2024-03-22

I’m not ready to say I did it on purpose, I’m not ready to say I didn’t

The starvation campaign in Gaza is almost certainly worse than you think it is. Very few of us have any actual knowledge of what starvation does to people - maybe we've been in circumstances or seen others in situations where they have gone hungry for a long time. Some people voluntarily subject themselves to calorie restricted diets and maintain them for a long time. None of this is starvation and the difference is huge. It is not easy to die of starvation, it takes weeks of zero calorie intake - and months if you instead have a drastically reduced intake. It is a slow death that is as horrific and ghastly as anything we can imagine.

The campaign is worse than I thought it was. You cannot reverse this degree of starvation easily. The attacks on aid seekers and places that are internationally recognized as sanctuaries exempt from war (unless Israel it is Israel killing off Palestinians) will discourage people from going to get food - even as they die of starvation. And the agency with the most capacity to distribute aid in Gaza and that retains at least some credibility among the people there is UNRWA, which has been defunded.

My other concern was about refeeding syndrome - the physiological and metabolic changes the body implements to deal with starvation are in some ways incompatible with eating. Your blood chemistry gets all messed up - and in this state, eating can kill you. The wiki has a pretty clean explanation of the mechanism. So even if you could open up the gates and flood food into the Gaza Strip, the mere act of eating will kill more people because they have already been starved for too long.

How much starvation is there? There's actually a measurement for this, the Integrated Food Security Phase Classification. There are 5 phases in this classification - 1 is normal, 2 is "stressed", 3 is "crisis", 4 is "emergency", and 5 is "catastrophe". Currently no one in Gaza is at stage 2 or lower. Meaning that the best fed in Gaza are still in crisis. This makes up 12% of the population. 88% are at emergency level or worse. Fully half of Gaza - over a million people - are so hungry that the only classification beyond that is "died of malnutrition". Even if aid could be delivered - a million people are at risk of death by refeeding syndrome, and maybe even more than that. Refeeding syndrome can be avoided through monitoring of blood chemistry and keeping track of electrolyte levels - but the healthcare system in Gaza has been destroyed after months of bombardment. And there are other health impacts like disease and physical trauma that are still on the triage list. Gaza is a place now where amputation (sometimes done without anesthetic) is so widespread that it would be a public health issue if there weren't more pressing emergencies.

But as I mentioned, it's worse even than I think it is. I'm very privileged. I have never known real hunger. I cannot comprehend what this does to people psychologically. And this state is the one most of us live in. But we don't need to have direct personal experience to know things - that's what science is for. BUT, starvation is so bad that we do not allow it under any circumstances (unless it is Israel killing off Palestinians). You cannot conduct an experiment even on willing volunteers to investigate the impacts of starvation. 

Well at least you cannot do that now, but there used to be a time when you could get away with all sorts of stuff so long as it was "For Science!". Which brings me to the Minnesota Starvation Experiment. Here, 36 young men - carefully selected for physical and mental health - were subjected to 24 weeks of starvation and 12 weeks of refeeding (although still at greatly reduced calories). A third of them had an additional 8 weeks of observed unrestricted eating after the program. You can read more about it here.

The impacts are nuts. And this is with people who knew they were in an experiment and that their lives would be returning to normal afterwards (their lives did not return to normal). Who weren't being subjected to round-the-clock bombings or being hunted by drones and IDF patrols. The title of this post is about one guy who cut three of his fingers off during the refeeding phase. Starvation breaks people's minds. And that's what's happen to literally millions of people right now.

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