The people of Gaza are experiencing a dire hunger crisis — and the consequences could reverberate across generations.
Roughly a third of the 2.1 million people in Gaza have gone multiple days in a row without food, and a quarter of the population is experiencing "famine-like conditions," Ross Smith, the director of emergency preparedness and response at the U.N. World Food Programme, told reporters last week.
"The hunger crisis in Gaza has sort of reached new and astonishing levels of desperation," he said.
On Saturday, amid growing concerns about the hunger crisis in Gaza, Israel's military said it will pause fighting for 10 hours each day in some parts of Gaza to allow more food and medical aid into the areas.
According to Smith, nearly 100,000 women and children are suffering from severe acute malnutrition. This month, Doctors Without Borders said its two clinics were treating over 700 pregnant and breastfeeding women for malnutrition.
Chronic hunger takes a toll on the body and mind, even long after recovery, several health experts agree. It's especially dangerous to children and fetuses developing in the womb, according to the U.N. World Food Programme.
The damage can run as deep as altering how genes function — meaning starvation may not just affect survivors but also their descendants, according to Marko Kerac, a clinical associate professor at the London School of Hygiene & Tropical Medicine who studies the long-term effects of malnutrition.
" It's a lifelong thing, and it's even across generations," Kerac said.
How the hunger crisis escalated in recent months
Widespread hunger has been a concern in Gaza since the early days of the Israel-Hamas war, which began in October 2023.
But the crisis worsened drastically starting in March, when Israel began blocking deliveries of food and medical supplies into Gaza in an attempt to pressure Hamas to accept an extension of the ceasefire deal. Around that same time, Israel resumed its bombardment of Gaza.
The blockade was eased in May. But since then, much of the aid delivery has been led by the Gaza Humanitarian Foundation (GHF), which was established this year in response to Israel's concerns that Hamas was stealing and selling food from other aid groups.
Gaza previously had 400 aid distribution points managed under a U.N.-coordinated system. Now that number has been cut down to four, all run by GHF, Aitor Zabalgogeazkoa, an emergency coordinator with Doctors Without Borders in Gaza, told NPR last month.
NPR has also reported that near GHF sites, people have faced Israeli military fire, crowds clashing over rations and masked thieves. As of mid-July, 674 people had been killed in the vicinity of GHF sites, according to the U.N. human rights office.
The series of events has led to rampant hunger in Gaza. As of Sunday, at least 133 people have died due to starvation since the start of the war, with over half the deaths having taken place this summer, Gaza's Ministry of Health reported. The deaths could not be independently verified by NPR.
Israeli officials have disputed the existence of a mass starvation event in Gaza.
Hunger is especially dangerous to children
During extreme hunger, the body starts feeding on itself — breaking down its carbohydrates, fat stores and the protein from muscles to keep the entire body functioning. Children are especially vulnerable because they have smaller bodies and less fat to rely on.
Malnutrition as a child can stunt physical growth and brain development. It is also linked to health conditions such as diabetes and heart disease as an adult. The earlier the malnutrition occurs, the greater the health risks, Kerac said.
" It's a bit like having a motor of a small car in a big truck," he added. "If it's pulling a lot more than its weight, it's gonna burn out a lot quicker."
In Gaza, children's development is also disrupted by exposure to violence, lack of education and forced displacement, according to Zane Swanson, deputy director of the Global Food and Water Security Program at the Center for Strategic and International Studies, a think tank based in Washington, D.C.
"A vicious cycle develops where conditions of poverty and food insecurity increase rates of malnutrition, which hampers community development and economic potential, which in turn increases the risk of malnutrition and insecurity for that community," he said.
The legacy of hunger and trauma is remembered in our cells
Malnutrition can also harm fetuses still developing in the womb, according to health experts.
A famous example comes from the Dutch Hunger Winter — a severe famine that hit the Netherlands near the end of World War II. Decades later, researchers discovered that children born to women who were pregnant during the famine were more likely to experience obesity, diabetes, cardiovascular disease and shorter lifespans.
On top of that, research showed that the survivors' grandchildren were also likely to have poor health outcomes, even though they were not directly exposed to the famine themselves.
"We inherit the memory of trauma on a molecular basis," said Hasan Khatib, a professor of genetics and epigenetics at the University of Wisconsin-Madison.
Epigenetics is the study of how environmental and behavioral factors can influence how our genes are expressed. While extreme hunger — and trauma more broadly — do not alter the DNA sequence itself, they can leave small tags on DNA, affecting how genes are turned on or off, and those epigenetic changes can be passed down to descendants, according to Khatib.
The studies on the Dutch Hunger Winter had some limitations, including to what degree factors such as socioeconomic status and preexisting conditions affected outcomes. Researchers today are still working to fully understand the mechanisms behind changes in gene expression and their full impact.
"The more studies are done, the more variety of symptoms and disorders you can see," Khatib said.
Recovery is possible, but it depends on swift action and consistent care, health experts say
Although children exposed to severe malnutrition face the risk of lifelong health challenges, there are ways to improve their long-term health outcomes, according to Kerac of the London School of Hygiene & Tropical Medicine.
One is early intervention. " We want to try and make sure that the periods of undernutrition are as short as possible," he said.
High-quality and consistent care are also crucial. " Recovering from malnutrition is not just about putting the weight back on. It's a far longer process, and it involves both physical, also mental healing," Kerac added.
Khatib, of the University of Wisconsin-Madison, said epigenetic changes might be reversible but would depend on significant improvements in a person's environment and overall living conditions.
" There is hope," he said. "This is the message as an epigeneticist [I] would like to convey to people — that epigenetics is not really our destiny."
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