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\u201cIt depends on the age of the person,\u201d said Zita Weise Prinzo, <\/strong>senior nutritionist with the World Health Organization. \u201cIt depends on their health status. It depends on whether they have access to liquids, or to some sort of food, even if it doesn\u2019t cover all the nutrient needs.\u201d<\/p>\nUNICEF, the humanitarian aid organization that focuses on children, is particularly concerned about infants, said Anuradha Narayan, the agency\u2019s senior adviser on child nutrition in emergencies. Before the war, about 60 percent of Gazan infants were formula-fed. Their families now have little or no access to any food supply for them.<\/p>\n
\u201cWe know that there are many families who are probably unable to feed their children with infant formula,\u201d she said.<\/p>\n
For families who have found formula, the challenge is getting clean water to make it; an estimated 1.6 liters of drinking water (versus the minimum of 15 liters per day recommended by the W.H.O.) are available per person in Gaza now.<\/p>\n<\/div>\n<\/div>\n
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Progression to severe malnutrition is fast<\/h2>\n Ms. Narayan said the agency estimated that 7,000 to 8,000 children are so severely malnourished that they are at risk of death without immediate treatment, but the active conflict in Gaza was making it difficult for aid agencies to evaluate the situation.<\/p>\n<\/div>\n<\/div>\n
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\u201cWe expect that those numbers can go up pretty dramatically in the next two to three weeks,\u201d she said.<\/p>\n
Ms. Narayan said that in her work in other food security crises, such as in Ethiopia, it was typical to see a child fall ill and progress to severe malnutrition and wasting within days.<\/p>\n
For Gaza, she said, \u201cIt\u2019s harder to predict but if there is nearly no food to feed young children, and illness involved, I would say it could be exactly the same. You go from being reasonably OK to being on some level of malnutrition, maybe not severely wasted, but still wasted, within a span of a few days. Particularly for the young, less than 2 years old, for sure that is likely to be the case.\u201d<\/p>\n
The trajectory for people with some access to food would be different, said Dr. Stanley Zlotkin, a professor of nutrition at the University of Toronto and an expert on the effects of critical food shortage. An adult may be able to survive for an extended period with only intermittent access to calories or with only foods that offer limited nutrients, he said. In a situation like Gaza\u2019s, where there is still sporadic availability of some food, most adults would be able to survive for some time, but that would not be enough for children to prevent a progression to malnutrition.<\/p>\n<\/div>\n<\/div>\n
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What happens in the body<\/h2>\n A malnourished body first burns fat reserves, said Heather Stobaugh, an expert on nutrition and emergencies with the aid agency Action Against Hunger, until those are depleted. Then, \u201cThe body will resort to using muscle, and eventually vital organs will begin to break down,\u201d she said. \u201cIn the most severe forms of malnutrition, immune systems are weakened and vital organs actually start to shrink \u2014 the heart, lungs and so on.\u201d <\/span><\/p>\n\u201cWhen a child or an adult reaches this point,\u201d she added, \u201ctheir body is literally wasting away.\u201d<\/p>\n
Ms. Weise Prinzo said that people in this state minimize energy expenditure. \u201cThey stop any movement not necessary for immediate survival, but also within the organs, there are changes in how the heart and liver function,\u201d she said. \u201cThey really try to manage, but eventually one or the other of the systems starts to fail.\u201d<\/p>\n
At this point, a starving person has a range of physical degradations, including extreme fatigue, an inability to regulate temperature and emotional impairment.<\/p>\n
\u201cWe say \u2018acute malnutrition\u2019 and <\/em>acute means that it could happen in a short period of time,\u201d Dr. Stobaugh said. \u201cIt doesn\u2019t always have to be months of a slow degradation.\u201d<\/p>\n<\/div>\n<\/div>\n\n
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Malnutrition and disease drive a grim cycle<\/h2>\n A malnourished person is vulnerable to disease because of a weakened immune system and because of the conditions of conflict, where there is a lack of clean water and sanitation facilities, and people are often living in crowded shelters.<\/p>\n
A malnourished body\u2019s defenses \u2014 epithelial cells, which make up the surface of the skin and barrier tissues in places such as the gut \u2014 break down, and white blood cells malfunction.<\/p>\n
\u201cThen when you get sick, the body uses whatever protein and energy stores that you have, trying to fight the infection, and that cycle of infection and malnutrition is what rapidly causes the wasting to take place,\u201d Ms. Narayan said. This process is more rapid in children, she said.<\/p>\n
Dr. Zlotkin said disease spreads rapidly in situations such as the current one in Gaza, where 90 percent of people have been displaced and are sheltering in tents or other temporary structures, and there are few adequate latrines or washing facilities. Pneumonia and gastrointestinal <\/span>infections are the main causes of death for malnourished people.<\/p>\n\u201cYou have outbreaks of illness such as extreme diarrhea in combination with no health care services, no food, no clean water,\u201d Dr. Stobaugh said. \u201cThis sort of perfect storm of adverse environmental conditions and health conditions is going to exacerbate the speed with which a body will become malnourished and can ultimately become on the brink of death quite quickly.\u201d<\/p>\n<\/div>\n<\/div>\n
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