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Abu Dhabi, UAEMonday 17 December 2018

In besieged Gaza, poverty exacerbates child malnutrition

Conditions under blockade have left many families unable to afford a proper diet

Dina Eljamaal has a new kitchen but not the food her one-year-old daughter needs to be healthy.

Ms Eljamaal, 20, lives in the dense, tough Shejaiya neighbourhood of Gaza City. Her extended family’s home was destroyed during the 2014 war with Israel. They have rebuilt two floors with money from Qatar and are awaiting a Saudi grant to rebuild the third, she told The National.

Having a new roof over their heads makes the family among the lucky ones in Hamas-ruled Gaza. But none of them have jobs and they cannot afford to buy healthy fresh foods such as fruit or eggs for the whole family. Even clean drinking water is out of reach. A recent study found that 97 per cent of Gaza's water supply was unhealthy, but bottled water is beyond their means.

The result is that Ms Eljamaal’s daughter Marah, named after her aunt killed in the war, is wasting away. Her mother says she weighs two kilos less than average for her age, is slow to respond and quick to tire – all signs that Marah is chronically malnourished.

It is a condition affecting an increasing number Gazans, particularly women and children, after 11 years of living under a blockade. US President Donald Trump’s recent cuts to aid and refugee services, including food assistance, have only pushed a precarious situation further to the edge, according to doctors.

Children like Marah are at risk of anaemia, folic acid and vitamin deficiencies, hypertension, chronic dehydration leading to liver failure, and a host of physical, cognitive, and behavioural problems that could affect their entire lives.

Many more children and adults suffer from malnourishment without visible symptoms or any awareness of the short and long-term damage being done to them — and to Gaza’s future.

Dr Adnan Al Wahaidi is the director of Ard El Insan, the only clinic focused on child malnutrition in Gaza. He has worked more than 30 years at the NGO and says he has seen an increasing number cases every year since the Israeli and Egyptian-led blockade began in 2007.

So far this year, Dr Al Wahaidi has treated 20,000 children with anaemia, the biggest figure in the past five years, he says, up from about 19,000 last year.

“The long siege and the intra-Palestinian conflict have created unfavourable conditions for all of the society,” he says. “They are a direct reason for the economic collapse in Gaza, and this is directly reflected in the daily food for all Palestinian people and the most affected are children, women and pregnant women, and other weak groups.”

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Dr Zohair Elkhatib, a family doctor with UNRWA, the UN aid agency for Palestinian refugees, says that unlike in other war-torn places, acute malnourishment, caused by severe and sudden decrease in food consumption, had not been a problem in Gaza. Instead, chronic malnutrition, characterised by long-term micronutrient deficiencies, is the main issue. But as there is no unified nutritional assessment in Gaza, it is also difficult to exactly determine how widespread the problem is.

“We suspect that quite a number of children born during the blockade period will be affected negatively in terms of their nutrition. They will be stunted. They will have anaemia. They will have many other issues," he says. "Their capability to be more focused will be lower because you expect that if he's malnourished he has multiple issues that will affect his development, his brain, and maybe his cognitive abilities.”

What scares Dr Al Wahaidi most is how “fragile and absolutely vulnerable” Gaza’s food security is. During just the first two days of the 2014 war, his clinic received a significantly high number of children with wasting - “skin and bone”. He worries how already malnourished children would fare in another war.

Ard El Insan treats more than 50,000 children a year at its two clinics in Gaza City and Khan Younis. Patients come directly or are referred by private and government-run clinics. At the centres, Dr Al Wahaidi and his colleagues assess each case and provide free treatments ranging from antibiotics, creams for skin lesions and infections and anti-diarrhoea and anti-parasitic medicines to nutrition powders and formulas for iron, folic acid or vitamin deficiencies.

Ard El Insan used to conduct outreach programmes but had to stop three years ago because of a lack of funds, Dr Al Wahaidi says. Earlier this year, the NGO was one of many Palestinian organisations to lose funding from USAID after the Trump administration’s cuts.

In the meantime, about one million of Gaza’s 1.9 million residents depend on quarterly distributions of food aid by UNRWA, which has also been under threat since Mr Trump’s cuts compounded longstanding shortfalls in promised donations.

UNRWA provides families packages of white rice, flour and sugar, powdered milk, sunflower oil, tahini, sardines, lentils and chickpeas. The latter three items were introduced in 2016, after the agency assessed the nutritive value of its aid and found it lacking.

Dr Al Wahaidi says agencies need to do better to address malnutrition in such an aid-dependent place as Gaza.

“Unfortunately most of the donated foods are not rich in nutrition and they are lacking fortification, which is a necessity for all age groups,” he says. “Even relying only on dry food rations is not something that’s always helpful. There should be fresh fruits, fresh vegetables, fresh meat, fresh oil and fresh fish.”

The challenge, he says, is that agencies such as UNRWA expect their food packages to cover only about 80 per cent of daily needs — but with the collapsed economy, Gazans cannot afford to make up the rest. Bread, sugar and dirty water are subsequently an increasingly core part of peoples’ diets.

Dr Jamil Jumaa El Bahnasawi, who works at Naser Paediatric Hospital in Gaza City, says Gaza’s healthcare system is not equipped to deal with cases of acute or severe malnutrition, which, while still rare, have increased.

“[It was] unusual to see these cases a few year ago, but now within a week or two weeks we’ve seen three cases of significantly malnourished [children],” he says. “This alarmed us that something wrong might be happening.”

Dr El Bahnasawi equates the “subtle suffering” of many children and adults to a hidden iceberg. Like many other communities, Gaza’s children are drawn to cheap processed foods such as crisps and sweets, he says. Vendors wait outside schools to sell children sugary snacks: it is a moment of sweetness and the only one they can afford, but bad for their health in the long term.

Malnutrition also affects other medical conditions. Four-year-old Omar Albaradee has been to the Naser hospital more than 27 times to treat his immune deficiency, which has been compounded by severe malnourishment, said his father, Saed Mohamed Albaradee.

Emaciated and glassy-eyed, Omar does not speak despite his age. He is an atypical case of severe malnourishment — but as Gaza’s healthcare, economy, and food and water systems continue to deteriorate, a sign of what could become more common.

While children are the most visible victims of chronic malnutrition, women also suffer acutely. Pregnancies in particular take a nutritive toll on women’s bodies, and many mothers prioritise their children and husband’s food needs over their own.

Mervat Hameeda Mahmoud, 48, was diagnosed with anaemia, folic acid deficiency and hypertension two years ago, soon after she divorced her husband and moved out on her own with four of her children — a rare feat for a woman in Gaza. Except now every time she climbs up to her sixth-floor flat her heart beats fast, she feels dizzy and she needs to rest. Ms Mahmoud has a college degree but is unemployed, and can barely afford food for her children, so she visits family members to eat, sometimes going two days without meals.

“I don’t have the money to buy medicine or vegetables,” she says. Now she barely even has an appetite.

Many of Gaza’s children go to school hungry, making it harder to focus and stay calm. The American Near East Refugee Aid, an NGO, has developed a programme to tackle both child malnutrition and widespread unemployment by supporting women’s cooking cooperatives that cook free food for schoolchildren.

In the small village of Zaweida in central Gaza, Fayza Ahmed Abu Sweireh, 58, heads a group of women who are all the breadwinners for their families. On a recent Sunday, they chopped spinach to mix with meat and fill into baked bread pockets for a customer’s order. The laughter and chatter of children rang out from an adjacent building housing the privately funded Future Children Preschool constructed by Dubai Cares.

When snack time came the children eagerly received the co-operative’s freshly baked bread crescents with cheese. White flour, which is comparatively inexpensive, is not the most nutritious on its own, says Ms Abu Sweireh, so they add whatever vegetables and proteins they can afford. It is a small snack, but makes life a little easier for the children and their families.

In the Jabaliya refugee camp, Mahmoud Sweila, 24, and his wife Sahar, 23, are trying to calm their colicky 11-month-old, Bara’a, who has been underweight since birth.

Sahar took her son to Ard El Insan and the medicines they gave her are now among the few items in the family fridge, along with eggs, bread and vacuum-packed cheese. The family lives in a makeshift two-room apartment on a roof where their uncle used to raise chickens. The smell of the chicken coop wafts in, but they have not eaten chicken since a charity gave out free meals two months ago.

In a big change for Gazans, they can now keep their fridge on for 12, sometimes even 24, hours a day compared four to eight hours in recent years, after the power plant received fuel from Qatar earlier this month as part of ceasefire package negotiations with Israel.

The fridge in the Sweila home, however, is only plugged in once in a while to chill the contents.

“Even if there is electricity, we don’t have food to put in it,” said Sahar.