Takeaways from AP's reporting on child malnutrition in Gaza

KHAN YOUNIS, Gaza Strip — Israel's total blockade of Gaza is entering its third month, and food and medical supplies in the aid-dependent Palestinian territory are running dangerously low.

Acute malnutrition among children is increasingly prevalent as hospitals hang by a thread, forced to prioritize deadly emergencies from mass casualty attacks. The price of what little food is still available in the market is exorbitant, unaffordable for most in Gaza, where the United Nations says more than 80% of the population relies on aid.

Israel's longest blockade on Gaza, which began March 2, has sparked a growing international outcry. But that has failed to convince Israel to open the borders. More groups accuse Israel of using starvation as a weapon of war. Israel, for its part, insists the blockade is necessary to pressure Hamas to release the hostages it still holds. Of the 59 hostages still in Gaza, 24 are believed to be still alive.

Israeli authorities did not immediately respond when asked to comment on accusations that Israel was using starvation as a weapon of war, but have previously said Gaza had enough aid after a surge in distribution during a two-month ceasefire, and accuse Hamas of diverting aid for its purposes. Humanitarian workers deny there is significant diversion, saying the U.N. monitors distribution strictly.

Here are some takeaways from AP's reporting:

No food coming in, no way to produce it locally

A lack of supplies means the distribution of food parcels has stopped. Community kitchens, a lifeline for hundreds of thousands for their daily meal, are shutting down one after the other. At those still open, chaotic scenes of desperate men, women and children fighting to get meager rations are common. Bakeries have closed, while water distribution is grinding to a halt due to lack of fuel.

The war has rendered farmland mostly inaccessible, while fishermen have reported being shot at when trying to catch fish along Gaza's coastline. Looting has been reported at warehouses with few remaining supplies.

Meanwhile, supplies languish at the borders, prevented by Israel from entering Gaza.

Malnutrition stalks the most vulnerable

U.N. agencies have documented a rise in acute malnutrition among children since March. They are finding low immunity, frequent illness, weight and muscle mass loss, protruding bones or bellies, and brittle hair.

Since the start of the year, more than 9,000 children have been admitted or treated for acute malnutrition, UNICEF said. The increase was particularly dramatic in March, with 3,600 cases – an 80% increase compared to the 2,000 children in February.

And conditions have only worsened. UNICEF says supplies to prevent malnutrition, such as supplements and biscuits, have been depleted. High-nutrition food used to treat acute malnutrition is running out.

Nearly half the 200 nutrition centers around Gaza have shut down because of displacement and bombardment.

''It is absolutely clear that we are going to have more cases of wasting, which is the most dangerous form of malnutrition,'' said UNICEF spokesperson Jonathan Crickx. ''It is also clear we are going to have more children dying from these preventable causes.''

In the pediatric ward

At 9 months old, Khaled, weak and dehydrated, is barely 11 pounds (5 kilos) — half of what he should be. Diarrhea has plagued him for half his brief life.

In Gaza's main pediatric hospital ward, as doctors try to save her son, Wedad Abdelaal, 31, can only watch and agonize over her four other children back in their tent who have nothing to eat.

''This border closure is destroying us,'' she said.

A low-weight baby at 4 1/2 pounds (2 kilos) but otherwise healthy at birth, Khaled began suffering from malnutrition at 2 months old. His mother, herself malnourished, can't produce enough milk.

''Breastfeeding needs food, and I am not able to give him enough,'' she says.

Two of Abdelaal's other children, Ahmed, 7 and Maria, 4, are also showing signs of malnutrition. At 17 pounds (8 kilos), Ahmed's bones pierce his skin. He gets no supplements at feeding centers, which serve only children under 6. Maria has also lost weight, but there is no scale to weigh her.

''My kids have become so frail,'' Abdelaal laments. ''They are like chicks.''

Struggling hospitals

Only critical malnutrition cases are admitted to hospitals, and just for short periods so more children can be treated.

''If we admit all those who have acute malnutrition, we will need hundreds of beds,'' says Dr. Yasser Abu Ghaly. ''We can't help many, anyway ... There is nothing in our hands.''

While the lack of food can decimate even previously healthy children, for those with pre-existing conditions and genetic disorders, the outlook is dire.

''They are sentenced to death,'' said Dr. Ahmed al-Farrah, head of the pediatrics and obstetrics ward at Nasser Hospital.

The youngest pay the price

''We are breaking the bodies and minds of the children of Gaza,'' said Michael Ryan, executive director of emergencies at the World Health Organization. ''Because if we don't do something about it, we are complicit in what is happening before our very eyes. ... The children should not have to pay the price.''

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El Deeb reported from Beirut.