Intended for healthcare professionals


Israel is using starvation as a weapon of war in Gaza

BMJ 2024; 385 doi: (Published 07 May 2024) Cite this as: BMJ 2024;385:q1018
  1. Sameer Sah, director of programmes1,
  2. Khaled Dawas, consultant surgeon and honorary associate professor2
  1. 1Medical Aid for Palestinians
  2. 2University College London Hospitals

200 days into Israel’s military bombardment and siege of Gaza, we are witnessing the onset of a man made and entirely preventable famine, say Sameer Sah and Khaled Dawas

In December 2023, we led Medical Aid for Palestinians’ ( and the International Rescue Committee’s first emergency medical team in Gaza. On that trip, three months into Israel’s bombardment and siege, we saw the disturbing and shocking conditions that Palestinians were forced to live in.

We have seen the warning signs of the current hunger crisis for months. In December 2023, the Integrated Food Security Phase Classification warned that famine would occur if Israel’s assault on Gaza continued.1 In January 2024, doctors volunteering for Medical Aid for Palestinians in Gaza reported seeing signs of serious malnutrition in both children and adults.2 Then in February, the World Health Organization warned that the decline in the nutrition status of the population in Gaza was unprecedented3—people were being starved at the fastest rate the world had ever seen. But still, the international community did nothing to avert this entirely foreseeable catastrophe.

Since then, the situation has become worse. In late March the International Court of Justice observed that, “Palestinians in Gaza are no longer facing a risk of famine, but that famine is setting in.”4 At Medical Aid for Palestinians, we have seen this happening and have repeatedly warned of the devastating harm that malnutrition and hunger has on civilians, especially among newborns and children under 5, in whom it can lead to development delays and long term adverse health outcomes.2

Approximately 1.1 million people, around half the total population, are currently facing catastrophic food insecurity in Gaza.5 One in three children under 2 years of age in the north are now acutely malnourished, affecting their immune systems and making them more likely to die from infectious diseases.6 Parents are witnessing their children die of starvation7 or are forced to live off animal feed to try and survive.89 None of this is inevitable, mass starvation is entirely preventable. This is not happening because of a natural drought or crop failure, but the deliberate withholding of food and aid by the Israeli government. This is exacerbated by the fact that nearly 50% of tree cover and farmland has been destroyed, and the heavy bombing and demolitions will contaminate the soil and ground water, making it difficult for the agriculture sector to recover in the future.10

Aid trucks destined for Gaza are still being prevented from entering, with hundreds of trucks queuing at the Rafah border crossing and facing arbitrary security checks. Although there is a severe lack of access to food in southern Gaza, the situation in northern Gaza is much worse. From 5 February to 5 March 2024, only 10-15 food trucks were allowed into northern Gaza to feed more than 300 000 people.11 The supplies averaged less than one kilogram of food per person for a full month, a fraction of what is needed for survival. There is not enough aid getting in. Proposals such as airdrops and extra ports are not realistic or lasting solutions and cannot provide the volumes of assistance that can be transported by land.

We are also seeing Palestinian people being attacked by Israeli forces when trying to get food for their families.12 The same goes for medical and aid workers who have found themselves at risk of indiscriminate, and sometimes even targeted,13 Israeli military aggression. Every day, our team in Gaza and other aid and medical workers are risking their lives to provide vital support to those in need. Our own emergency medical team of doctors was the target of an airstrike in January,14 and staff of the World Central Kitchen were killed by an Israeli air strike on 1 April 2024, despite coordinating their movements with the Israeli military.15

Destruction of hospitals like al-Shifa, the restriction of medical supplies, the detainment and killing of medical staff,16 and the restriction of essential services such as water and sanitation by Israel are destroying the healthcare system in Gaza. This diminishes the healthcare system’s ability to treat patients who are malnourished and means that other patients being treated for injuries and disease are also at risk of malnutrition.

World leaders and the medical community must demand an immediate and permanent ceasefire and take action to protect civilian life and infrastructure—including healthcare facilities—from attack. The international community must uphold its responsibility to protect Palestinian people from further harm,17 and pressure Israel to end its total siege on Gaza, so that food, water, fuel, electricity, and medical and shelter supplies can enter and be safely distributed to people who need them.


  • Provenance and peer review: Commissioned; not externally peer reviewed.

  • Competing interests: SS has previously served as a member of the First WHO Global Civil Society Task Force on TB and is currently a member of the WHO Regional Coordinating Committee on TB, HIV, and Viral Hepatitis at WHO Europe in Copenhagen. KD chairs the board of the medical education charity, Al Quds Foundation for Medical Schools in Palestine. He has been to Gaza twice with emergency medical teams with Medical Aid for Palestinians and the International Rescue Committee since December 2023.