Gaza and are contributing to deaths. Maintaining adequate nutrition and hydration is critical. Access to good nutrition and clean water reduces the risk of disease, and increases the ability to heal wounds. In that respect, Gazans are not off to a good start. The WHO notes that food insecurity has long been a burden (again carried in particular by women and children), and is related to poverty, food availability and fragile environmental conditions. Given the current obliteration of Gaza this could all be considered a moot point, but before the latest peak in conflict a third of the general Palestinian population had difficulty in accessing nutritious food on a regular basis. When it came to women and children, that figure was double.
Reasons for malnutrition in Gaza are multifactorial then, though all have political and military conflict at their root. Agricultural opportunities disappeared due to loss of land and no-go areas. Unemployment has significantly affected food affordability, and has been running at 80% or more for at least 20 years. In some areas, the physical availability of food wasn’t in itself a problem; having the financial means to buy staple cereal products, fruit, vegetables and meat was. And then there has been 15 years of blockades by Israel in the name of blunting the movement of arms supply and Hamas attacks, but in the process also severely restricting the supply of food and water to the residents of Gaza. No matter how it’s dressed up, civilian starvation is a clear breach of international humanitarian law.
With a bankrupt Palestinian Authority, Israel’s strangulating hold on Gaza and so much of the population below the poverty line, there is heavy dependency on international aid for food, fuel and general household goods. While the terrorist activities of Hamas are very visible within and outside Gaza, they have also been in a position of government that has had the support of 20% or more of its people. Some Gazans claim to have observed positive social, health and municipal changes in their neighbourhoods since Hamas seized power at the 2006 Palestinian Legislative Election. These include the establishment of food banks, medical clinics, and educational facilities. Most likely these were achieved through collaboration with outside agencies, and restricted to specific locations. Others living in Gaza have experienced little in the way of improved food availability or healthcare.
Earlier this year, major steps were put in place to address the nutritional health of Palestinians. In Gaza and the West Bank, despite limited funding, the World Health Programme provided direct assistance in food provision to 27,000 people over a three-month period during summer. WHP also set up 11 summer camps for children to educate on health issues including better nutrition and food choices, and collaborated with the Ministry of Agriculture to arrange for the transfer of olive oil produced in the West Bank to be transported to vulnerable families within West Bank and Gaza. In all an estimated 200, 000 Palestinians were assisted one way or another by WHP initiatives in August alone.
The reality is that significant under-nutrition persists in Gaza. Recent distressing scenes of rows of critically ill new-born babies taken out of their incubators due to power loss as Israeli forces advance on Al-Shifa Hospital reflect both the current situation and the routine high incidence of neonatal morbidity and mortality. Twenty-three per cent of births in Gaza are pre-term, placing a much higher demand on neonatal intensive care services than is seen in many western countries. This prematurity, again, is largely down to maternal malnutrition. UNICEF previously identified that a quarter of Palestinian mothers are anaemic, which not only compromises respiratory function and increases fatigue but also adversely affects normal foetal development. The anaemia of mothers and children is caused by poor combined iron and B vitamin status, but is also an indicator of generalised malnutrition, with other vitamin, mineral and trace element deficiencies reducing the ability to fight infection, and delaying wound healing from violent trauma. Around 40% of babies are breastfed, though milk quality varies dependent on the mother’s nutritional status. For those babies who are bottle-fed, clean water availability remains a concern in light of the current situation of displacement. For those children who wean successfully to solids, a quarter of children are estimated to have anaemia due to restricted food intake, and a significant number are under weight or have other growth delays related to nutritional deficiency. Malnutrition remains a significant cause of death in the under-5s.
That’s the baseline. Blockade, combined with mass displacement has now placed even greater demands for access to adequate nutrition. Without a ceasefire to facilitate the passage of food supplies and medical support, the latest conflict will only exacerbate this picture of widespread malnutrition among the most vulnerable in Gaza society. Hospitals have been bombed, lost power or have gone without deliveries of food and medicine for weeks now. At the beginning of November, over 50% of Gaza’s population sought refuge in the UN’s Relief and Works Agency facilities, who have been struggling to maintain nutritional supplies and clean water with the on-going blockade.
Gaza has also always been highly dependent on imported or donated bottled water, or desalination for the provision of safe drinking water. Even back in 2001, the Global Institute for Water, Environment and Health and the Euro-Mediterranean Human Rights Monitor described most of Gaza’s domestic water supply as undrinkable. Earlier this month, the IDF destroyed a reservoir in the north, a public water supply that covered a large neighbourhood in the south, and cut power to their desalination plants. Dehydration, diarrhoea and respiratory infection rates are increasing, adding to the infection-malnutrition cycle that will ultimately will lead to an exponential rise in mortality. An adult survives for a maximum of around 5 days without water. In a critically ill child, it can be hours.
On November 3rd the WHO’s call to action was for an immediate humanitarian pause in the conflict to “alleviate the suffering and prevent a desperate situation from becoming catastrophic”. Two weeks on there are no signs of that happening. Tragically for so many men, women and children of Gaza, it’s already too late.
(Copyright 2023) E. Mark Windle is a freelance writer and biographer, working independently, as a senior writer with Story Terrace (London, UK), and for Sheridan Hill / Real Life Stories LLC (North Carolina, USA). To discuss services for hire please contact Mark at https://windlefreelance.com/contact/