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LAST UPDATE | 22 Aug 2025
DAILY, WE ARE presented with photographs of skeletal children, almost unbearable to look at.
Gaza is being starved by Israel.
A famine has been officially declared in Gaza City by the United Nations, a famine that is entirely man-made according to UN experts.
The fact of this mass starvation can be difficult for those of us who have neither experienced nor witnessed such horror to understand: if not quite a total abstraction, starvation is a concept lacking, in our comprehension, in concrete and specific detail.
When the body does not receive food, it turns to its internal sources of energy. This happens in a particular order.
First, the body exhausts glucose, or sugar, stored as glycogen in the liver and muscles. This is likely to be used up quickly – perhaps within three days.
Billy Bourke, a consultant paediatric gastroenterologist and professor of medicine at UCD, said that apart from the “horrendous distress of hunger”, children deprived of food will experience in these first days “tiredness, lethargy, progressing to dizziness and even fainting”.
When glycogen is gone, the body turns to using fat an energy source.
How long fat will be available as a source of energy depends on the amount of fat present before acute starvation occurred. In Gaza, acute starvation comes after a long period of malnutrition.
When fat stores are used up, the body begins to consume protein from the muscles and major organs. Now, many things happen.
“There is a complex physiological response to this crisis including reduced heart rate, inability to regulate temperature, inability to regulate blood sugars, slowing down intestinal function, slowing down of activity and cognition, profound tiredness, eventually progressing to disordered consciousness, and ultimately death,” Bourke said.
Lack of protein affects the immune system, meaning even milder infections can be overwhelming and result in death. Children are now at very high risk of death from infections.
Fiona Cianci, a consultant in public health medicine, said babies are especially vulnerable to low glucose.
It can lead to them suffering seizures and coma and permanent brain damage.
The medical literature describes two types of malnutrition particularly affecting children: marasmus and kwashiorkor. Marasmus is starvation of all calories – carbohydrate, fat and protein. In kwashiorkor, protein in particular is lacking.
“This is associated with abdominal and limb swelling, fatty liver and other effects,” Bourke said.
“There are overlaps between the two. We are seeing evidence of both in Gaza.”
Bourke is involved with the medical charity Children Not Numbers, which provides care in Gaza.
Children are likely to die much more quickly than adults without food. That’s because they need more calories, per kilo of body weight, to grow and survive.
The ultimate process of death from starvation is complicated, because once a person loses consciousness, they are also affected by other problems, such as dehydration.
“Reduced level of consciousness followed by coma and death are described, but sudden and unexplained death can occur as well,” Bourke said.
When a person eats after a period without food, they remain at huge risk.
“The worry is a condition called ‘refeeding syndrome’,” said Bourke.
This was seen after World War II, when some starved prisoners of war and concentration camp inmates became unwell and died after being given large amounts of food quickly.
The problem is caused by low blood electrolytes, in particular low blood phosphate and potassium levels, Bourke said. Refeeding after a period of starvation must be done slowly and incrementally.
Any of the children the charity Children Not Numbers advises on in Gaza have already lost more than 10% of their bodyweight, putting them at “immediate risk” of refeeding syndrome, said Bourke.
He added that his medical colleagues in Gaza are “unfortunately all too familiar with this condition and how to avoid it”.
Nutrition, like water, sanitation and a functioning healthcare system, is a “basic building block” of short and long-term health, said Cianci. All of these are being withheld or have been destroyed in Gaza.
The impact of starvation on children stretches beyond increased mortality and disease in the short-term, to long-lasting effects on development.
“In public health, we talk about the first 1,000 days of life – from conception to 2-3 years – as the most important period that impacts long-term health and wellbeing,” Cianci said.
Malnutrition during this time will negatively affect neurodevelopment and cognition – things like memory and attention. This was described in a major 2022 study in the British Medical Journal.
Exposure to chronic stress as a child, meanwhile, is associated with mental health problems later in life, as well as chronic physical conditions such as disease and diabetes.
“This genocide will have devastating intergenerational consequences on the health and wellbeing of Palestinians for years to come,” Cianci said.
Intentional starvation of civilians as a method of warfare is a war crime.
The International Criminal Court issued a warrant last November for the arrest of Israeli Prime Minister Benjamin Netanyahu on suspicion of war crimes in Gaza, including the crime of starvation, and on suspicion of crimes against humanity.
The Irish Society of Specialists in Public Health Medicine wrote to the Taoiseach this month calling on him to do more to help people in Gaza.
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