By Hend Salama Abo Helow
This text was initially printed by Truthout
A sudden inflow of vitamins after famine could cause spikes in blood glucose and deadly electrolyte imbalances.
Loss of life in Gaza isn’t restricted solely to drones, gunfire, artillery shelling, infectious ailments, or the grinding famine. It might come, too, from the very act of consuming, after a chronic interval of hunger. Malnutrition has already claimed a whole lot of lives, but in Gaza, even meals can kill.
Since October’s ceasefire, which meant Israel would permit some — however not practically sufficient — help vehicles to enter our besieged Strip, individuals in Gaza have desperately been consuming, each time potential, what they’d been disadvantaged of beforehand. But, consequently, many have developed “refeeding syndrome,” which is a critical medical situation. It’s treatable, however it’s deadly if not correctly managed. Refeeding syndrome happens when meals is out of the blue reintroduced after a chronic interval of hunger — and Israel has subjected these of us in Gaza to such intervals on a number of events.
Israel tightened the noose of its blockade on Gaza in March of 2025, after breaking a ceasefire that had gone into impact in January. Beneath the brand new blockade, Israel prevented help vehicles from getting into with meals provides and pressing medical gear, pushing already exhausted civilians to the brink of whole collapse. As time handed, the indicators of famine spoke louder than any rhetoric trying to debunk it as an “orchestrated lie.” Our bodies started to close down. Organs failed. Weights have been slashed by half, if no more.
As flour and different carbohydrate-containing meals depleted, individuals’s our bodies started consuming themselves — utilizing saved fats and proteins, which has led to profound muscle loss, respiratory misery, and immune suppression. This was not an remoted plight. It was a humanitarian disaster, with its parameters widening daily.
The disaster grew extreme sufficient to power the Built-in Meals Safety Part Classification, the world’s prime famine authority, to reassess the manufactured “established order,” concluding that almost all of Gaza’s inhabitants had reached section 4 malnutrition and will probably enter the ultimate section by September 2025. The warning known as for instant, tangible intervention to halt the irreversible penalties.
Every day entry of not less than 600 meals vehicles and unrestricted entry for medical provides and gear have been among the many measures debated throughout U.S.-brokered ceasefire negotiations, and reportedly accepted within the deal in October. But, within the months following the ceasefire, a mean of not more than 200 vehicles have been allowed to enter per day. That is nowhere close to sufficient for a inhabitants that has been systematically starved for months.
The permitted vehicles carry secondary merchandise equivalent to comfortable drinks, on the spot noodles, chocolate bars, cigarettes, and low, lots of that are listed on international Boycott, Divestment, and Sanctions (BDS) Motion lists as a result of their corporations explicitly help funding genocide and sending weapons to Israel. This isn’t incidental, however moderately an intentional strategy from Israel to make up for the financial losses which have resulted from the worldwide BDS motion, by depriving a famished inhabitants of requirements — ample sources of proteins, carbohydrates, and fat. Flooding markets with snacks as an alternative of grains, eggs, fruits, and greens shouldn’t be an oversight; it’s one other type of systemic annihilation.
Individuals who had been intentionally starved for thus lengthy couldn’t, within the instant aftermath of the delicate truce, distinguish what was wholesome and the best way to appropriately reintroduce it. They ran out to markets, in concern of any sudden escalation and one other bout of deprivation, filling their baskets with no matter was edible. The random, uncoordinated reintroduction of meals into already fragile our bodies — typically extra dangerous than nourishing — can result in quite a few extreme well being issues. It could additionally lead to fast, unhealthy weight acquire over a brief span of time, which, in flip, might create the phantasm that hunger not exists in Gaza — permitting the world to show its again with a fleeting sense of conscience.
However not often does worldwide media look past the seeming abundance of meals, or towards the hazards it might impose. When the physique has fasted for thus lengthy, its metabolic adaptation shifts: Intracellular electrolytes grow to be profoundly depleted, and the physique turns to gluconeogenesis — producing urgently wanted glucose from non-carbohydrate sources. As soon as refeeding begins, the sudden inflow of vitamins causes a pointy rise in blood glucose ranges. In response, the physique will increase insulin secretion as a countermeasure. This insulin surge drives phosphorus, potassium, and magnesium quickly into the cells, leading to hypophosphatemia (decreased phosphate ranges within the blood), hypokalemia (decreased potassium ranges within the blood), and hypomagnesemia (decreased magnesium ranges within the blood).
These electrolyte shifts affect the physique severely. Hypokalemia and hypophosphatemia could result in cardiac arrhythmias — irregular coronary heart charges — in addition to weak point, profound fatigue, hypotension, renal failure, pulmonary edema, and respiratory misery, which may be deadly. Hypomagnesemia, in flip, could lead to shedding physique equilibrium, convulsions, and despair. As well as, thiamine deficiency is deeply linked to refeeding syndrome, contributing to temper disturbances, cardiac dysfunction, reminiscence impairment, and ophthalmoplegia (paralysis of eye actions).
I spoke with Shaimaa Bashir, a medical nutritionist working with one of many NGOs within the subject, about refeeding syndrome and its potential development in Gaza. She mentioned that, lately, “The indicators have been clearly showing amongst kids over the age of 5.”
“Most emergency dietary interventions throughout hunger targeted primarily on kids underneath 5, by offering supplementary and therapeutic meals, after which inserting them on weight loss program plans as soon as meals began to stream,” she mentioned. “This may increasingly, in a technique or one other, expose the kids older than 5 to be at larger threat of falling into refeeding syndrome, in comparison with lower than 5.”
Amongst 17 circumstances admitted to the Stabilization Heart (a specialised unit run by the NGO that Bashir works with that’s designed to deal with unstable malnourished sufferers), “5 introduced with edema and tachycardia,” she added. “Throughout weight loss program planning, we concentrate on stopping the affected person from falling into refeeding syndrome upfront, and we scale back the quantity of meals delivered if we suspect the kid’s situation could deteriorate towards it.”
She paused, then shared one in every of her sufferers’ situations: “A baby with extreme acute malnutrition, and one other well being complication, introduced within the ICU. He couldn’t tolerate oral feeding, so we launched vitamin parenterally by TPN [an intravenous feeding method known as Total Parenteral Nutrition] and progressively elevated the quantity. However as soon as we felt the situation was progressing towards refeeding syndrome, we stopped that plan and decreased the consumption instantly.”
Shaimaa emphasised the significance of elevating consciousness amongst individuals on the best way to navigate vitamin safely and stave off refeeding syndrome. She added, “However we aren’t solely witnessing rising issues a few refeeding syndrome outbreak; we’re additionally reporting each day on breaking excessive numbers of sufferers with celiac illness and malabsorption. That is nothing corresponding to what we noticed earlier than the genocide.”
Hadeel Awad, a nurse working at Al-Shifa Medical Complicated, mentioned bluntly, “Lots of the circumstances admitted to the hospital — most of them underneath the age of 20 — current with paralytic ileus and extreme belly ache.” This was linked to “the sudden drop in costs and the flooding of markets with merchandise, which pushed individuals to purchase giant, uncoordinated portions with out checking expiration dates.”
“These starved individuals have lengthy been disadvantaged of primary vitamins like eggs and meat,” Awad went on, declaring that their new weight loss program consisted largely of newly imported snack meals. She paused, then added: “We began recording an unprecedented variety of new circumstances of diabetes mellitus.”
She continued: “I bear in mind vividly how catastrophic the situations have been throughout the famine. It didn’t spare us — the healers who’re alleged to ship care.”
“Many individuals have been surviving nearly solely on canned meals, loaded with preservatives, which is able to go away a grave affect on their well being,” she mentioned. “There’s a dietary hole between the deadly famine and the continued irregular abundance, which paved the way in which for refeeding syndrome.”
The American Society for Parenteral and Enteral Vitamin (ASPEN) has established tips that docs can use to assist sufferers fastidiously preserve energy, replenish their electrolytes, and guarantee fixed monitoring of significant indicators. But, in Gaza’s ill-equipped well being care system, making use of such measures turns into practically inconceivable, as they’re layered onto myriad different unaddressed medical crises.
I actually, a genocide survivor and medical scholar, am not immune from the rising rise of well being crises. These should not incidental outcomes; they’re structural penalties of two years of ruthless carnage, the inhalation of poisonous residues, phosphorus bombs, air pollution, and famine. The struggle could have resulted in headlines and behind closed negotiations rooms, but many wars are nonetheless unfolding. Our our bodies’ homeostasis has been disrupted.
Again in January, after I first bit right into a Snickers chocolate bar after greater than a 12 months and a half of deprivation, I developed an allergic response and haven’t tasted it since. Weeks in the past, after I reintroduced milk into my weight loss program after an extended scarcity, I developed one other allergy. It appears my physique’s personal surroundings has been profoundly altered over the previous two years. None of us will really survive this unscathed.
My 3-year-old nephew, Jawad, who was only some months outdated when the genocide started, by no means had the prospect to know what regular life regarded like, nor what nutritious meals tasted like. When his mother and father introduced fruits dwelling shortly after markets have been flooded once more, he threw the apple away, considering it was a “ball,” and was too afraid to the touch the banana.
Israeli propaganda has maimed total generations, inflicting life-long ailments on each the aged and the younger. For youngsters, it has reshaped the mindset itself — forcing them to consider that the rattling of drones is chicken’s chirping, that hunger is a life-style, and that struggling is the norm.
Though the hunger insurance policies, and the continued denial of nutritious meals, perpetrated by Israeli forces have inflicted devastating results at this time, these ways have been first employed way back. Within the aftermath of the 2008-2009 struggle, Israeli forces used a “calorie rely” coverage, geared toward minimizing the quantity of meals getting into Gaza with out permitting the inhabitants to starve to loss of life outright. It was by no means meant to maintain life. It was meant to hurt, to erase, to kill, to torture, and to dehumanize Palestinians.
These death-making insurance policies didn’t start on October 7, 2023. They’re the continuation of a long time of racial colonial occupation.
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