Grabbing her daughter's feeble arm, Asmaa al-Arja pulls a shirt over the 2-year-old's protruding ribs and swollen belly. The child lies on a hospital bed, heaving, then wails uncontrollably, throwing her arms around her own shoulders as if to console herself.
This isn't the first time Mayar has been in a Gaza hospital battling malnutrition, yet this 17-day stint is the longest. She has celiac disease, an autoimmune disorder that means she can't eat gluten and requires special food. But there's little left for her to eat in the embattled enclave after 19 months of war and Israel's punishing blockade, and she can't digest what's available.
“She needs diapers, soy milk and she needs special food. This is not available because of border closures. If it's available, it is expensive, I can’t afford it,” her mother said as she sat next to Mayar at Nasser Hospital in Khan Younis.
Mayar is among the more than 9,000 children who have been treated for malnutrition this year, according to the U.N. children’s agency, and food security experts say tens of thousands of cases are expected in the coming year.
Experts also warn the territory could plunge into famine if Israel doesn’t stop its military campaign and fully lift its blockade — but the World Health Organization said last week that people are already starving.
“Everywhere you look, people are hungry. ... They point their fingers to their mouths showing that (they) need something to eat,” said Nestor Owomuhangi, the representative of the United Nations Population Fund for the Palestinian territories. “The worst has already arrived in Gaza.”
Israel eases blockade but little aid reaches Palestinians
For more than two months, Israel has banned all food, medicine and other goods from entering the territory that is home to some 2 million Palestinians, as it carries out waves of airstrikes and ground operations. Palestinians in Gaza rely almost entirely on outside aid to survive because Israel's offensive has destroyed almost all the territory's food production capabilities.
After weeks of insisting Gaza had enough food, Israel relented in the face of international pressure and began allowing dozens of humanitarian trucks into the territory this week — including some carrying baby food.
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“Children are already dying from malnutrition and there are more babies in Gaza now who will be in mortal danger if they don’t get fast access to the nutrition supplies needed to save their lives,” said Tess Ingram of the U.N. children’s agency.
But U.N. agencies say the amount is woefully insufficient, compared to around 600 trucks a day that entered during a recent ceasefire and that are necessary to meet basic needs. And they have struggled to retrieve the aid and distribute it, blaming complicated Israeli military procedures and the breakdown of law and order inside the territory.
On Wednesday, a U.N. official said more than a dozen trucks arrived at warehouses in central Gaza. The official spoke on condition of anonymity because they were not authorized to talk to the press. That appeared to be the first aid to actually reach a distribution point since the blockade was lifted.
Israel accuses Hamas of siphoning off aid, without providing evidence, and plans to roll out a new aid distribution system within days. U.N. agencies and aid groups say the new system would fall far short of mounting needs, force much of the population to flee again in order to be closer to distribution sites, and violate humanitarian principles by forcing people to move to receive the aid rather than delivering it based on need to where people live.
On top of not being able to find or afford the food that Mayar needs, her mother said chronic diarrhea linked to celiac disease has kept the child in and out of hospital all year. The toddler — whose two pigtails are brittle, a sign of malnutrition — weighs 7 kilograms (15 pounds), according to doctors. That's about half what healthy girl her age should.
But it’s getting harder to help her as supplies like baby formula are disappearing, say health staff.
Hospitals are hanging by a thread, dealing with mass casualties from Israeli strikes. Packed hospital feeding centers are overwhelmed with patients.
“We have nothing at Nasser Hospital," said Dr. Ahmed al-Farrah, who said his emergency center for malnourished children is at full capacity. Supplies are running out, people are living off scraps, and the situation is catastrophic for babies and pregnant women, he said.
Everything watered down to make it last
In the feeding center of the hospital, malnourished mothers console their hungry children — some so frail their spines jut out of their skin, their legs swollen from lack food.
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The Integrated Food Security Phase Classification, a leading international authority on the severity of hunger crises, has warned that there could be some 71,000 cases of malnourished children between now and March. In addition, nearly 17,000 pregnant and breastfeeding women will need treatment for acute malnutrition in the coming months.
Mai Namleh and her 18-month-old son, who live in a tent, are both malnourished. She wanted to wean him off of breastmilk because she barely has any, but she has so little else to give him.
She gives him heavily watered-down formula to ration it, and sometimes offers him starch to quiet his hunger screams. “I try to pass it for milk to stop him screaming,” she said of the formula.
An aid group gave her around 30 packets of nutritional supplements, but they ran out in two days as she shared them with family and friends, she said.
In another tent, Nouf al-Arja says she paid a fortune for a hard-to-find kilogram (about 2 pounds) of red lentils. The family cooks it with a lot of water so it lasts, unsure what they will eat next. The mother of four has lost 23 kilograms (50 pounds) and struggles to focus, saying she constantly feels dizzy.
Both she and her 3-year-old daughter are malnourished, doctors said. She's worried her baby boy, born four months earlier and massively underweight, will suffer the same fate as she struggles to breastfeed.
“I keep looking for (infant food) .... so I can feed him. There is nothing," she said.