The Hunger Crisis In Gaza And Beyond

0:07A worst-case famine scenario is unfolding across the Gaza Strip. That's the latest finding from the Integrated Food Security Phase Classification, or IPC. The U.N.-affiliated organization tracks food security worldwide. Still, it stops short of a formal declaration of famine in the region. Israeli Prime Minister Benjamin Netanyahu and President Trump have splintered on the issue of starvation. There is no policy of starvation in Gaza, and there is no starvation in Gaza. Some of those kids are, that's real starvation stuff. I see it. And you can't fake that. Elsewhere in the world, most of Haiti's population is experiencing critical levels of food insecurity.

0:51That's when people don't have access to enough safe and nutritious food for normal growth and development. And in Sudan, famine grips tens of millions of people. The starvation in Gaza is reawakening global attention to hunger crises unfolding around the world. Today, we examine how humanitarian aid factors into the equation. After the break, we start our conversation with someone who's witnessed the effects of Israel's mass starvation of Gaza up close. Mark Brawner is an American emergency physician. He volunteered at a hospital in the Gaza Strip for two weeks in June. He joins us from Eugene, Oregon, and tells us about his experience.

1:28I'm Jen White. You're listening to the 1A Podcast. Stay with us. We've got a lot to get to.

1:38Mark, thanks for joining us. Thanks for having me, Jen. And we should note this conversation will include potentially graphic details about the effects of starvation. Now, you and several other doctors volunteered at Nasser Hospital in Kanunis. That's in the southern part of the Gaza Strip. What was the journey like to get there? It was very surreal. We initially met in Jordan and proceeded to the Hussein, King Hussein Crossing. where we essentially met just legions and battalions of people, mostly families trying to get into Gaza or into Israel, and really had to jockey through enormous crowds to make it through finally getting on a bus and then to the Israeli border, where we met with a UN convoy and had an IDF lead through Israel, finally arriving at the northern border just below south of Tel Aviv.

2:41And, you know, when we got there, it was late, and there were these giant gates. It was kind of like a Star Wars set where they slowly opened. Our convoy went through and met at a parking lot where we exchanged vehicles, and we had to wait a few hours and walk across a parking lot with just lights blinding us intentionally so we really couldn't see arriving at a UN convoy and then where we had to wait a few more hours and then we slowly, we got a green light from the IDF, meaning that they would give us a window of opportunity to drive from the parking lot in the northern part of gaza to southern gaza without being bombed and so they give us a very short window of opportunity and so it was really frightening uh process um but the company that i uh went with the ngo Rakhma worldwide.

3:47They have a long history of getting people into Gaza. I was on the 36th mission to Gaza, so they had the process worked out pretty well, but very, very surreal and frightening. So once you arrived at your site, what were you able to understand about the scale of malnutrition in Gaza? Well, you know, I was prepared for the trauma, you know, the explosions and the gunshot wounds and the unstable patients. But what I didn't realize is that this was a mass casualty starvation event at the same time. That was shocking. It was systemic and pervasive and very clear from the moment that we got there. Even people who are working for NGOs or healthcare providers that are given one small meal a day are still very underweight.

4:56And then when we started taking care of the patients, many of them are skeletal and where you can see the rib prominences, There's lots of body fat, you know, wasting people with so much muscle loss that they are walking with, you know, ataxia, which means that they're barely keeping themselves erect. They're falling all over the place. It is just truly shocking. As of today, at least 159 people have died from hunger related causes since October 2023. That's according to hospital officials in Gaza. Most of those deaths occurred in the last several weeks. Now, you say that thousands of children in the region are experiencing levels of malnutrition far beyond the point of recovery.

5:49From a medical perspective, what does that mean for these children? Well, this is most significant in children under five where the severe acute malnutrition or SAM category puts them at extremely high risk for mortality. So we're seeing probably about 20 % of the children in that age category are meeting the SAM one, 15 to 20 % are meeting the SAM five category and there gets to be becomes a point where physiologically there's no return when the body is so wasted and depleted and they have developed such a neuro hormonal dysregulation that they're not able to absorb nutrients or even water anymore where the body completely collapses where the immune system is essentially gone, where bacteria that are in the gut, what we call translocate or migrate across the barrier into the abdomen of developing sepsis, which is a systemic inflammatory condition and imminent death under the circumstances.

7:08And we're seeing this. So this population under the five is at extreme risk. And the issue is that we're seeing the number of deaths from malnutrition climb, I should say starvation, climb month by month. But I think we're all going to be very shocked by the numbers for September, October, and November because so many children have really crossed that barrier where it's going, even with extreme medical careful care, are still going to ultimately die. You mentioned the physical effects, but Mark, what about the cognitive effects of starvation and malnutrition, both for children and adults? Yeah, I think that's really one of the things that was most shocking to me and really sad because it really, you know, tears apart the family unit, but it really starts, you know, at really young age.

8:13So some of the people that are the highest risk are mothers and children. So infants that are born to mothers that are under starvation conditions, their cortisol levels, their stress levels are so high, their calorie intake is so low that they're unable to produce breast milk. So that initial colostrum, the very first amount of milk that really sets the metabolic stage and the connection between the mother and the child is gone right off the bat. And then in the first six months, milk goes way beyond just nutrition. It really emotionally ties the mother and child together with prolactin levels and oxytocin, really creating a connection between mother and child.

9:11And that's gone in a lot of patients. And it certainly has a metabolic programming issue and increases obesity and diabetes and, you know, increases mortality, morbidity over the course of their life. But more importantly, it disrupts, you know, the bond between the mother and child, creates apathy, increases postpartum depression. and this is like a really untold effect of starvation in this connection between mother and child and it's really profound. But children, especially under the age of five, this is a point where there's all kinds of neurohormonal development leading to long-term cognitive dysfunction.

10:04Some of it is reversible if they can get enough folate and vitamin B and nutrition. But a lot of these children are going to end up having long-term cognitive deficits that are really irreversible. And it's true, too, as we age on the other side of the spectrum, older adults, they experience the same issue. They develop cognitive impairment, really poor concentration. They get osteopenia, so their bones are brittle. They're at high risk for falling. So we see, you know, hip in among the, all of the trauma that we see hip fractures in older people. It mimics, you know, you know, depression, amplifies depression.

10:50There's, you know, lots of delirium that we see in every age group, which is a reversible, you know, state of altered mental status. And, you know, people are, you know, on, you know, incapable of even making simple decisions. You know, their family members are standing in the trauma bay. You know, they're mourning, they're in grief, and they're wailing, but, you know, they don't know what to do. They are simply, like, stumbling around, sometimes, you know, not able to speak. So this is, like, the psychological effect of the starvation is, you know, really profound. Mark, let's turn to refeeding for a moment.

11:32This is the process of reintroducing nutrition to a person who's been severely malnourished. Now, we don't know if refeeding will happen on a massive scale, given Israel's ongoing blockade. But what could happen if refeeding occurs? Well, yes, refeeding is a very tenuous process. It requires ICU-level support, really, or advanced medical support. What happens is when you have had such depleted calorie consumption, when that restarts, the carbohydrate level goes up, sugar level goes up in the blood, causing a spike of insulin, which then drives a lot of important electrolytes like potassium and magnesium into the cell, depleting the amount of electrolytes circulating in the blood which causes arrhythmias or irregular heart rhythms and can put people into cardiac arrest so there's very high lethality with the process itself and it has to be done under extremely controlled environments so you know you need to check electrolyte levels in the blood two to three times a day it requires you know very careful feeding and each each individual has to have like an individualized plan so it's very tough there were a few places small places in in palestine and gaza where this was occurring but you know right now the the number of places are dwindling and um the uh the it is not an easy process so uh so many of the people that would benefit from you know controlled medical refeeding, we'll never receive it.

13:19So what I hear you saying is that it's a complicated process. It needs to have medical oversight, but we also have seen reports about Gaza's health infrastructure and how it's been decimated. So from what you've seen, are many people in Gaza able to return to full health, even if aid comes swiftly? No, not at all. So this is like a, it's kind of like a radiation injury. You know, you get the initial acute injury, but then there's a slow burn. And that's what the problem is now is that so many people have crossed that threshold where no matter what we do, they're still kind of have a downward trajectory, unfortunately, to death.

14:07And so the the numbers are no doubt going to climb over the next several months. And, you know, while that is absolutely tragic and man-made, you know, still it's a call for immediate change in policy and getting food in. Like you said, we're getting 100 trucks in a day here and there. But, you know, most days they're only getting in about three cubic tons, which is less than one half of 1 % of the necessary food for the 2.1 million people. So yeah, things are looking grim for the fall, for sure. That's Mark Bronner. He's an Oregon-based emergency physician who volunteered at a hospital in the Gaza Strip for two weeks in June.

14:53Mark, thank you so much for speaking with us. You're welcome, Shane. We'll be back with more in a moment. Stay with us.

15:04Gaza is far from the only place gripped by mass starvation today. In Sudan, more than 24 million people are acutely food insecure. That's about half the country's population. And of those 24 million, the World Food Program says more than 637 ,000 people in Sudan are facing catastrophic levels of hunger. In Haiti, an April report from the IPC found that a record 5.7 million people, or more than half of Haiti's population, were projected to experience acute food insecurity through June. As the U.S. scales back its humanitarian aid under the second Trump administration, what will that mean for countries that rely on foreign aid to address their growing hunger crises?

15:47Joining us now to discuss from Amman Jordan is Juliet Tuma. She's the Director of Communications at the United Nations Relief and Works Agencies for Palestinians. Juliet, Welcome back to the program. Thanks for having me. Nice to be here. Also with us is Jean-Martin Bauer. He's the director of the World Food Program, Food Security and Nutrition Analysis Service. He's also the author of The New Breadline, Hunger and Hope in the 21st Century. Jean-Martin, welcome. Hi. And Jake Johnson. He's a researcher and writer at the Center for Economic and Policy Research. He's also the author of Aid State, Elite Panic, Disaster Capitalism, and the Battle to Control Haiti.

16:27Jake, welcome back to the program. Thanks for having me. So earlier this year, the Trump administration shut down the United States Agency for International Development, or USAID. Before it was gutted, the agency distributed billions of dollars of life-saving foreign aid, disaster relief, economic development funding for nations around the world. John Martin, what effects has the shuttering of U.S. aid had on food-insecure countries that relied heavily on U.S.-funded aid? There's been quite an impact. I need to clarify that there are also a lot of other donors that have curtailed their aid budgets at the same time.

17:00So unfortunately, an agency like WFP, which relies 40 % on U.S. funds, is also facing cuts from its other major donors in Europe and elsewhere. That means it's a perfect storm. That means in some countries, rations are being cut for people who are extremely vulnerable to food insecurity. That means that people are being taken off programs. It means that programs like school meals programs are no longer covering as many children. And this is a huge problem at a time when needs for food assistance haven't been higher. Before the pandemic, we had about 135 million people who were acutely food insecure worldwide.

17:36According to the UN, published a report just about a month ago, that's up to 300 million. So these cuts are happening right when levels of vulnerability are at a very high level. I want to get into some of the reasons driving that vulnerability and why countries have withdrawn support. But, Jake, in February, you wrote that since October 2023, USAID allocated$368 million in contracts and grants for Haiti. Here's what Angeline Anastas, the director of the charity ActionAids Haiti, told France 24 in February about the extent of the country's hunger crisis. Now we are talking about a very deep crisis where the population is on the break of starvation.

18:20In our survey taking place in the south of Haiti, so we found out that 99 % of families are skipping meals, going days without food. And of course, this situation put the population and particularly the children at at health complications and malnutrition. Now, Jake, in your book, you make the case that Haiti is an AIDS state. First, define that term. Yeah, sure. Well, I think, you know, to really push back on this concept of Haiti as a failed state and noting that, you know, really decades of policies, not just humanitarian assistance, but sort of political interventionism and foreign policies from other countries have shaped the current Haitian state as much as the Haitian people themselves.

19:09And that plays a key role in the reduced capacity of a state, the lack of legitimacy in the state that I think are really driving factors of the hunger and the insecurity that we're seeing in Haiti today. So what parallels, if any, do you see between Haiti's dependence on foreign aid and the hunger crises in Gaza and Sudan? man you know i think you know the first thing comes to mind and this is a point that john martin makes in his book as well is that these are not uh famines uh hunger crises as a result of natural disasters as a result strictly of poverty this is conflict right these are um you know wars genocide in gods's case and haiti's case civil conflict that is causing hunger and we're focusing on the humanitarian aspect it's obviously important we want to get as much humanitarian assistance and life-saving assistance in there as possible.

19:58But we also have to be paying attention to the root causes that is actually driving these crises and working to end the conflict, which will obviously save tremendous lives as well. Juliette, the IPC has stopped shy of declaring famine in Gaza. Instead, the panel predicts widespread death without immediate action on Israel's part to end the blockade. How, if at all, does a formal declaration of famine change the nature of resources that governments or humanitarian groups allocate to address a crisis? Yeah, look, I'm not sure that there is a difference. The fact of the matter is that people are starving in Gaza.

20:39They're very hungry. When we speak to our staff and their staff in Gaza, they themselves are hungry. Some of them are fainting in the line of duty. Some of them are walking for miles on end before finding like a bag of lentils that they can make some soup for them and their families. The caretakers in Gaza are now in need of care. An estimated 8.2 % of the world's population or about 673 million people experienced hunger in 2024. It's down slightly from 2023 and 2022, according to the UN State of Food Security and Nutrition in the World Report. But not every region saw hunger decline. The World Health Organization says the number of people experiencing hunger rose in most subregions of Africa and Western Asia last year.

21:34Jean-Martin, what are some of the main reasons we're seeing hunger drop in some parts of the world but not others? The reason why hunger is increasing in Western Asia and in Africa is conflict. So what we do need to make the distinction between different types of hunger. To be really clear, the numbers you mentioned from the State of Food and Security report, that's about chronic hunger. That's hunger that stunts. What we're talking about in places like Gaza, Sudan, and Haiti, it's acute hunger. Hunger that taken to its extreme can kill. What we're seeing for chronic hunger is a stabilization, an increase in some areas.

22:09often due to the fragility of the environments that they're taking place in anti-conflict. And acute hunger, that's really been the geopolitical tensions that have been around for the past few years. What we're seeing is that the most extreme forms of hunger are rising. There were about 80 ,000 people in the highest form of hunger, which is the fifth phase of the IPC. You talked about the IPC system. It's the international system we use to rate hunger. It's it's a five-point scale, one being food secure, two stress, three crisis, four emergency, and five a catastrophe. If enough people are in catastrophe, that becomes a famine.

22:47There were about 80 ,000 people in phase five before the pandemic. We ended last year with 1.9 million, essentially in Sudan and in Gaza. That shows that what's going on is that these conflicts create tremendous barriers for the people on the ground, for the civilians on the ground for the humanitarians who try to support them, and that this is a problem that's not under control currently. That's why we're seeing these increases. Well, last fall, we discussed why Sudan's humanitarian crisis hasn't received as much attention as other crises around the world. Arif Hussain is chief economist at the United Nations World Food Program, and here's what he told us about the attention gap.

23:23I started this humanitarian work back in 2003-04 in Sudan. My The first humanitarian crisis, if you will, was the Darfur crisis. And at that time, it was the biggest crisis in the world. And it didn't matter where you were in the world, it was everybody knew about it. And everybody wanted to do something. People like George Clooney, others were out there talking about this. Right now, we probably have a situation that's a lot worse than that, 20 years down the road. And there's just no traction. There's just not enough going on. And I think that's a big problem. Jake, I'd love your thoughts on why crises like what we're seeing in Sudan, like what we're seeing in Haiti, haven't gotten traction in the public sphere.

24:22Yeah, I think it's an excellent question. I think part of it is we see this and they last and it goes on and on. And it's like, oh, OK, I've seen this story before. And I think there's another part of this, which is delivering humanitarian assistance is actually relatively easy. I mean, there are plenty of barriers, funding, things like this that we can talk about, but it's an easy solution. It's not addressing, like I mentioned earlier, these root causes. And then we begin to confront what it actually takes to address those root causes. And that means addressing much bigger issues, bigger issues of U.S.

24:54foreign policy, as in our support for Israel and its ongoing genocide, etc., our support for other allies that are feeding the conflict in Sudan, our support for certain actors in Haiti, right? And confronting those things is a much more challenging thing. It's much more difficult. And I think that's often where these efforts sort of run out of steam. And so we see the sort of perpetual cycles of humanitarian interventions. But again, they're continuing because we're unable or unwilling to confront these bigger issues. Well, while global hunger is declining, when we look at acute food insecurity and child malnutrition, they actually rose for a sixth consecutive year in 2024.

25:32I want to refer here to some data from the 2025 Global Report on Food Crises. It says that more than 295 million people across 53 countries and territories experienced acute food insecurity in 2024. Juliette, what does this increase in child malnutrition signal to you that this very critical level of food insecurity is growing among the youngest and most vulnerable? Yeah, look, when it comes to Gaza, that was a first and a critical indicator for us when those babies who come to the agency's clinics and our doctors would screen them against malnutrition. and the numbers kept rising every single day, especially in the past few months, and especially since the Israeli authorities imposed this siege on the Gaza Strip and very, very little food was coming in.

26:35For us at UNRWA, for example, we've got 6 ,000 trucks that are loaded with food and with medicine and with nutrition supplies for babies that we've been banned from bringing into Gaza. And right now, our teams in northern Gaza, they report a daily increase in the number of malnourished children. And the latest is one in five kids in Gaza has malnutrition in the northern part. Let's head to a quick break. We'll be back with more in a moment. Stay with us.

27:17Now, Jake, you alluded to this, but many people think of humanitarian aid as apolitical. Your book, Aid States, suggests otherwise. How has foreign aid become a tool of influence or control between different countries? Yeah, well, I don't think it's something that has sort of happened over time. This is sort of from its inception. Foreign assistance and U.S. foreign assistance has always been political. And this isn't sort of a conspiracy or fringe. I mean, it says it right on the website. And I'm not sure USAID's website even exists anymore, but it did at least before it was dismantled. Right.

27:48And so, you know, this is part and parcel of assistance. And it's not just in terms of who gets aid, but also how we actually deliver it. Right. So, for example, with food assistance and U.S. food assistance specifically, historically, what is determining the levels of U.S. food assistance, there's been a number of studies on this, is not actually necessarily the needs on the ground, but what the result of that year's crops were in the United States. And that's because a lot of the food aid that we're sending abroad are being purchased from U.S. farmers, a sort of de facto subsidy for U.S. agricultural producers.

28:22And so we've sort of created a system that has baked all of these interests in together, and they're often in direct conflict. And we've seen that sort of play out in various ways. But certainly food assistance has played a historically really problematic role in undermining local farmers in Haiti, for example. And I will give Jean-Martin credit as when he was at WFP and running some of these programs, they massively increased the amount of locally produced and locally sourced food aid in Haiti. And that has a big impact, not just on those in need, but also in the rest of the economy writ large.

28:58Well, I want to circle back to something Juliet mentioned, which is the thousands of truckloads of aid just outside of Gaza sitting unused. In some cases, the food and supplies are expiring, but this is aid that's already been purchased, Jake. So who benefits regardless of whether that aid is actually distributed? Yeah, you know, an aid worker many years ago sort of clarified things for me with a simple statement. And he said, you know, the success of a program is not delivering something. It's spending the money. Right. And so when I look at this, right, in terms of U.S. interest, simply purchasing the money from U.S.

29:32farmers has satisfied a certain interest. What happens to it after that fact, how effectively it is delivered and things like that are, quite frankly, less important to those who are setting these budgets and determining these things in Washington. We got this from Elizabeth, who says, I've heard in conversation with various people that they are under the impression that there is not enough food or resources to feed everyone in the world. I'm under the impression that our world has enough money and resources to feed everyone. But what we are lacking is the political will, the appropriate distribution of resources, and the ability to get into places with conflict.

30:07Is my impression correct? Do we have the resources to feed everyone, but we have simply not managed to put the pieces in place? Jean-Martin, I'll come to you first. That's absolutely right. We have enough food in the world to feed everyone. It's a truism that is true. What's missing is addressing the inequalities. It's the systems to reach the most vulnerable. And Jake mentioned this earlier in the interview, resolving acute hunger is about also attacking root causes that are really complex. It can be conflict. It can be deep-rooted discrimination in a society. The most exposed to acute food insecurity are women, are ethnic minorities, religious groups that are in the minority that might be under oppression.