Is Gaza starving?

A new report says the entire population of Gaza is experiencing "acute food insecurity" at emergency to catastrophic levels. But what does this mean?

“Over one million people in Gaza are starving,” proclaims a dramatic headline in the Wall Street Journal. Citing a new report from the International Food Security Phase Classification (IPC), a partnership of 15 international agencies and non-government organisations, the Journal goes on to say:

More than a million people in the Gaza Strip, around half of the enclave’s population, are experiencing famine-like conditions, according to new estimates by food-insecurity experts who found evidence of widespread starvation and a sharp increase in child mortality in the war-ravaged enclave. 

I expected this figure to be disputed. Both sides in this conflict inflate (or deflate) statistics when it suits them, and each side accuses the other of manipulating the numbers. So Israel’s supporters would probably insist that the number was much smaller and Palestinian supporters would claim it was twice as large.

But I didn’t expect an argument about what “starvation” meant. You’d think we’d know what starvation is, but apparently we don’t. Several people refused to believe any Gazans at all were starving: they sent photos of Gazans eating the first meal of Ramadan as proof that starvation reports were a myth. Some even said that the fact that Muslim Palestinians were fasting for Ramadan meant they couldn’t be starving. This is nonsense. Fasting and starvation are entirely different things: fasting is a voluntary decision not to eat for a short period of time, whereas starvation is involuntary food deprivation. And people who are starving do eat. They just don’t eat enough to survive.

Other people said the IPC report didn’t say people were starving. “It says they are experiencing food insecurity, not starvation,” they said.

So I looked up the report. And indeed, it talks about “food insecurity,” and does not use the word “starvation.” But this does not mean Gazans are not starving.

The IPC distinguishes between acute food insecurity, chronic food insecurity and acute malnutrition. This report is specifically about acute food insecurity in Gaza, though there is almost certainly acute malnutrition as well, especially in the north (more on this later).

The words “food insecurity” don’t tend to conjure up the images of skeletal figures with hollow cheeks and sunken eyes that we associate with the word “starvation”. Rather, what springs to mind is the insecurity typically experienced by the insecure poor in developed countries: skipping meals now and then, or buying nutritionally poor food because it’s cheap. This is chronic food insecurity, which the IPC defines as:

persistent or seasonal inability to consume adequate diets for a healthy and active life, mainly due to structural causes.

Chronic food insecurity has long-term effects. A study in the UK showed that in poor areas, where there is chronic food insecurity coupled with inadequate healthcare, children are significantly shorter than in richer areas.

But acute food insecurity is a wholly different phenomenon. The IPC defines it as:

food deprivation that threatens lives or livelihoods, regardless of the causes, context or duration.

Acute food insecurity kills people.

The Collins dictionary defines “starvation” as

extreme suffering or death caused by lack of food.

And the Cambridge dictionary defines it as

the state of having no food for a long period, often causing death

Acute food insecurity therefore meets the dictionary definition of starvation. It should conjure up images of skeletal figures, because that is what it causes.

But it’s not quite that simple. The IPC identifies five phases of acute food insecurity:

Phase 1: Food security
Phase 2: Stressed
Phase 3: Crisis
Phase 4: Emergency
Phase 5: Catastrophe

Phase 1 can’t possibly be starvation, since it is food security. So we have to decide at which phase acute food insecurity becomes starvation. The IPC’s technical manual provides a useful chart indicating the characteristics of each phase:

According to this table, food consumption becomes inadequate and the death toll starts to rise from Phase 3. So perhaps we should regard phases 3, 4 and 5 as starvation.

These charts from the IPC report show the number of Gazans currently in each phase of acute food insecurity, and the projection for the next four months:

Consistent with my suggestion above that phases 3, 4 and 5 equate to starvation, the IPC labels Phase 3 and above as “high acute food insecurity.”

Somewhat confusingly, the IPC’s headline says “1.1 million people, half of Gaza, experience catastrophic food insecurity.” This is evidently the Phase 5 number from the “projected” chart, not the number from the “current” chart. But as it is now 19th March, perhaps we should regard the projected chart as current?

This headline seems to be the source of the Wall Street Journal’s claim that “over a million Gazans are starving”. The Journal has taken “catastrophic food insecurity” as the definition of starvation.

We can perhaps question whether Phase 3 justifies the term “starvation”. But there is surely no doubt about Phase 4. In its technical handbook, the IPC provides a handy guide to Phase 4 acute food insecurity (“Emergency”):

• Phase description. Households experiencing Phase 4 conditions typically have large food consumption gaps, which are reflected in very high acute malnutrition and excess mortality, or are partially able to mitigate large food consumption gaps but only by employing emergency livelihood strategies and asset liquidation that threaten future food security. •

• Priority response objective. Households experiencing IPC Phase 4 should be targeted with responses that focus on saving their lives and livelihoods. Activities such as food assistance, cash assistance and asset redistribution, together with an analysis of key drivers and limiting factors, should be optimally considered during the response analysis. •

• Common characteristics. Populations of households experiencing large food consumption gaps (IPC Phase 4) are also more likely to be engaging in crisis or emergency livelihood coping strategies, such as eating seeds intended to be used for next season, selling the last adult female livestock or selling land. In addition, households in these conditions are also more likely to have been affected by shocks and have some dimensions of food availability, access, utilization and stability that are limited. If areas have at least 20 percent of households experiencing these conditions, acute malnutrition and mortality should be relatively high or increasing.

The IPC calls Phase 4 “Emergency” because people are dying from lack of food and urgent intervention is needed to save lives. This meets the dictionary definition of starvation. The only difference between this and Phase 5 is that people may have seed corn and breeding livestock they can eat. But if they do, then they will inevitably move into Phase 5, because this destroys their future food supplies.

The whole of Gaza is currently in Phase 4, and the north is about to move into phase 5:

So the Wall Street Journal’s headline is wrong. It is not 1.1 million people that are starving, it is over 2 million.

Six months ago, there were no starving people in Gaza. Now, everyone is experiencing some degree of starvation. “The speed at which this man-made hunger and malnutrition crisis has ripped through Gaza is terrifying,”, says Cindy McCain, executive director of the World Food Programme (a contributor to the IPC report).

Terrifying indeed, but not surprising. Because of Israel’s sustained blockade and repeated wars, Gazans have been in chronic food insecurity for well over twenty years. As a result, they lack resilience to starvation. They will suffer more, and more of them will die, than if they were better nourished to start with. This explains the extraordinary speed at which this disaster is taking hold.

The IPC also warns that in the north of Gaza, famine is imminent. Famine is a rare occurrence for which the criteria include acute food insecurity and acute malnutrition, both generalised across an entire area, and high mortality:

Famine (IPC Phase 5) occurs when at least 20 percent of the population in a given area have an extreme lack of food; the Global Acute Malnutrition prevalence (measured by weight-for-height z-score) exceeds 30 percent; and mortality (measured by the Crude Death Rate) exceeds 2 people per 10,000 per day.

As with acute food insecurity, the IPC identifies five phases of malnutrition:

Phase 1: Acceptable
Phase 2: Alert
Phase 3: Serious
Phase 4: Critical
Phase 5: Extremely critical

The IPC says conditions in Gaza make it difficult to screen for malnutrition, but measures of mid-upper arm circumference in children indicate that in February, north Gaza entered phase 4-5 (Critical to Extremely Critical) and Khan Younis phase 3-4 (Serious to Critical). Other areas are in phase 1-2 (Acceptable to Alert) as of early March.

The famine warning is not new. The IPC said in December that there was a risk of famine in the north of Gaza by the end of May 2024 unless there was an immediate ceasefire and sustained provision of essential supplies and services to the population there. It has now updated its warning:

Since then, the conditions necessary to prevent famine have not been met and the latest evidence confirms that Famine is imminent in the northern governorates and projected to occur anytime between mid-March and May 2024.

According to the most likely scenario, both North Gaza and Gaza Governorates are classified in IPC Phase 5 (Famine) with reasonable evidence, with 70% (around 210,000 people) of the population in IPC Phase 5 (Catastrophe).

And it has also extended its warning to other areas of Gaza:

The southern governorates of Deir al-Balah and Khan Younis, and the Governorate of Rafah, are classified in IPC Phase 4 (Emergency). However, in a worst-case scenario, these governorates face a risk of Famine through July 2024.

Israel’s spokesman Eylon Levy disputed the IPC’s report, saying in a post on X that it was “based on an out of date assessment, and as such does not take account of the recent efforts to turbocharge aid deliveries to the minority of Gazans still in the north.” The report itself says at the top that it “factors in all data and information available up to 10 March 2024 and does not take into account the latest developments on the ground.” So it won’t include the air drops in the past week, nor the aid convoys that were used as decoys to draw out Palestinians who were then fired on by Israeli forces, nor the ship from Cyprus. Frankly I am sceptical that these developments will make a significant difference to the dire living conditions of people in the north.

Levy has also been involved in a slanging match with the UN about who is responsible for the fact that aid hasn’t been reaching the north. Aid agencies on the ground say Israel is delaying the entry of aid and arbitrarily blocking the import of many essential items. Israel insists it is not imposing any limits or blocks, and the problem is that the UN is not distributing the aid. Both sides are right, but the responsibility rests firmly with Israel. Hundreds of trucks are queueing outside Gaza for days on end waiting for checks to be performed. And inside Gaza, especially in the north, distribution of aid is extremely hazardous: roads have been destroyed, there is unexploded ordnance and shrapnel everywhere, bombed buildings can collapse at any time, and there is the constant risk of attack by Israeli forces. It is hardly surprising that aid workers balk at delivering aid to the north. Indeed, the remarkable thing is that they deliver aid at all, since even in supposedly “safe” areas there is a significant risk that they will be injured or killed. They are brave people who deserve gratitude, not criticism.

Whatever the reasons, the fact is that insufficient food is reaching the people of Gaza and because of the war they are unable to obtain much food through their own efforts.

So the IPC is not wrong. Over two million people really are starving. And unless there is an immediate ceasefire and urgent action to provide the people of Gaza with adequate food, water and medical care, an awful lot of people will die.

This man-made famine is completely preventable. It must be prevented.

Related reading:

The tragedy of Gaza

Tunnel economy

Productivity and Employment: A Cautionary Tale