The humanitarian crisis in the Gaza Strip has only worsened, particularly for children. Last month, UNICEF declared that the number of children being admitted to hospitals in Gaza for acute malnutrition had risen by fifty per cent between April and May. “Of the 5,119 children admitted in May, 636 children have severe acute malnutrition (SAM), the most lethal form of malnutrition,” the statement explained. “These children need consistent, supervised treatment, safe water, and medical care to survive—all of which are increasingly scarce in Gaza today. The number of children with SAM has surged 146 per cent since February.”
A temporary ceasefire between Israel and Hamas earlier this year led Israel to allow more aid into Gaza; but, since then, Israel has alternately cut off all aid and allowed a trickle to come in. Moreover, Israel has largely replaced the previous aid-delivery system, which operated in part through the United Nations, with a new system, run by a private organization called the Gaza Humanitarian Foundation, in which Palestinians are forced to trek to one of four locations to receive food. Israeli forces, and private American contractors who are guarding the sites, have fired weapons at Palestinians as they approach; more than six hundred Palestinians have been killed while collecting aid, according to the United Nations.
I recently spoke by phone with James Elder, UNICEF’s global spokesperson, who just returned from the Strip. Elder has previously worked in countries including Angola, Zimbabwe, Libya, and Sri Lanka. During our conversation, which has been edited for length and clarity, we discussed the wounded children he spoke to in Gaza, the risks people are now willing to take in order to find food, and how parents are trying to cope with unimaginable loss.
When were you last in Gaza?
I was last in Gaza in June, and I was there for two weeks. It was my fifth mission to Gaza since the horrors of October 7th. In a typical emergency, my job is to go and see the situation, report on it, and share what UNICEF is doing. But, in Gaza, ninety-five per cent of it is to bear witness. I spend entire days in hospitals and camps simply listening to people and hearing the situation. I learned very early on in November or December of 2023 that it was much more important to spend my time sharing the grave violations that are occurring consistently to children rather than speaking about what our program is doing. In terms of what’s happening, there has been a great degree of disinformation and, obviously, a great degree of credibility given to statements that have been found to be completely false. So it’s been very important, I think, to simply bear witness, and I have met hundreds of children and families.
How would you say your visit in June was different from your previous visits, if it was different?
Yes, it was, even though I didn’t expect it to be. It was different for several reasons. One is the wounds I saw on children. There were burns on little girls and boys, fourth-degree burns I didn’t know existed. And shrapnel riddled through a body. Shrapnel is designed to go through cement, and what it does to a child’s body is horrific. On one previous trip, I saw a bus of children who spent two days trying to get from the north to the south after being held at Israeli checkpoints, and I walked in the bus, and all I could smell was children’s burning flesh. It doesn’t leave you. And one of the things that struck me this time was that I wasn’t just seeing these children—I was hearing them. There is such a horrendous lack of painkillers that when I’d be in a hospital—and hospitals are wall to wall with people with wounds of war—you’d hear the children and their screams. So I certainly noticed that as a person, parent, human.
The other thing was food and water. Whenever you have warnings of famine, there is big international pressure, and Israel loosens controls so more aid can come in. But then international pressure wanes and the restrictions are tightened again. Once you have famine, people are dying en masse. But there is starvation where a child’s body is degrading and the immune system is starting to collapse, and that’s happening—so children’s bodies aren’t waiting for that technical definition.
We are now so far below the emergency threshold for water. It is in critical shortage now, and it is controlled entirely by Israel. Since electricity to Gaza was cut after the horrors of October 7th, diesel became essential to treat and distribute water, but there’s been a hundred-plus-day blockade on fuel coming into Gaza. We’ve got to a point where, if that doesn’t change or if the electricity isn’t turned back on, which would solve a lot of problems, you’ll start to see children dying of thirst. Water was something that really, really struck me, because it’s absolutely political, not logistical. If Israel allowed fuel or turned on the power for these desalination plants, that problem would be solved. That’s a level of stress on a population I saw that I hadn’t seen before.
The most lethal crisis isn’t just hunger or thirst—it’s the brutal collision of both. And those deaths are often not recorded; when children are severely malnourished, they’re eleven times more likely to die from common childhood illnesses. They’re often not getting to a hospital—first because the hospitals are full of people with wounds of war, and, second, if you just look at the south, there is one fully functioning hospital, and it’s in an evacuation zone. It’s almost impossible to get to unless you’re in an ambulance, because you have to walk through an evacuation zone, which is militarized.
What have you learned about children starving to death?
Starving to death is dying of severe acute malnutrition, and there is a number, but, honestly, I’m not sure how reliable it is. [The director of Gaza’s field hospitals told NBC News last month that more than sixty-six children had died from hunger and malnutrition since the war began.] The problem is that, for the vast majority of children, if you die, if you are severely, acutely malnourished and you die, it’s very unusual to have “starved to death.” You’ve died because of diarrhea, basically, or acute watery diarrhea, which is very, very commonplace now, particularly given the restrictions on water and food. You’re killed by something that a healthy child’s immune system wards off very, very easily.
What are your conversations like with these kids’s parents? Is there anger? Sadness? How would you characterize it?
I would say that anger is infrequent. There’s an immense vulnerability. And they’re holding their medical-evacuation forms, meaning that they were approved for medical evacuation from Gaza. But there are thousands of children who need medical evacuation from Gaza. I mean, literally thousands. So they’re holding this piece of false hope in their hands. There’s a grace and generosity in speaking to me, but there’s an absolute sadness.
There’s a level of powerlessness that I’ve noticed for a long time. I noticed it more than a year ago when a parent would explain to me that their child had realized that this parent could no longer protect them, and what a horrifying moment that was. These parents know that they’ve lost the ability to keep their children safe, so that powerlessness cuts deep into people. You sit and you listen and you talk, and it’s a little girl or a little boy, and they are trying to be brave in some way, or they’re in a coma and the parent’s trying to. And in doing so, the parents, sometimes fathers in a very paternalistic environment, are in tears.
