In the dusty scrubland of the Gaza Strip, children hunt for eggplant in abandoned fields.

Many have gone days without food. Others have eaten nothing more than half a piece of pita bread or a can of beans, shared with several members of their family.

On the days when the aid trucks roll into the sprawling camps that have formed in southern Gaza, the same children can be seen jostling within crowds – buckets and pans in hand, pleading for food.

“We get one meal a day, it’s normally half a piece of pita bread,” says 13-year-old Ahmad as he waits for food in Rafah, alongside hundreds of others. “There are no ingredients to help us live our lives. We just want to live. My relatives are dying before my eyes.”

This is the new reality of life in Gaza, where crippling food insecurity is pushing hundreds of thousands into malnutrition. Many fear the territory is on the brink of famine, the consequences of which could kill more people than bombs.

The UN has estimated that the entire 2.3 million Gazan population is now contending with ‘food insecurity,’ defined as unreliable access to sufficient and nutritious food to meet basic needs.

Of those, at least half a million are estimated to be facing ‘catastrophic conditions’ – the highest classified level of acute food insecurity – in which people experience “extreme food gaps and collapse of their livelihood”.

Humanitarian workers on the ground in Gaza say that many are regularly going up to three days without eating.

Naouar Labidi, a senior officer at the World Food Programme (WFP), stressed the “unique” nature of the food security crisis. “The fact that this is affecting the total population is unprecedented,” she said.

“Even during the conflicts in Yemen and Somalia, we were never in a situation where 100 percent of the population was food insecure. For us, 40 to 60 percent is significant – this is incredibly unique.”

Toddlers and babies are most at risk as they are especially dependent on food and nutrition to fuel their nascent physical and mental development.

Research suggests that without a sufficient energy supply in the first 1,000 days of life, the growth of a child can be impaired, causing irreversible physical and cognitive damage known as ‘stunting’.

With more than 135,000 children under two in the Strip, experts fear an entire generation is now at risk of the condition.

“If a child is malnourished, particularly under two years of age, they are unable to cognitively catch up with other [children]. The brain is such a big part of caloric and nutrient consumption in a child’s development,” said Anuradha Narayan, a senior nutrition adviser at Unicef.

The functional consequences of stunting can haunt a child throughout their life, hindering educational performance, heightening vulnerability to nutrition-related chronic diseases in adult life, and reducing productivity in the workplace.

“What each child has experienced today, in terms of hunger and malnutrition, is going to last a lifetime,” said Narayan.

Stunting can arise in babies and toddlers in a matter of months, if proper nutrition is not provided, and the WFP has warned that malnutrition rates “have changed dramatically in terms of magnitude, speed, and intensity” since the beginning of the war.

Dr Nasser Bulbul, head of the Neonatal Intensive Care Unit at Shifa Hospital, but currently based at the European Gaza Hospital, said that hospital cases of severe child malnutrition were increasing “every day”.

“There is no nutritious food for them,” he said. “Poor children – they are turning into skeletons.”

The conflict has damaged or destroyed essential water, sanitation and health systems in the Gaza Strip, hindering the ability to treat severe malnutrition, while access to infant formula has been extremely difficult due to restrictions on aid flow.

Children under six months of age face the highest risk of death if malnourished, and prenatal babies can even be affected in the womb if their mothers are not eating enough food.

These groups should be a priority in the humanitarian response, yet, according to the UN, food delivery programmes in Gaza will only meet 25 percent of the nutritional needs for malnourished children and vulnerable mothers in the next two months, leaving 375,000 individuals vulnerable.

Malnourished children are also more susceptible to disease, as nutritional deficiency exhausts the immune system.

Tess Ingram, a Unicef spokesperson, said that she was “incredibly worried” about the “lethal combination” of malnutrition and disease.

“There’s a deadly cycle that occurs. If a child is [both] sick and malnourished, they become more prone to disease and the likelihood of that child dying is so much higher than if they had just one of those challenges,” she explained.

There have been nearly 419,000 reported cases of infectious disease in the Gaza Strip from mid-October to 29 December, according to the World Health Organisation.

Cases of diarrhoea in children under five rose from 48,000 to 71,000 in just one week, starting 17 December. Globally, diarrhoeal disease is the second biggest killer of this age group, and severely impacts a child’s ability to absorb nutrients, perpetuating the cycle.

Ingram said she has been increasingly receiving reports from her colleagues in Gaza of children appearing “visibly thin” with “obvious signs of disease”.

The origins of the unfolding humanitarian crisis stretch back to before October 7, when nearly two-thirds of Gazan households were already food insecure and 124,500 young children were in food poverty.

The population’s unemployment rate of 45 percent was one of the highest in the world, with 80 percent of the territory’s population dependent on international aid, according to a report by the UN Conference on Trade and Development.

Having teetered on the brink of catastrophe for years, the Israeli invasion pushed Gaza over the edge.

“We were already starting from a very low base and, of course, the war has severely compounded that situation,” said Tom White, director of the United Nations Relief Works Agency for Palestinian Refugees (UNRWA) in Gaza.

“It’s important that the current crisis is seen as part of the continuum of an Israeli policy to restrict access. It isn’t like we’ve flipped a switch for these issues of dietary requirement, starvation, famine. This is an accumulated problem.”

The aid blackout – which ran between October 7 and 21 – has proved especially ruinous. During this period, not a single truck of aid, many of them carrying food supplies and medical aid, entered Gaza.

Juliette Touma, director of communications at UNRWA, the largest aid organisation in the Strip, said the consequences were still being felt.

“There was a hermetic siege on the Gaza Strip which led to a backlog of 5,000 trucks in those first two weeks that has never been replenished,” she added. “This siege is a silent killer of people.”

The flow of aid into the territory has slowly increased – 177 trucks entered Gaza last Thursday, up from 100 a day at the start of November – but it remains a trickle of what it was before the beginning of the war, when roughly 500 trucks were granted access on a daily basis.

However, trucks that are given permission to enter will sometimes arrive at night, “when it’s very difficult for our colleagues to go to the borders in a sky full of airstrikes and then deliver the humanitarian assistance under fire,” added Touma.

Because of the limited deliveries, UNRWA workers are often forced to restrict their food distribution to one can of tuna and one bottle of water per family, as they “simply don’t have enough,” she said.

The high levels of food insecurity have started to take their toll. Despair and hysteria is beginning to take root.

“In some places, you can’t even get the aid convoy through that part of town before the vehicles are looted,” said White.

He described one recent raid in which hundreds, if not thousands, of people descended on a convoy in a frenzy. Young boys scaled the trucks and frantically scrambled for bags of flour, as high energy biscuits were thrown into the crowds.

“People are that short of food, that they’re taking matters into their own hands,” said White.

“As we’re driving around, all the kids are increasingly gesturing with a hand gesture to the mouth indicating that they want food,” he added. “It used to be that they wanted water. Now they’re hungry.”

Amid the ongoing Israeli offensive, which makes delivering aid to certain areas of Gaza near impossible, humanitarian organisations are doing what they can to support the population’s needy.

The WFP is providing food from community-led kitchens every day; in December, an estimated 80,000 people received hot meals in 47 locations across Gaza.

UNRWA’s flour distribution operation had meanwhile reached more than 1 million people, including 75,000 families outside shelters, by December 10.

High nutrition supplements are being handed out to breastfeeding women and children in shelters in Rafah, with therapeutic milk supplies provided to acutely malnourished children.

Yet such provisions are simply not enough. Despite the best efforts of the humanitarian community, daily food assistance in the last week of December reached only eight percent of the targeted people in need.

“We’re not sitting on our hands, but at the same time, we’re just not meeting the demand,” said White.

As the crisis intensifies, with no immediate end to the fighting in sight, the spectre of famine is now beginning to loom large over Gaza. The UN says that 40 percent of its population is currently “at risk”.

Yet famine is a highly technical specification that experts are hesitant to declare.

It occurs when an area has at least 20 percent of households facing an extreme lack of food, at least 30 percent of children suffering from acute malnutrition, and two people – or four children – for every 10,000 dying each day due to outright starvation or the interaction of malnutrition and disease.

There have only been two instances of famine in the last decade: in Somalia in 2011 and South Sudan in 2017.

Labidi, however, thinks it’s only a matter of time before famine is officially declared in Gaza.

“According to the analysis, the risk of famine increases each day as the current conflict continues and restricted humanitarian access persists.”

If famine does come to pass, it won’t just be the children of Gaza who pay the price, but every living soul in the territory.

Protect yourself and your family by learning more about Global Health Security