NNA - Children in Gaza have been dying from starvation-related complications since the Israeli government began using starvation as a weapon of war, a war crime, Human Rights Watch said today. Doctors and families in Gaza described children, as well as pregnant and breastfeeding mothers, suffering from severe malnutrition and dehydration, and hospitals ill-equipped to treat them.

Concerned governments should impose targeted sanctions and suspend arms transfers to press the Israeli government to ensure access to humanitarian aid and basic services in Gaza, in accordance with Israel’s obligations under international law and the recent International Court of Justice order in South Africa’s genocide case.

“The Israeli government’s use of starvation as a weapon of war has proven deadly for children in Gaza,” said Omar Shakir, Israel and Palestine director at Human Rights Watch. “Israel needs to end this war crime, stop this suffering, and allow humanitarian aid to reach all of Gaza unhindered.”

A United Nations-coordinated partnership of 15 international organizations and UN agencies investigating the hunger crisis in Gaza reported on March 18, 2024, that “all evidence points towards a major acceleration of death and malnutrition.” The partnership said that in northern Gaza, where 70 percent of the population is estimated to be experiencing catastrophic hunger, famine could occur anytime between mid-March and May.

Gaza’s Health Ministry reported as of April 1, that 32 people, including 28 children, had died of malnutrition and dehydration at hospitals in northern Gaza. Save the Children confirmed on April 2 the deaths from starvation and disease of 27 children. Earlier in March, World Health Organisation (WHO) officials found “children dying of starvation” in northern Gaza’s Kamal Adwan and al-Awda hospitals. In southern Gaza, where aid is more accessible but still grossly inadequate, UN agencies in mid-February said that 5 percent of children under age 2 were found to be acutely malnourished.

Human Rights Watch in March interviewed a doctor in northern Gaza, a volunteer doctor who has since left Gaza, the parents of two infants who doctors said died of starvation-related complications in both mother and child, and the parents of four other children suffering from malnutrition and dehydration.

Human Rights Watch reviewed the death certificate for one of the children, and photos of two of the children in critical condition that showed signs of emaciation. All had been treated at Kamal Adwan hospital in Beit Lahia, northern Gaza.

Human Rights Watch health advisers also reviewed verified pictures and videos online of three other evidently emaciated children who died and four others in critical condition who also showed signs of emaciation.

Dr. Hussam Abu Safiya, who heads Kamal Adwan hospital’s pediatrics unit, told Human Rights Watch on April 4 that 26 children had died after experiencing starvation-related complications in his hospital alone. He said that at least 16 of the children who died were under 5 months old, at least 10 were between 1 and 8 years old, and that a 73-year-old man suffering from malnutrition had also died. 

Dr. Safiya said one of the infants died at just two days old after being born severely dehydrated, apparently exacerbated by his mother’s poor health: “[She] had no milk to give him.”

Nour al-Huda, an 11-year-old girl with cystic fibrosis, was admitted to Kamal Adwan hospital on March 15. Doctors there told her mother that Nour was suffering from malnutrition, dehydration, and an infection in her lungs, and administered her oxygen and a saline solution. “Nour al-Huda now weighs 18 kilograms [about 40 pounds],” her mother told Human Rights Watch. “I can see her chest bones sticking out.”

International humanitarian law prohibits the starvation of civilians as a method of warfare. The Rome Statute of the International Criminal Court provides that intentionally starving civilians by “depriving them of objects indispensable to their survival, including willfully impeding relief supplies,” is a war crime.

Since the Hamas-led October 7, 2023, attacks in Israel, the Israeli government has deliberately blocked the delivery of aid, food, and fuel into Gaza, while impeding humanitarian assistance and depriving civilians of the means to survive. Israeli officials ordering or carrying out these actions are committing collective punishment against the civilian population and the starvation of civilians as a method of warfare, both of which are war crimes.

Israeli government actions that undermine the ability of the UN Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) to carry out its recognized role in distributing aid in Gaza have exacerbated the effects of the restrictions.

A doctor who volunteered at the European hospital in Khan Younis in southern Gaza for two weeks in late January said that medical staff were forced to treat patients with limited medical supplies. He described the difficulty of treating malnutrition and dehydration, lacking essential items such as glucose, electrolytes, and feeding tubes. He said that one patient’s mother, desperate for solutions, resorted to crushing potatoes to create a makeshift liquid for tube feeding. Despite its nutritional inadequacy, the doctor said, “I ended up telling my other patients to find potatoes and do the same.”

On January 26, the International Court of Justice, in a case brought by South Africa, ordered provisional measures, including requiring Israel to “take immediate and effective measures to enable the provision of urgently needed basic services and humanitarian aid” and other actions to comply with the 1948 Genocide Convention. On March 28, the court indicated that Israel had not complied with this order and imposed a more detailed provisional measure requiring the government to ensure the unimpeded provision of basic services and aid in full cooperation with the UN, while noting that “famine is setting in.”

Governments should impose targeted sanctions, including travel bans and asset freezes, against officials and individuals responsible for the continued commission of the war crimes of collective punishment, deliberate obstruction of humanitarian aid and using starvation of civilians as a weapon of war.

Several countries have responded to the Israeli government’s unlawful restrictions on assistance by airdropping aid. The United States also pledged to build a temporary seaport in Gaza. However, aid groups and UN officials have said such efforts are inadequate to prevent a famine. Another attempt to deliver aid by sea was halted after an Israeli attack on aid workers on April 1.

On April 4, the Israeli cabinet agreed to several measures to increase the amount of aid entering Gaza, apparently following pressure from the US government.

“Governments outraged by the Israeli government starving civilians in Gaza should not be looking for band-aid solutions to this humanitarian crisis,” Shakir said. “Israel’s announcement that it will increase aid shows that outside pressure works. Israel’s allies like the US, UK, France, and Germany need to press for full-throttle aid delivery by immediately suspending their arms transfers.”--HRW

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