In July sixty-three people, including more than twenty children, died of starvation in the Gaza Strip, according to Gaza’s Health Ministry. More have been dying this week. Israel is now facing increased international pressure to end the war, and, more immediately, to insure that greater quantities of aid are allowed into the territory. American negotiators have proposed an “all-or-nothing” deal that would end the hostilities if Hamas agrees to disarm and to release the remaining Israeli hostages it took during the October 7, 2023, attack. There are believed to be around twenty still alive, and one of them was shown emaciated and hungry on a recently released video. But Hamas disarmament seems unlikely, and the group has said that it will not even consider doing so without the establishment of a Palestinian state, which Netanyahu opposes. Meanwhile, Netanyahu has shown no real willingness to end the Israeli campaign.
Even before October 7th and the ensuing war, Gazans were largely reliant on international aid; many of them had trouble accessing sufficient amounts of food and clean water. The war has worsened the situation on the ground and resulted in an estimated sixty thousand deaths. In March, Israel decided to end a temporary ceasefire with Hamas, and then cut off aid almost entirely for more than two months. When aid distribution resumed, it was primarily overseen by the Gaza Humanitarian Foundation, a hazily organized nonprofit staffed by American contractors, and set up with a significant degree of Israeli influence. The U.N., which had until then largely controlled aid distribution, was relegated to a minor role. Within weeks, hundreds of Gazans were being killed at or near G.H.F. sites, and desperate civilians were surrounding U.N. trucks in the hopes of getting food. The situation is bleak enough that, even if aid increases rapidly in the coming weeks, deaths from starvation are almost certain to rise.
I recently spoke by phone with Alex de Waal, one of the world’s leading experts on famine, and the director of the World Peace Foundation at Tufts’ Fletcher School of Law and Diplomacy. De Waal has written numerous books about Africa, including several on Sudan, which is also currently beset by war and hunger. During our conversation, which has been edited for length and clarity, we discussed the immediate steps needed to prevent more starvation in Gaza, why returning to the old system of delivering aid is now insufficient, what makes Gaza unique among the catastrophes de Waal has studied, and what the Trump Administration’s attack on foreign aid has done to Sudan.
What do people in Gaza need right now? Does the fact that the situation has become so bad recently change how you answer this question?
You’ve put your finger on it. If you’d asked me this question at the beginning of June, I would have said that the United Nations has an action plan, the resources, the skills, the networks, the distribution plans, et cetera. It’s on standby. All you need to do is give them the green light. You’re not going to solve all the problems because there are a whole lot of fundamental problems to do with basic services: water, sanitation, the state of the health-care system. But you’re going to be able to stabilize the food situation. And so I would say if you did that, you are pretty much in the clear in terms of large-scale starvation.
Today, you have a situation in which it’s impossible to know the true numbers, but there are an increasing number of children—probably in the thousands—that need to be in the hospital because they can’t eat food. They have got to that stage of severe acute malnutrition where their bodies just can’t digest food. And so those kids need to be in intensive care. I was just trying to figure out how many hospital beds there are in Gaza. It looks like there are about eighteen hundred total surviving beds, but the number fluctuates daily for all sorts of reasons. So on top of flooding Gaza with food, which remains essential, there needs to be a massive emergency infusion of intensive-care capability.
So people going through starvation reach a point where food alone is insufficient?
The process of starvation goes through several stages. When you’ve used up all your body fat, which in the case of children isn’t much, you get to the stage where the body starts consuming itself for energy. It starts basically cannibalizing the brain—it’s eating essential organs: heart, kidney, liver, brain, stomach lining. When you get to that stage, you are going to die or you are getting into intensive care to stop you from dying.
I want to take a step back. You alluded to the system that the United Nations had in place before we got to this point—how did that work and why may it be insufficient now?
As of February, during the ceasefire, the U.N. and its partner organizations had about four hundred places where they were giving assistance directly to people. And that would include hot food. There were sometimes about eight hundred and fifty thousand hot meals being served every day, and then a whole lot of nutritional supplements and specialized food for kids.
So it was working at a minimal level, but not enough was getting in. And one of the big problems it was facing was Israel’s very unpredictable permission system. The supplies were unreliable because of the arbitrary and unpredictable conditions and checks imposed by Israel at the border. Some trucks were totally blocked, some were disrupted, and some were able to move. For those that were able to move there had to be some security, and some of them had a lot of hassles either from armed gangs or from Israel, which would, even during the ceasefire period, disrupt them in some way. Then, in early March, you had the complete siege imposed and nothing moved. Israel started military action again. Then, in May, access was permitted again in two forms. One was the Gaza Humanitarian Foundation. The other was limited U.N. activities.
It’s important to note that there were U.N. efforts to get the locals—sometimes clans, sometimes community groups—to protect the aid because the biggest threat was from armed gangs. Actually, the biggest armed gang is a group called the Abu Shabab gang, which is supported by Israel. [Yasser Abu Shabab, the group's leader, has denied that it receives support from Israel.] But there were reasons it was hard to make that work. There was one case on the twenty-sixth of June where a community group organized its own youth, who were armed to protect some aid trucks. A video was taken of this and circulated by members of the Israeli government who said, Look, this is Hamas stealing aid. So that system, which was tried for one day, didn’t continue. That shipment was actually tracked, and it went to a World Food Programme warehouse and was safely distributed. [The I.D.F. did not respond to a request for comment.]
In late May, the G.H.F. became the major provider of aid in Gaza. Hundreds of people have been killed at these sites. There are only four of them, as opposed to the four hundred you were talking about. When you said in your first answer that you can’t just turn the old U.N. system back on again—is that because some children now need more than food, or because of logistics? My sense is that even getting the trucks to these four hundred sites would be chaotic now, because people are so desperate.
I meant primarily the medical stuff, but what you say about the desperation and the breakdown in social order is also true. I really don’t know how one would address that problem. But one thing I would say is that if people have the confidence that more aid is coming that’s much better. One of the reasons why you have problems with U.N. distribution is that no one knows when the next one is coming. If you’re doing this in Somalia, say, you enlist the community and you say, O.K., this is what we’re going to do. This is the amount that’s coming. This is going to go to place A; this is going to go to place B. Everyone sort of knows what’s going on. Then you can enlist the communities to provide protection.
But here the U.N. has no sense of what is even going to get across the border on a given day, much less how they’ll be allowed to operate?
Yes, in order to make that kind of system work, you need Israel to just basically say, O.K., go ahead. You work with these people. And of course it won’t be perfect, but that’s the basic modus operandi for working in this field.
And my understanding is that there’s limited contact between Israel and the U.N. That also makes this very difficult. Is that your understanding as well?
Yeah, and they keep expelling U.N. people from Israel in addition to not talking to them.
In the very short term, the phrase I keep reading is “flood the zone”—that you need to just send a ton of aid in because the situation is so bad. Meanwhile, the World Food Programme says that ninety-five per cent of its trucks are being looted. So what would flooding the zone mean in practice?
Here is an example from my own experience: In Mogadishu, Somalia, you had a complete breakdown of order and growing famine. There was a port, and the World Food Programme chartered a ship and it started unloading. Food prices were incredibly high, and there was a shortage of food and there were armed gangs. It got to the stage where Somali community groups had soup kitchens, but those needed armed guards because other armed men were coming to take soup meant for kids. Anyway, the warehouse with the W.F.P. food was looted. I remember men coming into the hospital with gunshot wounds and they were covered in flour.
But what flooding the zone did was bring down the price of food. Food had been so exorbitantly expensive. But this brought it down. There were criminal cartels, and this also broke their hold on the market. They decided to sell the food, thinking it would go down in value. And it meant that you could do the soup kitchens with more safety. So, let in trucks. Just park and let people come and get them. And as soon as you have enough food, you bring down the market price and break the cartels. And you allow the men with guns—including gangs and Hamas both—to get food so they won’t terrorize everyone else. It is partially a market solution and partially letting the strong feast to allow more for everyone else. But this will only solve the famine issue if you can get in with specialized care for those starving kids.
In the past, you have been a critic of aid groups and the way humanitarian organizations work. [De Waal has argued that international aid groups often ignored the political context behind humanitarian crises, and that their efforts could sometimes undermine what democratic accountability existed in the countries they were serving.] Do you have any of those critiques in Gaza?
I was a big critic back in the nineteen-nineties, but I became less critical over time. I think they have learned a lot. Their professionalism, their reach, and also the sensitivity to the political context and ethics have hugely improved. And they have been a big part of why I wrote, eight or nine years ago, that I thought we could solve this problem of famine. I then wrote last year that I was wrong. Now, I do have criticisms of the humanitarian groups in Gaza. I think they could have done quite a lot more to collect some of the precise data around child malnutrition that is needed to help with assessing exactly how bad it is and where more help is needed and so on. But my over-all verdict is that they’ve done pretty well.
I also want to say that one thing we know about starvation is that the people who starve last are the men with guns. In international law, you can starve a combatant. So if you have a garrison that is basically just combatants, you can try to starve them. But, if you have a population that is like Gaza and is ninety-five per cent or so civilian, you know that in order to starve the five per cent, basically, everyone else has to starve first.
If you look at the G.H.F., you see that in action. What you see is the healthy young men getting there first, getting the food and not just getting one box. They break open the boxes, they have sacks, and then the smaller young kids and women will come. That hierarchy is the law of the jungle. That’s what it is. And that’s one of the reasons why starvation of civilians is prohibited and why starvation of a predominantly civilian population is prohibited. The Geneva Conventions weren’t written by soft-headed humanitarians. They were negotiated by generals, and they recognized, O.K., if we allow starvation as a tactic, we’re just going to be starving civilians, not the guys doing the fighting.
This all leads to one of the most extraordinary points, which is that the G.H.F. was supposed to minimize Hamas looting. Who is eating or selling the food that they are distributing? They can’t tell. The U.N. has a pretty good idea of who was eating its food. The G.H.F. has not got a fucking clue.
Is there something that makes Gaza unique among all of the famines and conflict zones you’ve studied? And what is not unique?
Let’s start on the ways in which it’s either not unique or not as bad as others. The gross magnitude of numbers of people affected in Gaza is small compared to Sudan and other places. That’s simply because of the size of the population.
You’re talking about Sudan now or Sudan two decades ago?
Both. There are 2.1 million people in Gaza. The worst-case scenario of mortality would be around two million. Mao starved thirty-six million people. And then you have Stalin and Hitler. And the British Empire is up there, too. In terms of magnitude of deaths, Gaza, however horrible it is, is not going to be up there. In Sudan today, there are between eight and nine million people in a state of what’s called Phase 4 of a five-stage international classification system of food insecurity. And, basically, all of Gaza is in either Phase 4 or 5. We don’t know exactly how many people have died in Sudan, but I suspect the numbers are quite a lot higher than in Gaza.
In terms of the starvation of Gaza being a deliberate act, that is quite common. Netanyahu ranks with the likes of Sudan’s previous dictator, Omar al-Bashir, and Syria’s Bashar al-Assad in terms of the way that he’s used starvation as a weapon.
The way that Israel and Gaza is unique is that the system of control is extraordinarily tight and precise. So in the worst sieges in Syria, people could smuggle themselves in and out. Food could get in if you bribed the right people or knew where the tunnels were. The same is true in Sudan. In Gaza, that just isn’t possible. And the other feature that makes Gaza unique is that you have a capable international system that could respond basically at a moment’s notice. If Netanyahu wanted every child in Gaza to be fed tomorrow, he could just give that instruction and it would happen.
Whereas I assume that in Sudan, where you have two duelling generals who are wrecking the country, there’s not a single person, or even two people, who could decide tomorrow that every person would have food pretty quickly. Is that what you’re saying?
Yeah, if the two generals agreed, that would be fantastic, but a number of things would have to happen. There are a bunch of junior commanders who would need to be brought on side, and there are independent groups there. It’s a thousand-mile trek from the nearest port, and the aid apparatus is only about twenty-per-cent funded. So the U.N. and others are not, as it were, ready to go. It needs to happen, but it would take quite a lot of additional negotiation, quite a lot of meeting logistical challenges, all sorts of things before you could relieve the situation.
When I’ve talked to people who’ve worked in Gaza, it does seem, especially with people who work in international conflicts regularly, that there’s something about the sheer number of children who they see with lost limbs or other trauma that has made it feel different.
I think that’s true. The physical traumas to children are quite astonishing. And there are a bunch of data points where Gaza is off the charts. You see the number of aid workers killed, and it’s just totally off the charts. The number of health workers killed, the number of journalists killed. Israel is fighting this high-intensity war in a place with a very densely packed civilian population.
I interviewed a defender of the Israeli war recently who asked why the American media isn’t covering other conflicts more. I think there are all kinds of reasons why Americans should care about what’s happening in Gaza, where we have reports of American contractors on the ground shooting at Palestinians, and we have our tax dollars going to fund bombs that Israel is dropping there. But Sudan is a conflict that a close American ally, in this case the United Arab Emirates, is doing a lot to fund and exacerbate, and it has a death toll that seems like it’s probably bigger than Gaza. As someone who has a long association with Sudan, and who cares a lot about it, how do you think about this?
It’s a really good question. And it’s true: Sudan has been grossly neglected. One of the terrible things in Sudan, actually, is that the most effective aid mechanisms were these things called “emergency response rooms,” which are local neighborhood committees that coördinate aid. There are fourteen hundred of them. The problem is that, while they can deliver, they’re very bad at the paperwork. They can’t put together the project proposals, et cetera. U.S.A.I.D., to its credit, had actually figured out ways to help them manage that. But when U.S.A.I.D. was shut down virtually overnight, nine hundred of them no longer had enough money to carry on. That is a particularly egregious example of how the Trump Administration has been gratuitously cruel to the Sudanese.
When I was writing my mass-starvation book, one of the reasons I was quite optimistic that we could actually solve the starvation problem was that humanitarian norms for providing assistance and for outlawing starvation crimes seemed to be solid. They seemed to have been consolidated. And even in Trump’s first term, when Nikki Haley was the Ambassador to the U.N., she was a champion on this issue. She did have a little bit of a double standard. She went after Assad much more harshly than she went after the Emiratis and the Saudis for what they were doing in Yemen. But, nonetheless, she did actually put pressure on them. Hypocrisy may be the tribute vice pays to virtue, but it has an effect. And the big worry now is that the basic norm or value of respecting humanity and human life is just being shredded. And everyone, whether they’re Sudanese or Palestinian or Syrian, will suffer from that. ♦
