Just Security: Gaza’s Famine is Underway 

This piece was originally published by Just Security.

Three months ago the Integrated Food Security Phase Classification (IPC) process (the official process for assessing famine risk) issued an urgent warning: the entire population of Gaza was “at risk” of famine, and over half a million people were already experiencing famine-level food shortages. Last week, the IPC upgraded that warning, projecting that famine in Gaza is now “imminent.” 1.1 million people, half the territory’s population, are in IPC Phase V, the highest level of risk. Yet the IPC process stopped short of declaring an active famine.

So is famine in Gaza looming? Imminent? Or already happening? Here is a quick rundown on how to understand the new projections.

Bottom line up front: available evidence strongly indicates that famine is getting underway in Gaza. The window to “avert” it has closed, and the focus must now pivot to containing the damage. As prospects for an enduring cease-fire remain pessimistic, tens of thousands of lives, perhaps more, hang in the balance. 

How are Hunger Crises Measured?

Humanitarian language around famine tends to be cautious and highly technical – and sometimes difficult for people outside the field to decipher. Humanitarian professionals use a 5-phase scale to characterize the severity of food crises, similar to better-known systems like the hurricane early warning system. And like the hurricane warning scale, the famine warning system produces highly rigorous forecasts built on decades of experience and research.

A formal declaration of famine (typically made either by the affected country’s government or by the United Nations) hinges on reaching Phase V on the 5-phase IPC scale, specifically once a crisis has breached three quantitative thresholds. Breaching one or two of these thresholds is enough to characterize a population as Phase V, but a formal declaration typically requires evidence that all have been surpassed:

• Hunger: At least one in five households facing an extreme lack of food, meaning that their daily consumption consistently falls far below minimum daily nutritional requirements.
• Malnutrition: At least 30% of children under 5 are suffering from acute malnutrition.
• Death: At least 2 people per 10,000 population are dying per day from starvation or related health problems.

In humanitarian circles the December warning from the IPC was the equivalent of projecting that a Category V hurricane is headed for the Florida coast. But outside of humanitarian circles it had far less impact. The warning prompted no fundamental change of direction from the U.S. or Israeli governments, and received limited media coverage. The devastating Israeli military offensive continued apace, and the volumes of aid allowed into Gaza actually declined from mid-January through February. 

This lack of reaction reflects a major drawback of the IPC system: it makes the data threshold for a formal famine declaration so rigorous that famines tend to be declared only retroactively, after extensively vetted analysis. And up to that point the language remains heavily caveated, sometimes diluting the ensuing public and diplomatic reaction. 

This is somewhat by design – famine is a powerful word, and there is an understandable impetus to ensure it is not thrown around loosely. But this conservatism ultimately undermines the usefulness of the IPC scale by making it too slow to confirm when famines are getting underway. By the time a famine is officially recognized, it has inevitably been underway for quite a while already and is already killing many people – a fact that is not widely appreciated by global political leaders. In the case of Somalia’s famine in 2011, for example, half of the mortality is estimated to have occurred before the formal declaration was made.

Which brings us to Gaza’s situation today – still short of a formal (retroactive) declaration, but with conditions worsening rapidly and mortality beginning to accelerate.

Deciphering Gaza’s Catastrophe

Notwithstanding the hedged technical language of the official IPC forecast, Gaza’s famine is no longer “imminent.” Its impact is now being felt. If the December IPC forecast was telling us that the hurricane was 50 miles offshore and barreling towards the Florida coast, the new IPC forecast is telling us that its outer bands are making landfall as a Cat V.

The window to “avert” Gaza’s famine has now closed. The priority now must be to stem the damage. The actions by the U.S. and Israeli governments in the coming weeks will determine whether the famine kills thousands, tens of thousands, or potentially more.

While the official analytical process will take time to catch up, the signs are clear. The IPC report itself indicates that two of the three famine thresholds have already been met. Food deprivation had already surpassed famine-like conditions in the IPC’s earlier warning in December, and has now reached catastrophic levels throughout the territory. Malnutrition is exploding, with rates of acute malnutrition doubling since January. Famine thresholds for malnutrition appear to have been breached in the north of Gaza and are being rapidly approached elsewhere.

And, terrifyingly, this sustained deprivation and spiraling malnutrition is now beginning its inevitable transition into growing mortality. In recent weeks, pictures have begun emerging of children with skeletal frames and sunken faces – telltale signs of severe wasting malnutrition. Humanitarian professionals have powerful tools for saving children from this kind of advanced malnutrition, as Refugees International has outlined elsewhere. But Gaza’s health system is shattered by unrelenting Israeli assaults, and Israeli government obstruction of aid groups makes it nearly impossible to scale up on-site therapeutic malnutrition treatment operations in the places that most need them.

Many of these children are now dying in under-supplied hospitals for want of adequate treatment. More are likely dying in the communities. Far, far more will begin dying in the weeks ahead, as the widening starvation takes hold.

Where Do Things Go From Here?

The only question at this point is how bad it might get. Famine expert Alex de Waal has written that Gaza’s famine is on track to be the most intense since World War II. Famines develop a momentum of their own as deprivation deepens, and the longer they go without definitive humanitarian intervention, the longer and more devastating they become. Accurate forecasts of deaths are difficult, but comparisons to Somalia in 2011 yield some frightening indications of how this might play out. 

The first concern is Gaza’s trajectory. The run-up to Somalia’s 2011 famine occurred slowly and steadily over the course of more than a year, intensifying as several successive rainy seasons failed. Somalia’s population had a high baseline level of hunger and malnutrition even before the famine took hold, making it comparatively easier to reach the famine thresholds. Gaza, by contrast, had much more modest food insecurity and limited malnutrition prior to the Israeli military operation. For a generally healthy and nutritionally stable population to reach famine thresholds in under six months suggests a historically unprecedented rate of deterioration; a descent that is now only gathering speed.

The second worrying comparison is the potential duration. In Somalia, the famine was declared in July 2011 and then persisted above famine thresholds for six months, despite a huge upsurge in relief operations. It was finally downgraded to a mere “humanitarian emergency” in February 2012. The longer Gaza goes without a full-scale famine relief operation – which in turn hinges on securing a lasting cease-fire simply because sufficient aid operations are not possible without one – the longer it will take to bring the crisis back under control.

The last concern is the relative scale of need. Around the peak of Somalia’s famine in September 2011, when its geographic spread was greatest, 750,000 people were estimated to be experiencing famine-level conditions (IPC Phase V). Another 1.85 million were in pre-famine “Emergency” conditions (IPC Phase IV). Both phases produce high mortality. In Gaza today, more people – 1.1 million – are assessed to be in IPC V despite a population almost six times smaller than Somalia’s. Another 854,000 people are assessed to be in IPC IV. This represents nearly the entirety of Gaza’s population. Such pervasive famine- and pre-famine- level deprivation across an entire population has no precedent in recent decades.

Somalia’s 2011 famine ultimately killed nearly 260,000 human beings. Gaza’s death toll will be smaller, given its smaller population. But it could well reach the tens of thousands if there is not a major change in the famine trajectory: Gaza today has more people in Phase V than Somalia had at the peak of its famine. 

If a cease-fire cannot be secured, or if it amounts to only a temporary truce followed by a resumption in bombardment, the basic course of the famine will persist unchanged. In that kind of scenario, it would not be long before mortality trends begin to breach IPC V and IPC IV thresholds in much of the territory (2 deaths/10,000 people/day and 1 per 10,000/day, respectively). With 1.1 million Gazans in IPC V and 854,000 in IPC IV, a six-month famine could easily generate mortality in the mid-five-figures. 

And there are also scenarios that could drive such a figure higher. A major outbreak of cholera or other deadly communicable disease would worsen the mortality outlook. Cholera is currently surging in many other countries but has not yet been detected in Gaza. But if it emerges, it will find ideal conditions there for explosive spread. And if the Israeli government proceeds with its planned offensive in Rafah, it would re-displace millions of already deeply vulnerable people and completely disrupt what remains of the humanitarian presence in Gaza (as the U.S. government acknowledges). 

The question now facing the American and Israeli governments is what they will do to mitigate the most catastrophic outcomes. The current trendlines are grim beyond description. Nothing resembling an adequate humanitarian response to this crisis is possible as long as this war persists. Humanitarians are desperate to mount a massive response and save as many lives as possible – they have the expertise and capacity to do so. But they cannot act until the politicians halt the fighting.