After months of aid agencies’ warnings that Palestinians in Gaza Strip were at a high risk of famine, many worry it is now taking hold in the northern part of the enclave where children have begun to die of malnutrition and dehydration.
Gaza’s Ministry of Health said Wednesday at least 20 people have died of malnutrition at hospitals and warned that it believes “dozens are dying silently” unable to reach medical facilities. The World Health Organization visited northern Gaza over the weekend and confirmed at least 10 child starvation deaths at the time of the team’s visit.
Israeli officials have repeatedly stated that they are committed to humanitarian assistance for civilians and have not placed any limits on aid entering the Palestinian enclave.
A famine has not yet been declared in Gaza, but the Integrated Food Security Phase Classification (IPC) has activated its famine review committee to assess the situation.
While hunger is a longstanding issue around the world, a declaration of famine is relatively rare.
What is famine?
The dictionary defines famine simply as an “extreme scarcity of food,” but among world aid agencies addressing food insecurity, it has a much clearer definition and specific guidelines for when to classify a situation as such. According to the IPC, famine is a situation where starvation and extremely critical levels of acute malnutrition are evident.
“It’s a technical term that sort of encapsulates a series of conditions,” said Tobias Stillman, Action Against Hunger’s director of technical services and innovation. “So very significant food insecurity, meaning people don’t have sufficient food to support their physiological need … so they are both experiencing hunger and physiologically in many cases, compensating for the lack of food.”
What pushes food insecurity into a famine declaration?
Both the IPC and the World Food Programme offer a mathematical threshold for what constitutes a famine for the population of a specific area: 20% of households with an extreme lack of food, 30% of children suffering from acute malnutrition, and two in 10,000 people dying per day “due to outright starvation or to the interaction of malnutrition and disease.”
The IPC was created in 2004 by the United Nations’ Food and Agriculture Organization but partners with more than a dozen organizations worldwide as well as governments to examine food insecurity using evidence-based analysis.
It uses a five-phase index that measures food insecurity, with Phase 5 being catastrophe or famine. Currently, Gaza is in the “emergency” phase, which is a step below famine.
“Even though the levels of acute malnutrition and non-trauma related mortality might not have yet crossed famine thresholds, these are typically the outcomes of prolonged and extreme food consumption gaps,” the website states.
NBC News reached out to the IPC, but a representative noted that its experts are working on an upcoming report on Gaza and not available for interview.
Who declares a famine?
Declaring a famine is a multi-step process for the IPC, according to Stillman, and requires complete consensus from five people on the independent committee.
Currently, a group of 25 to 30 people are assessing data from Gaza to offer its recommendation for analysis to the famine review committee. If there is a specific point of contention on a particular data point, that would be noted in a manner similar to what someone might see in the U.S. Supreme Court, Stillman noted.
“If the five of them can’t achieve consensus — if there’s one, for example, that digresses — they can they can draft a dissenting statement,” Stillman said. “So that that committee will still come out with an overall recommendation or an overall classification, but there may be a dissenting voice.”
After the review committee makes its designation, the analysis is sent to IPC’s global steering committee, which Action Against Hunger currently chairs, to make the official declaration of famine.
Those who work on hunger and food insecurity understand that it’s a complex system, Stillman said. But the teams working on these declarations “will be justifying their conclusions every step of the way.”
“It needs to be complicated because it is so incredibly important,” Stillman said. “And, you know, famine carries such important political connotations that nobody wants to take that lightly … it is very, very process-oriented.”
How is hunger being assessed in Gaza?
The situation in Gaza has posed unique challenges because the limited access has complicated the ordinary process. But teams are collecting real-time data to provide to the IPC, Stillman said.
Usually, the larger country-level committee that consists of government representatives, aid groups and other partners would meet in person to go over the data. The Gaza team, however, has had to meet virtually and work anonymously, according to Stillman.
“It’s never been done that way before,” Stillman said. “And the reason it’s been done that way is because of the highly sensitive nature of what’s happening out there.”
Decisions are based on a series of surveys that look at factors such as malnutrition diagnoses and mortality rates. In Gaza, adjustments have been made about how some of that data is collected because of the limited access.
“There are people in Gaza, as we speak, who are measuring malnutrition, and they are not using the traditional method of weight and height,” Stillman said. “They are using mid-upper arm circumference.”
Though faster, Stillman notes, by IPC standards, the method is not the best standard for data collection. Information is also more readily available in some areas of Gaza than others.
If the committees are not entirely confident in the data collection, or if all the information indicates catastrophe conditions but doesn’t quite meet specific thresholds for famine, Stillman says the IPC may declare a “likely famine.”
“And that likely means, you know, there’s a very strong case to be made that there is actually famine present, but they don’t have all the data they need to truly classify as famine,” Stillman said.
What is the current situation in Gaza?
Since shortly after the Hamas-led attacks on Oct. 7, Gaza has been essentially cut off from the outside world as Israel enforces its blockade on the strip, restricting access to food, fuel and running water. It wasn’t until two weeks after the start of the war that aid convoys entered the Palestinian enclave through the shared border with Egypt.
From the beginning, the United Nations and aid groups warned that the convoys were incapable of meeting the needs of more than 2 million people who required the most basic needs.
The U.S. urged Israel to open access to a commercial crossing, Kerem Shalom, to help streamline the process. Kerem Shalom has been used to help conduct security screenings, but Israeli citizens have conducted protests at Kerem Shalom to try and stop aid from entering Gaza.
Starvation is most apparent in northern Gaza, where convoys have had inconsistent access and civil order has broken down. Last week, a number of deaths were reported after witnesses alleged Israel Defense Forces opened fire on a crowd that surrounded an Israeli convoy of aid.
The IDF has denied the allegation, saying a crowd swarmed the trucks and soldiers fired “warning shots” in a failed attempt to disperse the group before retreating. Israel attributed most of the deaths to a crush and stampeding during the chaos that surrounded the convoy.
This incident prompted the U.S. to drop thousands of ready-to-eat meals as convoys face repeated struggles traveling from the southern border to the north.
On Tuesday, the World Food Programme announced that its first convoy to the north since February 20 was turned away by the Israel Defense Forces. Food supplies were able to be air-dropped with help from the Royal Jordanian Air Force, according to Carl Skau, the group’s deputy executive director.
“Airdrops are a last resort and will not avert famine,” Skau said. “We need entry points to northern Gaza that will allow us to deliver enough food for half a million people in desperate need.”