A surge in the flow of aid into the Gaza Strip since the truce between Israel and Hamas took effect on January 19 is likely to ease the acute food emergency afflicting people in the war-ravaged territory, especially its children. But even after relief reaches them, the hunger they have endured could cast a shadow over their health for years to come.
More than 60,000 children in Gaza will need treatment for acute malnutrition in 2025, according to United Nations estimates from January 22. Some have already died – estimates of how many vary widely. Survivors who are able to return to adequate levels of nutrition nonetheless face an insidious threat: the multiple long-term health problems linked to childhood malnutrition. This troubling prospect is of urgent global concern. As Reuters has reported in a series of articles, famine and other acute food crises have ravaged populations across the developing world over the past year, from Haiti to Afghanistan to Sudan and many other African nations, as well as Gaza.
About 131mn children, nearly 40mn of them under age 5, live in areas experiencing acute food crises around the world, according to estimates provided exclusively to Reuters by the United Nations’ World Food Programme. Nearly 4.7mn pregnant women live in these areas, the United Nations Population Fund said. The UN estimates are based on the most recent data from countries where assessments were possible.
The lasting damage of childhood hunger is wide-ranging and can be profound, according to scientists, nutrition experts and officials at humanitarian organisations. Children who experience severe malnutrition may never reach their full cognitive or physical potential, according to multiple studies that have tracked survivors of past food shortages. Other studies have shown that undernutrition in childhood, and even in the womb, can be associated with increased risk of cardiovascular disease, type 2 diabetes and other non-communicable illnesses later in life.
“People focus, quite rightly, on the short-term aspects of malnutrition,” said Marko Kerac, professor of nutrition for global health at the London School of Hygiene and Tropical Medicine. “What’s missed ... is that the damage done will not suddenly stop when the emergency stops.”
Studies have shown that some effects of severe hunger can be mitigated if a child later gains access to good nutrition. But that is a big if. In many countries where food crises occur, poverty, war and civil strife persist long after the crisis has passed, limiting children’s access to adequate food and healthcare.
That makes it hard to get exact data on how many are affected in both the short and long-term, said Hannah Stephenson, head of nutrition with Save the Children. But “the more severely malnourished a child is, the harder it will be to recover,” she said. The duration of malnourishment is also a crucial variable, she said.
She and other experts stressed that while every malnourished child is a tragedy, famines and other food crises can do lasting harm to society as whole by leaving an entire generation with physical and cognitive deficits. “It costs the person, the family, the country,” said Professor Mubarek Abera, a child and maternal nutrition and mental health researcher at Jimma University in Ethiopia who was born during that country’s famine in the early 1980s.
In a food crisis, children are more vulnerable than adults to malnourishment and death from starvation or infectious diseases, which are more lethal to those weakened by hunger. Children are also more vulnerable than adults to long-term health problems from a period of extreme malnourishment, scientists said, because their bodies and brains are still developing.
There are four different kinds of undernutrition, as defined by the World Health Organisation. All can be present during a famine or other severe food crisis, leave lasting marks, and can also co-exist in one child:
WastingThis occurs when a child’s weight is low for their height and often indicates a recent episode of intense hunger and weight loss. It is a medical emergency, but 90% of children can recover in the short-term if they get treatment, which involves therapeutic foods, antibiotics and deworming. In 2023, the UN children’s agency Unicef estimated that 73% of children in the most urgent need received treatment.
StuntingThis is when a child’s height is low for their age, and it is usually seen as a broad indicator of chronic undernourishment, putting a child at risk of not reaching full physical or cognitive potential. Nutritionists are divided over the extent to which children can recover from stunting if they later receive adequate nutrition. Many believe the effects are irreversible, particularly for those who experience deficiencies for a long time during their development.
UnderweightA child is underweight when their weight is low for their age. An underweight child can be stunted or wasted or both.
Micronutrient deficiencies Sometimes described by WHO as “hidden hunger,” this form of undernutrition occurs when vitamins, minerals and other essential nutrients essential to healthy growth are missing from a child’s diet. They can occur on their own or as part of stunting and wasting. Key micronutrient deficiencies include iodine, vitamin A and iron. A lack of dietary iodine is the leading cause of brain damage in childhood globally. Vitamin A deficiency can cause blindness. Iron deficiency also impacts brain development, the UN health agency says. The damage can be irreversible if the child cannot quickly access the needed nutrients.
Many variables can affect how a child’s body copes with an extreme lack of food. A child who is already suffering with chronic malnutrition, or has a disability, is often more vulnerable to both the short-term and long-term impacts of a food crisis, said Amir Kirolos, a doctor with Britain’s National Health Service who worked on a study in Malawi led by the University of Liverpool/Malawi-Liverpool Wellcome Trust.
In their study, Kirolos and his fellow researchers followed up on a group of 1,024 children in Blantyre, Malawi, one, seven and 15 years after they were treated in hospital for acute malnutrition between July 2006 and March 2007. Many of them had underlying conditions that made them more vulnerable to malnutrition.
After one year, the team could confirm the survival of only 462, or 45%, of the children. A few of them had left the area or were untraceable, but 427 of them had died during treatment or shortly after. Mortality was greatest among the youngest and those who were the most malnourished when they came for treatment, as well as those with HIV or a disability.
By 2021, 15 years after the initial hospitalisation, only 168 of the original cohort were alive and traceable. In effect, they represented the very healthiest of those originally treated, but as adolescents, they still bore evidence of malnutrition. They were shorter compared to their siblings or adolescents in the community, and they had some signs of weaker grip strength, an indicator of reduced overall muscle strength. The gaps were smaller than they had been seven years after treatment, showing that some recovery and catch-up is possible, Kirolos said.
A growing body of research has shown that babies born to women who were pregnant during a hunger crisis are also at risk of long-term damage. In a study published in Science magazine last August, scientists focused on the 1932-33 Ukraine famine engineered by the Soviet government of Joseph Stalin. That man-made disaster killed about 4mn people. And as the researchers found, it also had lingering health effects on the survivors, particularly among those who were exposed in utero.
The researchers cross-referenced the birth records of 10mn Ukrainians born before, during and after the famine with diabetes diagnoses from a national registry seven decades later. They found that exposure to famine in early gestation increased the risk of type 2 diabetes two-fold.
“I’m now finally satisfied that there’s something going on,” said Bertie Lumey, lead author of the study and a professor of epidemiology at Columbia University Medical Center in New York.
Studies of the Great Chinese Famine of 1958-62 and the Dutch Hunger Winter at the end of World War Two have yielded similar findings. Researchers have also shown that malnourishment in the womb resulted in higher rates of obesity and schizophrenia later in life. In a systematic review of dozens of studies, researchers found a strong association between exposure to severe malnutrition in childhood and a higher risk of some non-communicable diseases, including diabetes and cardiovascular disease, later in life. — Reuters
