The Struggle to Help Gaza’s Starving Children

The people of Gaza are in desperate need of food. Five months into Israel’s bombing and near-blockade of Gaza, the country’s response to Hamas’s October 7 attack, public health officials are reporting dire food shortages and rising rates of infectious disease. For many young children, the threat of famine has already turned deadly. To help understand the crisis, I spoke with UNICEF’s Middle East and North Africa regional director Adele Khodr. From headquarters in Jordan, Khodr described the danger for Gazan children, her organization’s role in providing limited aid to the region, and the urgency of a ceasefire to avoid further humanitarian disaster.

At least 20 children have reportedly died due to dehydration and malnutrition in Gaza, with most of those dying at hospitals in northern Gaza. Why is the situation in the north so dire?
It is dire simply because this is the region of Gaza to which access is very, very limited. Meaning that the road there is not safe, to start with. And the security situation is also very bad. These people don’t have enough food to sustain them, and UNICEF is having problems sending in drugs. The latest shipment we were able to do was on March 3, but it was a very small quantity transported not even in a truck, but in two four-wheel-drive cars. So it’s basically the insecurity — the fact that missions there are dropped at the last moment for security reasons. This is why food hasn’t been there for a very long time. And of course this is the area that has witnessed the highest level of military action since the beginning of the war.

Children, especially those under the age of two, cannot eat everything the way an adult would. They need special food — breast milk for the kids who are less than a year old. And if the mother doesn’t have enough food, she will not be able to breastfeed a child. Other specialized food for children, like infant formula, is simply not available. And on top of that, there are very limited quantities of water. We are not sure about the safety or the quality of it. This leads to dehydration, and the infections that cause diarrhea and cause complications in a child’s body.

According to UNICEF’s State of Palestine report last week, thousands of babies due to be born in Gaza over the next month are at risk of dying. Is that because of all the factors you just mentioned, in addition to the bombing itself? 
Yes. Plus, vaccine-preventable diseases in Rafah, where most of the population is. We were able to get vaccines there, and have the children vaccinated. But then there is the north, where we took vaccines, but are the children vaccinated? We really don’t know. So yes, malnutrition, dehydration, a rise in the proportion of infectious diseases. You have no water — maybe there will be cholera. There is very poor sanitation, very poor hygiene. So anything could happen. These are all reasons for an increase in the proportion of child death — all preventable reasons. I think the most important part of the statement we put out a few days ago is that there is a rate of 15.6 percent of severe acute malnutrition among children in the north. In the south, in Rafah, it is 5%, which means that where you have aid that is reaching the people, the situation is much better. So it means that it is preventable.

Once you have reached severe acute malnutrition, unless it is treated, there’s more possibility of getting an infection. There has to be RUTF, “ready to use therapeutic feeding,” for the children, what is usually known as Plumpy’Nut. And sometimes the child has to be followed up with and given other medications in case they have complications associated with severe acute malnutrition.

Is it difficult to get a child out of severe malnutrition even in a well-stocked hospital that is not in a war zone?
In some places, you can have an 80 or 85 percent success rate in treating children with severe acute malnutrition. In good hospitals, it could reach 90 percent. And I’m not talking about advanced countries. I’m talking about hospitals even in some developing countries where we work.

The stat you mentioned, of 15.6 percent acute malnutrition among children in the north, was from January. Is it safe to assume the number has risen since then? And why?
One reason that it has risen could be that in February, the number of trucks that went into north Gaza has gone down 50 percent from what it was in January, overall. And this is the main reason you have less and less supplies going in.

Are the supply trucks getting stopped by IDF forces, or are UNICEF and other organizations deciding that it’s too dangerous to send them? 
The entry points into Gaza are very few in number to start with. It also takes a long time to screen the trucks. Sometimes it takes so much time that those who are waiting at the border, when their turn comes, will hear, “Oh, no, the truck point is closed.” So they have to start at zero and go back the next day. This is why trucks are spending a very, very long time on the route. Sometimes, also, they have to transfer items from one truck to another because some of the roads are simply too small.

What do Israeli soldiers say when they stop a truck full of aid?
There are some items — not the nutrition items, but sometimes medical supplies and sometimes water supplies — we call them dual-use items. They say that those items could be used for other purposes and this is why they are not allowed to let them in.

Has there been a change in strategy after Israeli troops reportedly fired on crowds who had gathered for food packages?
No. Why? We don’t have any other means of doing this, right? When people are really hungry, they will assemble around where the food is. There is no other means of distribution — you cannot send the food to people’s houses. When you come in with a truck, it is very human and very normal that people will come around to try to take supplies. You cannot prevent them from doing that, but you also have to make sure you have the necessary security to prevent chaotic scenes. That security has to be provided by a certain police force that has not been working recently, something called the Blue Police. You also have to ensure that locations that are marked, which have GPS coordinates usually given to the military, are de-conflicted locations, so that they are not bombed. This is what we call deconfliction.

What specifically is UNICEF delivering into Gaza, when it’s allowed to?
At the beginning, we were delivering, number one, large quantities of drinking water. Now we are not doing that anymore, but we are securing the operation of one of the desalination plants, so we can do operation and maintenance on it. And that’s a major source of water.

Number two are vaccines. Then we have what we call emergency supplies. We have an emergency kit that contains some very basic mother-and-child health medical supplies. They are not surgical supplies because this is not our specialty — it’s the specialty of the WHO. But the kit includes antibiotics, analgesics, special medications for acute respiratory infections, for diarrhea, for the mothers and their children. Then we have something called a family hygiene kit for sanitation, which includes detergent, soap, and toothpaste.

We have also distributed something called high-energy biscuits, and some ready-to-use food for the small kids, and this is not only for the kids who are malnourished, but for the regular kids, who might be six months old. And then ready-to-use-therapeutic food, and a special type of milk powder that is given with the ready-to-use therapeutic food. Sometimes we bring in fuel. We also send some dignity kits, mostly for women, for issues that have to do with female hygiene. And we distributed a lot of winter clothes for children when the weather was very bad.

You’re not delivering drinking water because the focus is on the desalination plant, which does more?
We were bringing in bottled water. Bottled water is super expensive and it’s simply not sustainable. So it’s better to look at other ways of disinfecting the water you have in the pipes. And NGOs and other charity organizations were bringing bottled water in too. We were asked to put a hold on water and prioritization of other supplies.

Things like the family hygiene kits, like vaccines, like the medical supplies.

Where are the UNICEF workers organizing all this?
We have an office in Gaza. We moved the staff to Khan Yunis, and now our staff are in Rafah. And we have increased the number of international staff we have there. Before the war we had two, and now sometimes we have 10, sometimes it could be 12 or 13 international staff. The number of locals is much higher than that.

And then we have what we call a supply hub in Egypt that makes frequent visits to el-ʻArīsh, but the majority of them are based in Cairo, basically doing supply and logistics.

If there were a ceasefire, how would that help UNICEF bring in more aid?
First, there would be more security. We expect that we would have a higher number of trucks going in, and that we would be able to distribute aid with less risk of people getting killed from gathering around the distribution, because there would be more food and water available for people. It would definitely reduce the number of children who are malnourished, and prevent them from getting sick and from eventually dying.

What do you think of recent U.S. efforts to provide aid through air-drops and a floating dock to ship in aid?
I think there is a lot of talk about air drops, and about opening a new port or a maritime corridor. We really welcome this additional aid, but we don’t think that the air drops can replace the land crossings, the land routes. They remain the only way that we are able to deliver the supplies at scale. You cannot drop all the supplies from the sky — it’s simply not possible.

And some specialized supplies like vaccines and food items for the children, especially a specific type of milk powder, have to be temperature-controlled. So we need to make sure that we secure additional land entry points, that we have speeding up of inspections at the borders, that we allow a larger number of trucks to cross, that the dual-list items are allowed, and that there are enough trucks within Gaza to be able to move freely without any security impediments to be able to really make sure that our aid is delivered.

And we hope that all this will be achieved with a ceasefire, and this is why we’re calling for one. Because unless this is done, then it is really very difficult to see an end to this situation.

This interview has been edited for length and clarity.