On Gaza malnutrition ward, a child’s arm is as wide as mother’s thumb

Ward is silent as hungry children too exhausted to cry

Khan Younis: On the pink walls of Nasser hospital’s child malnutrition ward, cartoon drawings show children running, smiling, and playing with flowers and balloons.

Beneath the pictures, a handful of Gazan mothers watch over their babies who lie still and largely silent, mostly too exhausted by severe hunger to cry.

The quiet is common in places treating the most acutely malnourished, doctors told Reuters, a sign of bodies shutting down.

"She is always lethargic, lying down, like this… you do not find her responsive," said Zeina Radwan, mother of 10-month-old Maria Suhaib Radwan. She has not been able to find milk or enough food for her baby, and cannot breastfeed as she herself is underfed, surviving on one meal a day.

"My children and I cannot live without nutrition."

Over the last week, Reuters journalists spent five days in Nasser Medical Complex, one of only four centres left in Gaza able to treat the most dangerously hungry children. While Reuters was there, 53 cases of acutely malnourished children were admitted, according to the head of the ward.

Gaza's food stocks have been running out since Israel, at war with Palestinian militant group Hamas since October 2023, cut off all supplies to the territory in March. That blockade was lifted in May but with restrictions that Israel says are needed to prevent aid being diverted to militant groups.

In response to a request for comment, COGAT, the Israeli military aid coordination agency, said Israel does not restrict aid trucks entering Gaza, but that international organisations face challenges collecting aid inside Gaza.

As food stocks ran out, the situation escalated in June and July, with the World Health Organization warning of mass starvation and images of emaciated children shocking the world. The Gaza Health Ministry says 154 people, including 89 children, have died of malnutrition, most in recent weeks. A global hunger monitor said on Tuesday that a famine scenario is unfolding.

Israel says it has no aim to starve Gaza. This week it announced steps to allow more aid in, including pausing fighting in some locations, air dropping food and offering more secure routes.

The United Nations said the scale of what is needed is vast in order to stave off famine and avert a health crisis.

"We need milk for babies. We need medical supplies. We need some food, special food for nutritional department," said Dr Ahmed al-Farra, head of the paediatric and maternity department in Nasser Medical Complex. "We need everything for the hospitals."

Israeli officials say many of those who died while malnourished in Gaza were suffering from pre-existing illnesses. Famine experts say this is typical in the early stages of a hunger crisis.

"Children with underlying conditions are more vulnerable. They get affected earlier," said Marko Kerac, clinical associate professor at the London School of Hygiene and Tropical Medicine, who helped draw up the WHO's treatment guidelines for severe acute malnutrition.

Farra said his hospital was now dealing with malnourished children with no previous health problems, like baby Wateen Abu Amounah, born healthy nearly three months ago and now weighing 100 grams less than she weighed at birth.

"During the past three months she did not gain one gram. On the contrary the child’s weight decreased," the doctor said.

"There is total loss of muscles. It's only skin on top of bones, which is an indication that the child has entered a severe malnutrition phase," said Farra. "Even the face of the child: she has lost fat tissues from her cheeks."

The baby's mother, Yasmin Abu Sultan, gestures at the child's limbs, her arms about as wide as her mother's thumb.

"Can you see? These are her legs... Look at her arms," she said.

Supplies running out, few spaces in hospital

The youngest babies in particular need special therapeutic formulas made with clean water, and supplies are running low, Farra and the WHO told Reuters.

"All the key supplies for the treatment of severe acute malnutrition, including medical complications, are really running out," said Marina Adrianopoli, WHO nutrition lead for the Gaza response. "It's really a critical situation."

The treatment centres are also operating beyond capacity, she said. In the first two weeks of July, more than 5,000 children under five received outpatient treatment for malnutrition, with 18% suffering from the severest form. That was a surge from 6,500 in the whole of June, already the highest of the war and almost certainly an underestimate, said the WHO.

Baby Wateen's mother said she tried to get the girl admitted last month, but the centre was full. After ten days with no milk available and barely a meal a day for the rest of the family, she returned last week because her daughter’s condition was deteriorating.

Like several of the infants at Nasser, Wateen also has a recurring fever and diarrhoea, illnesses that malnourished children are more vulnerable to and which make their condition more dangerous.

"If she stays like this, I'm going to lose her," her mother said.

Wateen remains in hospital getting treatment, where her mother encourages her to take tiny sips from a bottle of formula milk. A side-effect of severe malnutrition is, counter-intuitively, loss of appetite, doctors told Reuters. Yasmin herself lives on the one meal a day provided by the hospital.

Some of the other babies Reuters met, like 10-month-old Maria, were discharged over the weekend after gaining weight, and given formula milk to take home with them.

But others, like five-month-old Zainab Abu Haleeb, did not make it. Vulnerable to infection because of her severely malnourished state, she died on Saturday of sepsis. Her parents carried her tiny body out of the hospital for burial, wrapped in a white shroud.