Childhood under siege: battling malnutrition, disease, and despair during genocide in Gaza

Abstract

Background

Since 7 October 2023, Gazan children have been enduring a catastrophic humanitarian crisis marked by severe malnutrition, rampant disease, and overwhelming psychological distress as a result of the Israeli deliberate policies that restrict access to food and essential services, compounded by the systematic destruction of agricultural, healthcare, and water infrastructure under a crippling blockade.

Aims

This study aims to document and analyze the multifaceted impacts of conflict-induced deprivation on the health and development of these vulnerable children, highlighting how state policies exacerbate food insecurity and hinder effective healthcare delivery.

Methods

Employing a qualitative approach, thirty semi-structured interviews were conducted with displaced Gazans in Rafah camps; the data, gathered in Arabic and transcribed for analysis, were examined using thematic content analysis to identify recurring themes related to malnutrition, disease outbreaks, unsafe living conditions, weakened immune systems, and limited healthcare access.

Results

The analysis revealed that children are suffering from widespread malnutrition leading to stunted growth and cognitive deficits, compounded by outbreaks of infectious diseases in overcrowded, unsanitary shelters, and further endangered by unsafe environments marked by bombed infrastructure and contaminated water; these factors, along with a deliberate collapse of healthcare services, create a cycle of deprivation and despair.

Conclusion

The findings confirm that the crisis in Gaza is a deliberate outcome of the Israeli policies designed to undermine civilian survival, necessitating immediate humanitarian intervention, strict adherence to international humanitarian law, and comprehensive policy reforms to restore access to essential resources, halt the intergenerational transmission of trauma, and rebuild a resilient future for Gazan children.

Introduction

The Gaza Strip has been enduring a relentless surge of violence and an escalating humanitarian crisis since 7 October 2023. As of May 2025, over 51,000 Palestinians have been killed and 115,688 injured, with the majority being women and children [1]. Israeli military operations, combined with the ongoing blockade, have resulted in widespread displacement, the destruction of 90% of homes and infrastructure [2], the targeting of healthcare facilities, the growing sanitation crisis, and significant restraints to humanitarian access. These circumstances have disproportionately devastated all Palestinians, particularly children who are now facing striking levels of malnutrition.

The Israeli systematic destruction of agricultural infrastructure, including the bombing of farmland and the contamination of soil and water supplies, has crippled local food production. Gaza’s dependency on imports, tightly controlled under the blockade, ensures that 96 per cent of the population face acute food insecurity [3]. Reports from humanitarian organizations reveal that most households survive on only one meal per day, often consisting of canned goods or bread, with children skipping meals entirely so others in the family can eat [3, 4]. On 8 November 2024, the IPC Famine Review Committee issued an alert warning that famine is imminent, particularly in the northern Gaza Strip [5]. The classification of “famine” indicates that one in five households experiences severe food scarcity, and one in three children suffers with acute malnutrition (i.e., a nutritional deficiency caused by either inadequate energy or protein intake [6].

The blockade has escalated malnutrition to emergency levels, with acute malnutrition rates among children under two rising dramatically from 0.3 to 15.6%. Of these, 3% suffer from severe wasting, the deadliest form of malnutrition where a child’s immunity is compromised by severe food deficiency and repeated bouts of diseases including diarrhoea and malaria [6]. 28 children have died due to malnutrition and dehydration in the first 6 months of the war [7]. The lack of access to nutritious food undermines cognitive development and immune responses, creating a dangerous cycle of vulnerability to disease. In March 2024, at least 90 per cent of children under five were found to be suffering from one or more infectious diseases while 70 per cent have diarrhoea [8]. Moreover, Pregnant women suffer from dehydration and malnutrition resulting in a high prevalence of low birth weight and health complications among newborns [9, 10]. According to the United Nations International Children’s Emergency Fund (UNICEF) report in December 2024, over 96% of Gaza’s women and children are unable to meet their basic nutritional needs, surviving on a limited diet that undermines their health [11]. Moreover, the undernutrition of breastfeeding mothers has gravely compromised lactation, leaving mothers unable to breastfeed. Consequently, families are forced to rely on unsafe and improvised alternatives, such as feeding infants dates wrapped in gauze and biscuits soaked in water, for lack of any milk [12]. These conditions not only threaten immediate survival but also set the stage for long-term health and developmental challenges [7].

The use of starvation as a weapon of war contravenes international humanitarian law, as stated in the Geneva Conventions [13]. Yet, as Devereux notes, such practices persist in conflict zones where food access is used as a tool for control and displacement [14]. The deliberate deprivation of Gaza’s children is not merely a byproduct of war but a calculated strategy aimed at undermining the population’s future. On October 9, 2023, Israel Defense Minister Yoav Gallant announced “a complete siege on the Gaza Strip… no electricity, no food, no fuel, everything is closed and cut off… We are fighting human animals, and we act accordingly” [15]. Such a policy has disproportionately affected Gaza’s youth who make up 47% of its population [7]. As of April 5, 2025, over 17,000 Palestinian children have been killed in Gaza since October 7, 2023 [16], and over 600,000 children are deprived of education, living in constant fear amidst genocide [17]. In one of South Africa’s requests to the International Court of Justices (ICJ) for urgent provisional measures to save Palestinians from starvation, South Africa asserts that Israel’s deliberate acts of starving Palestinians breach the Convention on the Prevention and Punishment of the Crime of Genocide [18]. Israel’s attempts to starve people include restricting and even denying humanitarian aid into the Gaza Strip, attacking Palestinian civilians seeking aid, and opening fire on humanitarian aid convoys [8]. In one of the deadliest Israeli attacks in Gaza called the ‘flour massacre’, Israeli forces killed 118 Palestinian who were desperately striving to get flour amid extreme hunger and injured 760 others [18].

Coupled with starvation, the collapse of Gaza’s healthcare and water infrastructure has unleashed a secondary wave of suffering in the form of preventable diseases. Israel has weaponized the destruction of infrastructure as a means of exerting control over Gazans, achieving military objectives and securing concessions from Palestinian resistance groups. In fact, Israeli authorities have engaged in collective punishment of Gaza’s population by deliberately targeting and destroying critical infrastructure, blocking the entry of fuel and food, and obstructing the efforts of humanitarian agencies [19]. Even prior to October 7, 2023, Israel authorities had imposed restrictions on the entry of dual-use imports, including construction materials and essential equipment necessary for water and sanitation projects [20]. These measures have severely undermined the quality of basic services; before the war, 97% of Gaza’s water was deemed unfit for human consumption, and the current situation has further deteriorated leaving most Gazans with little to no access to clean water [21]. The destruction of water treatment plants and sanitation systems has contaminated drinking water, leading to widespread outbreaks of waterborne diseases such as cholera, typhoid, and gastroenteritis [22]. Children, with their weakened immune systems due to malnutrition, are disproportionately affected, experiencing higher mortality rates from these preventable illnesses. 90% of Gaza’s children lack access to clean water, and families in displacement shelters often receive less than 1.5 L of water per person per day—far below the minimum survival threshold [23]. Long lines of children and women waiting for water in overcrowded shelters underscore the dire conditions. Hygiene facilities are almost nonexistent, with reports indicating that approximately 500 individuals share a single toilet [24]. These dire conditions have compelled many people to resort to open defecation, which exacerbates the spread of infectious diseases.

The environmental degradation caused by the war further compounds these health risks. The bombing of agricultural areas has led to “ecocide,” contaminating water sources and increasing soil toxicity [25]. These conditions create fertile ground for respiratory infections, skin diseases, and vector-borne illnesses, all of which disproportionately affect children [26]. The accumulation of waste in urban areas, coupled with decomposing bodies buried under rubble, adds to the risk of epidemics, making the living conditions in Gaza a breeding ground for catastrophic health crises [27].

Already strained from a death toll of at least 51,000 Palestinians and 115,688 injuries reported between October 7, 2023, and April 2025 [1, 28], Gaza’s hospitals and clinics have been systematically targeted, rendering much of the healthcare system inoperable [29]. After 15 months of the aggression on Gaza, only 17 out of 36 hospitals remain partially functional while more than 1,000 healthcare workers have been killed [30]. The destruction of the healthcare system, coupled with the collapse of sanitation infrastructure and the systematic deprivation of food, has resulted in a rapid spread of disease and malnutrition, exacerbating the humanitarian crisis further.

The physical devastation in Gaza is paralleled by a profound psychological toll on its children, whose formative years are marked by hunger, illness, and the constant threat of violence. Hunger itself exacerbates psychological distress, with studies showing a direct correlation between food insecurity and deteriorating mental health [31–33]. Children in Gaza exhibit signs of acute trauma, including anxiety, depression, and behavioral disorders, which are compounded by the inability to access adequate nutrition or healthcare [34]. Ted Chaiban of UNICEF warned of the intergenerational impacts of the current nutrition crisis, stating that the effects of malnutrition during critical developmental years will haunt Gaza’s children for the rest of their lives [35]. Mothers, already burdened by extreme stress, struggle to provide emotional support in the face of starvation and displacement [36]. This psychological strain is transmitted to children, creating a feedback loop of despair that impacts familial and community resilience.

The social fabric of Gaza is further eroded by the conditions in displacement shelters, where overcrowding and the lack of basic amenities exacerbate feelings of hopelessness [37]. The devastating impact of the war on Gaza has severely disrupted its security, economy, and social fabric, compromising the fragile stability and civil harmony that existed before the conflict. The challenging conditions of the war endorse alienation among Gaza’s youth and fracture the society, weakening its sense of unity and national awareness [38]. Families are forced to prioritize survival over education, play, and other developmental needs, depriving children of the stability and security necessary for healthy growth. Furthermore, between October 7, 2023, and August 2024, more than 17,000 children in Gaza are unaccompanied or separated from their families due to mass displacement, arrests and fatalities, with family reunification efforts being obstructed [39]. These children are at high risk for mental health issues, child labor and exploitation [40]. Previous research indicates that children in war zones experience traumatic events that affect their social skills, mental and physical health, and cognitive and literacy development [41].

International aid has struggled to meet the scale of the crisis in Gaza. United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) and other humanitarian organizations have faced significant challenges in delivering food and medical supplies due to the blockade and targeted attacks on aid workers [42, 43]. Trucks carrying essential supplies are often delayed or blocked entirely, leaving their contents to spoil while families starve just miles away [44]. The politicization of humanitarian aid, coupled with legal restrictions on assisting populations in territories controlled by designated terrorist organizations, has further hindered relief efforts. According to the Inter Agency Standing Committee (IASC), humanitarian organizations have to consider providing humanitarian aid while complying with counter-terrorism and sanctions regulations. Humanitarian groups face legal and operational challenges working in regions affected by counter-terrorism measures such as the Gaza Strip [45]. As of April 2024, the aid reaching Gaza met less than 12% of daily caloric needs [4], a figure grossly insufficient to prevent famine. While global organizations call for an expansion of aid routes and the lifting of the blockade, the lack of political will continues to exacerbate the crisis. The consequences for Gaza’s children are devastating, as they face starvation, disease, and psychological trauma with little hope of reprieve.

Despite extensive documentation of Gaza’s humanitarian crisis, no integrated analysis has examined how malnutrition, the collapse of water and sanitation systems, and the breakdown of healthcare services jointly affect the physical growth and psychosocial well-being of displaced children. This study therefore aims to (1) assess acute and chronic malnutrition among children under five in displacement shelters, (2) evaluate the relationship between water and sanitation system damage and the incidence of nutrition-sensitive diseases, and (3) explore caregivers’ perceptions of their children’s health and resilience.

Methods

Sampling

We employed purposive, maximum-variation sampling within Rafah’s displacement camps. Two research assistants—students from Gaza displaced in Rafah, studying clinical psychology at An-Najah National University online due to the destruction of universities and schools—compiled a registry of 45 households with at least one child under eighteen, drawing on camp records and community networks. Each household was visited in person to explain the study’s aims and procedures and to confirm that the adult caregiver (a) was at least 18 years old, (b) had been displaced to Rafah since October 2023, (c) served as the biological or primary caregiver of at least one child under eighteen, and (d) spoke fluent Arabic. Of the 45 caregivers approached, 30 consented to participate (67% response rate). To capture a broad range of experiences, we interviewed only one caregiver per household—no two participants were drawn from the same family—and balanced gender evenly (15 women, 15 men). To be included in the study, participants must meet the following criteria: displaced women living in internally displaced camps in the Rafah region and native Arabic speakers. Furthermore, individuals with severe hearing or speech impairments that would hinder meaningful participation, as well as those experiencing acute psychological distress at the time of recruitment, were excluded. Such individuals were immediately referred to mental health services and not enrolled in the study.

Data collection

Interviews were conducted using a semi-structured guide covering four key domains: strategies for securing food and water; barriers to healthcare and sanitation access; exposure to environmental hazards and shelter conditions; and psychosocial and developmental impacts on children. Sample prompts included: “Describe your daily process for finding and preparing food for your family,” “What challenges have you faced when seeking medical care for your children?” and “How have camp conditions affected your child’s behavior or schooling?” All sessions were led by the same team of students from Gaza displaced in Rafah, studying clinical psychology at An-Najah National University online due to the destruction of universities and schools, each trained in trauma-informed interviewing. Before each interview, participants provided written informed consent for both participation and audio-recording; consent forms emphasized confidentiality, voluntary participation, and the right to pause or withdraw at any time. Interviewers were gender-matched to participants (female interviewer with female participant; male with male) to foster comfort when discussing sensitive topics. Sessions lasted 35–60 min (mean ≈ 50 min) and took place in private rooms within shelter schools, with field teams ensuring auditory privacy and participant safety. Interviews were audio-recorded, transcribed verbatim in Arabic, and supplemented by detailed field notes capturing nonverbal cues and contextual details. Ethical approval was obtained from the An-Najah National University Institutional Review Board (IRB) under protocol Mas.Dec.2024/12, and immediate referral pathways were established to support any participant experiencing distress.

Data analysis

The qualitative data collected through semi-structured interviews were initially in Arabic and were subsequently translated into English for analysis. The translation was carried out by authors, who are fluent in both Arabic and English and have experience in translating academic texts. To ensure the accuracy of the translation, several quality control measures were implemented. First, a sample of translated quotes was back-translated into Arabic by a bilingual researcher, and any discrepancies were discussed and resolved. Additionally, the translations were reviewed by a bilingual expert in Arabic-English translation to ensure linguistic and cultural accuracy. The research team conducted multiple rounds of review to ensure that the nuances of the original data were preserved. In terms of thematic analysis, the translated transcripts were analyzed based on Braun and Clarke’s thematic analysis framework [46]. The researchers familiarized themselves with the data by reading the translated transcripts multiple times, followed by open coding to identify key themes. This analysis was conducted manually to support the organization of codes. Throughout the analysis, the researchers worked to ensure that the cultural and linguistic nuances of the original Arabic data were preserved in the translation and analysis process.

We identified meaningful segments of text and created initial codes inductively, based on the data itself. Following this, we grouped similar codes into broader categories, or potential themes, through an iterative process. For example, one of the main themes that emerged was “Widespread Malnutrition.” As themes began to emerge, they were refined through multiple rounds of discussion among the research team to ensure they accurately represented the data. Themes were then finalized by revisiting the coded data to ensure coherence and alignment with participants’ responses. Throughout this process, we kept detailed documentation of how codes were applied and how themes evolved, ensuring transparency and consistency.

Data collection proceeded until thematic saturation was reached, the point at which no new themes emerge from further observations and analysis [47]. Throughout the coding process, saturation was evaluated iteratively by the researchers through recurring reviews of the transcripts and codes. All of the major themes had been consistently identified by the 25th interview while the final five interviews (26–30) confirmed the consistency and redundancy of those thematic patterns. The operationalisation of the saturation reflected the findings of Guest et al., who suggested that the majority of themes emerge early in the analysis and that thematic saturation could be achieved in the first twelve interviews due to the study’s relatively homogeneous participant group and targeted research questions [48]. Therefore, extending the sample size to 30 participants allowed to capture both common and less frequent experiences adequately, supporting the thematic findings’ depth and reliability.

Coding reliability

A random selection of transcripts was independently coded by the researchers to establish inter-coder reliability, with coding disagreements resolved through discussion until consensus was reached.

Results

Thematic content analysis of the interview transcripts led to the identification of five main themes. First, Widespread Malnutrition. Second, Diseases and Epidemics in Shelters. Third, Unsafe Environments. Fourth, Weak Immune Systems and Growth. Fifth, Inaccessibility of Healthcare. Sixth, Daily Struggles for Basic Needs.

Theme one: widespread malnutrition

1 A: scarcity of nutritious food

Malnutrition is one of the most harrowing outcomes of the war, leaving many children in Gaza physically frail and stunted. Participant 1 described the bleakness of their diet: “My children eat bread and tea every day. They don’t know the taste of fruits or vegetables anymore.” Participant 25 shared, “My son asked me why he’s always hungry. I could not tell him it’s because we can’t afford food.” High food prices exacerbate the issue, with Participant 3 noting, “An egg costs as much as a full meal used to. Feeding my family is an impossible task.”

1B: visible physical deterioration

The impact of this food insecurity is visible in the children’s appearances and behaviors. Participant 1 observed, “My daughter is so thin; you can see her ribs. She does not have the energy to play anymore.” Participant 4 shared a heartbreaking anecdote: “My son said, ‘Mama, I won’t eat today so my sister can have more.’” This selflessness among children underscores the severity of their deprivation. Participants 3, 5, 17 and 20 also worry about the long-term effects. “They’ve stopped growing,” Participant 6 lamented. “My eldest wears the same clothes she did two years ago.”

1 C: food-related emotional distress

Malnutrition not only robs children of physical strength but also damages their emotional well-being. Participant 10 shared, “My son said he wishes he could eat like his friends in other countries. He feels like he’s being punished for something he did not do.” Participant 21 added, “They cry when they see food on TV. It is a cruel reminder of what they don’t have.” The lack of proper nutrition in Gaza has created a generation of children who associate food with anxiety and despair.

Theme two: diseases and epidemics in shelters

2 A: skin and respiratory infections

Overcrowded shelters in Gaza have become hotbeds for disease, with children bearing the brunt of the unsanitary conditions. Participant 16 described the situation: “Skin infections and rashes are everywhere. I have used every home remedy I can think of, but nothing works.” Respiratory illnesses are equally rampant, with participant 8 sharing, “The damp air and dust in these shelters are suffocating. My youngest coughs all night.” These illnesses spread rapidly due to the cramped living conditions. “If one child gets sick, it’s only a matter of time before everyone else does,” participant 11 noted.

2B: inadequate sanitation facilities

The lack of adequate sanitation exacerbates these health issues. Participant 15 explained, “We share one broken toilet with dozens of people. The stench is unbearable, and my children refuse to use it, but they have no choice.” Participant 1 highlighted the psychological toll: “My daughter cries every time she has to go. She says, ‘Mama, I feel dirty all the time.’” The absence of proper hygiene facilities creates a cycle of illness and despair. “There’s no soap, no clean water, no privacy. How can we keep our children healthy like this?” participant 28 asked.

2 C: Illness-linked psychological trauma

Diseases in shelters are not limited to physical ailments but extend to mental health as well. Participant 5 recounted, “My son has nightmares every night. He tells me he is scared of dying from sickness.” The shelters, meant to be safe havens, often become sources of further trauma. Participant 19 shared, “The children here are exposed to constant suffering. They see their friends getting sicker and wonder if they’re next.” The overcrowded and unsanitary conditions have turned these shelters into spaces of relentless hardship for Gaza’s children.

Theme three: unsafe environments

3 A: physical hazards

The war-torn environment of Gaza poses constant physical dangers to children, from rubble-strewn streets to polluted water. Participant 3 shared, “My daughter tripped over debris and cut her leg. We could not find a clinic to treat her, and now the wound is infected.” Participant 22 described the perils of unexploded ordnance: “A boy in our neighborhood lost his hand picking up something he thought was a toy.” The lack of safe spaces has left children vulnerable at every turn. “They play among ruins because there’s nowhere else to go,” participant 4 noted.

3B: contaminated water sources

Polluted water sources further compromise children’s health. Participant 15 explained, “We drink water that smells foul. My children constantly complain of stomach aches.” Participant 30 shared, “We don’t even have clean water to wash their wounds. Every scrape becomes a potential infection.” The scarcity of safe drinking water forces families to make impossible choices. “Do we let them drink this water or let them stay thirsty?” Participant 7 asked. This exposure to contaminated water exacerbates the health crisis in Gaza.

3 C: loss of sense of safety

The physical environment also leaves emotional scars. Participant 4 shared, “My son refuses to leave the house because he’s scared of stepping on something dangerous.” Participant 9 added, “My children cry every time they hear a loud noise. They think it is another bomb.” The constant exposure to danger has stripped children of their sense of safety. “They have lost the ability to feel secure,” participant 2 observed. The unsafe environment in Gaza not only endangers children’s bodies but also shatters their spirits.

Theme four: weak immune systems and growth

4 A: comprised immunity

Years of malnutrition and inadequate healthcare have left Gaza’s children with weakened immune systems, making them susceptible to preventable illnesses. Participant 14 shared, “My son has been sick for weeks. Even a simple cold becomes life-threatening here.” Participant 20 noted, “My daughter’s body does not fight off infections like it used to. She is constantly unwell.” These compromised immune systems are a direct result of prolonged nutritional deficiencies. “They haven’t eaten properly in months. How can their bodies recover?” Participant 6 asked.

4B: stunted growth and social isolation

The stunted growth of children is another tragic consequence. Participant 24 observed, “My son’s friends are all taller than him now. He feels ashamed and avoids playing with them.” Participant 3 shared, “My daughter does not fit in with her peers because she looks so small and frail.” The social impact of stunted growth further isolates children, compounding their suffering. “They see their bodies as a reflection of their struggles,” participant 12 explained. “It’s heartbreaking.”

4 C: parental fear for future health

Parents also fear the long-term implications. Participant 26 said, “What kind of future will they have if they can’t even grow properly?” Participant 9 added, “I worry that their bodies will never recover. This war has stolen not just their present but their future too.” The physical toll of malnutrition and illness in Gaza will linger long after the bombs stop falling. “They will carry these scars for the rest of their lives,” Participant 18 concluded.

Theme five: inaccessibility of healthcare

5 A: destroyed infrastructure and financial barriers

The destruction of Gaza’s healthcare system has left families without access to even the most basic medical services. Participant 1 explained, “Our local hospital was bombed. Now we have to travel hours to find any help, and even then, there is no guarantee of treatment.” Participant 27 shared, “I sold my wedding ring to buy medicine for my child. It still was not enough.” The financial strain of seeking healthcare adds to the despair. “We can’t afford the treatment they need,” participant 10 lamented.

5B: absence of mental-health services

The lack of mental health support is equally devastating. Participant 3 recounted, “My daughter wakes up screaming from nightmares. There’s no one to help her cope.” Participant 15 added, “The trauma my children have endured is beyond anything I can handle. We need professionals, but there are none.” Even when healthcare facilities are available, they are often overcrowded and under-resourced. “We waited for hours, only to be told they’d run out of medicine,” Participant 9 shared.

5 C: lack of specialised paediatric / maternal care

The absence of specialized care for children is particularly alarming. Participant 30 explained, “Pregnant women give birth in these shelters with no medical assistance. The newborns are so fragile.” Participant 21 added, “Children with chronic conditions are left to suffer. There’s no one to monitor their health.” The healthcare crisis in Gaza has turned minor ailments into life-threatening conditions, leaving parents desperate and children vulnerable. “We’re watching them fade away, and there’s nothing we can do,” participant 2 said.

Theme six: daily struggles for basic needs

6 A: water scarcity and physical labour

The relentless struggle for water, food, and other necessities defines daily life for Gaza’s children. Participant 14 shared, “My son wakes up before dawn to stand in line for water. By the time he’s back, he’s exhausted.” Participant 25 recounted, “My daughter carries heavy containers of water. She’s only nine, but she works harder than most adults.” The physical toll of these tasks is evident. “Their hands are blistered, their backs ache, and they’re always tired,” participant 4 observed.

6B: Erosion of childhood and emotional burden

These daily struggles rob children of their childhood. Participant 16 explained, “They spend their days waiting in lines instead of playing or learning.” Participant 20 added, “My youngest asked me, ‘Is this what life will always be like? ‘I did not know how to answer.” The emotional burden on children is immense. Participant 5 shared, “My daughter told me, ‘Mama, I feel like an old woman already.’” Such statements highlight the premature loss of innocence among Gaza’s children.

6 C: Intra-family tensions and resilience

The scarcity of resources also creates tension within families. Participant 11 described, “We argue over who gets to eat first or drink the last cup of water.” Participant 19 added, “My children fight because there’s not enough for everyone. It breaks my heart to see them turn against each other.” Despite these hardships, Participant 1 finds moments of resilience. “My son said, ‘Don’t worry, Papa. I’ll grow strong even without food.’” These glimpses of hope amidst despair underscore the indomitable spirit of Gaza’s children.

Discussion

The crisis described by the interviewed Gazans highlights a profoundly ingrained system of deprivation, marked by a purposeful state-directed approach intended to diminish the population’s access to essential human necessities. Israeli authorities have deliberately and systematically obstructed Gazans access to essential resources, including water, by cutting off pipelines and destroying water infrastructure [49]. The lived experiences of Gazans highlight a convergence of hardships—from pervasive malnutrition to the systematic dismantling of essential infrastructure—that mirrors the findings of international agencies who labelled Israel’s blockade of humanitarian aid ‘cruel collective punishment’ [50]. Essentially, the experiences of Gazans not only validate but also enrich the evidence by illustrating how intentional policies materialize in daily struggles and prolonged developmental challenges.

At the heart of the crisis lies the issue of pervasive malnutrition, which those in Gaza characterize as a fundamental fight for survival. Residents interviewed consistently indicate severe food shortages, highlighting that the intense hunger faced by more than 82% of the population [51, 52] is not just a result of a broken supply chain but instead the result of deliberate restrictions on food imports and systematic undermining of local agricultural resources. Assessing the severity of the aggression on Gaza’s agricultural sector, it was found that 64–70% of tree crop fields and 58% of greenhouses were damaged by September 2024, with areas like Gaza City and North Gaza having all of their greenhouses damaged and experiencing up to 90% destruction of tree crops [53]. Such destruction of Gaza’s agricultural sector has impacted its food security. These concerning statistics not only reflect the collapse of the humanitarian situation but also mark the strategic deprivation of nutritional resources. Israel’s prolonged blockade and its current deliberate obstruction appear calculated to undermine both the physical development and cognitive well-being of Gaza’s children. Researchers have long recognized the dual effects of malnutrition on development and cognitive ability, and the data coming from Gaza reflects this recognized framework [31, 32]. When integrated with the historical insights, these results indicate the intentional application of starvation as a means of control—an aspect of warfare that goes beyond conventional military tactics by crippling the prospects of upcoming generations [14].

The individual accounts of Gazans provide additional insight into how malnutrition acts as a constant reminder of the systemic disregard they face. Interviewees discuss not only the lack of food but also the mental strain that comes with ongoing hunger—emotions of despair, hopelessness, and a widespread feeling of unfairness. These personal reflections reflect the wider literature that connects food insecurity to adverse mental health effects [33]. A published systematic review found that there is a significant correlation between food insecurity and the risk of depression and stress [54]. This psychological aspect is vital as it emphasizes that the effects of malnutrition go beyond physical weakness to encompass lasting cognitive and emotional deficits. In Gaza, where malnutrition is a constant issue rather than an isolated occurrence, the result is a generation weighed down by enduring developmental deficits and reduced ability to participate in societal recovery. Therefore, the testimonies of persistent hunger and nutritional deficiency provided by Gazans act as a clear, experienced confirmation of the academic and observational data that portrays malnutrition as both a sign and a tactical instrument in the conflict.

Adding to the problem of malnutrition is the breakdown of essential infrastructure—especially in healthcare and water sanitation—which exacerbates the humanitarian crisis further. Those interviewed from Gaza uniformly detail the decline in medical facilities, the lack of clean water, and the regular interruptions to essential sanitation services. These accounts resonate with previous research findings, which indicate that under 10% of children in the area have access to potable water [21, 23]. Additionally, the rise of waterborne illnesses like cholera, typhoid, and gastroenteritis demonstrates the immediate health effects of deteriorating infrastructure [55]. The intentional assault on water treatment facilities and sanitation systems [20, 25]. Rather, it plays a crucial role in a wider strategy aimed at undermining civilian life by removing access to vital services.

The deterioration of healthcare services in Gaza worsens this crisis, as ongoing assaults on hospitals and clinics have resulted in a breakdown of medical care access. A large number of healthcare facilities are non-functional, leaving individuals unable to address both regular and urgent medical issues [28, 30]. Moreover, there is currently no therapeutic support available to Palestinians, as all of Gaza’s mental health centres and hospitals are no longer functioning; they have either run out of medications or been bombed [56]. Therefore, the probability of Gazans enduring tragic long-term psychological consequences is high [57]. Children are particularly vulnerable, having been exposed to extreme violence, the loss of family members, deprivation of shelter and food, and the potential trauma associated with amputations. Children in Gaza are suffering from acute trauma symptoms including mutism, frozenness, seizures, and loss of bladder control [58].

Children living in war zones are known to suffer from long-term psychological distress [59, 60]. Relentless exposure to armed conflict places children at risk of abuse, post-traumatic stress, and developmental disruption [61]. In addition, the destruction of healthcare systems during conflict undermines both the immediate and future survival and well-being of children [62]. In line with these findings, previous research on child health in the Gaza Strip has documented significant psychological trauma and reduced health-related quality of life, particularly affecting emotional and psychosocial functioning. These distresses are compounded by the intergenerational effects of repeated exposures to armed conflict [63–65].

The broader context of Israeli occupation since 1948 has yielded successive wars and aggressions, leaving prolonged psychological scars and fostering intergenerational trauma among Palestinians. Over a decade, social and cultural historian Heidi Morrison conducted oral-history interviews with Palestinians who grew up during the Second Intifada (2000–2005), a major Palestinian uprising against the Israeli occupation. Her research reveals that Israeli occupation’s policies and practices affected children, denying them their childhood and sense of safety. As these participants matured, their trauma was not only immediate but also re-lived and reconstructed in their life stories [66]. Trauma, in this context, extends beyond psychological wounds; it impacts family dynamics and could contribute to the transmission of generational trauma. In this regard, Palestinian professor Nadera Shalhoub-Kevorkian proposes that Israel exploits Palestinian children as “political capital”. She introduces the concept of “unchilding” to describe Israel’s strategic stripping away of childhood from Palestinian children to further political objectives [67]. Palestinian children are systematically constructed as intrinsically violent and a threat to Israel’s security, and are reduced to pawns in negotiations. The current escalations are likely to further exacerbate children’s mental health. Gaza’s children are in critical need of comprehensive, long-term psychosocial support programs.

This dismantling of the healthcare system has significant consequences: minor ailments turn into life-threatening issues, and the overall effect of neglected medical conditions leads to elevated morbidity and mortality rates. In fact, Gaza’s official Ministry of Health underestimates mortality by 41%, underscoring the pivotal impact the collapse of healthcare system on death rates [68]. Along with the immediate physical damage, the failure of medical services intensifies the psychological suffering within the community. Families, observing the reduction in their healthcare access, feel increased anxiety and a diminishing sense of hope for what lies ahead. By April 2025, more than 1,000 attacks on healthcare facilities and personnel had been documented, eroding Gazans’ trust in the medical system [57]. Civilians are left with the bleak reality that getting treated may be futile or dangerous.The legal and operational hurdles faced by humanitarian organizations [45] add to the difficulties in providing essential aid, perpetuating a cycle of neglect and suffering that remains unbroken.

The environmental deterioration highlighted by Gazans introduces an additional layer of complexity to the crisis. Personal accounts often highlight the ongoing presence of dangers like debris, unexploded munitions, and hazardous contaminants. These environmental threats are not merely incidental consequences; they stem from the ongoing military operations that have intentionally converted ordinary areas into hazardous zones. About 5–10% of the munitions dropped since 7 October have failed to detonate, resulting in thousands of unexploded lethal devices scattered around the Gaza Strip, which is now also packed with over 50 million tons of rubble [12]. This substantial contamination leaves much of the enclave uninhabitable and dangerous. The ongoing exposure to these risks can lead to both short-term and prolonged effects on physical and mental well-being [41]. Contact with environmental toxins leads to various health problems, including persistent respiratory conditions and increased susceptibility to additional illnesses, exacerbating the consequences of malnutrition and structural disintegration. In fact, early-life exposure to environmental toxicants can negatively affect immune and lung development [69]. Additionally, the widespread anxiety caused by the ongoing risk of environmental dangers forms a mental obstacle that hinders people from imagining a secure future. This circumstance not only diminishes present welfare but also hinders the capacity for future recuperation and community restoration. Research found a strong correlation between environmental degradation, eco-anxiety, and heightened post-traumatic stress symptoms among Palestinian adults experiencing deteriorating living conditions due to Israeli occupation [70]. These stressors cripple Palestinians’ capacity to plan for the future or engage in restoring the country.

An additional important aspect of the crisis, as highlighted through interviews with Gazans, is the deep effect on the growth and well-being of children. Participants often highlight the noticeable indicators of stunted growth, ongoing health issues, and developmental setbacks in the youngest community members. These findings reflect information from humanitarian organisations in Gaza which record the lasting cognitive and physical impairments linked to early-life undernutrition [71, 72]. Previous research offers a strong theoretical foundation for grasping how nutritional deficiency in crucial developmental periods can result in enduring impairments [31, 32, 73]. These developmental challenges are intensified by the ongoing stress linked to frequent exposure to conflict and environmental dangers—a combined strain that greatly restricts the future opportunities of children in Gaza. The accounts of parents and caregivers show a deep feeling of hopelessness, as they observe directly the lasting effects of extended neglect on their children’s development and general health. This combination of factors suggests that the developmental issues seen in Gaza are not just temporary but reflect a larger strategy intended to reduce the future prospects of a whole generation. Evidence from both historical and contemporary wars reveals that targeting children’s health and development can constitute a deliberate strategy of warfare, presenting as a form of “structural violence” [74] or “slow violence” [75, 76], and resulting in increased mortality, injuries, and psychological distress [77]. The systemic deprivation of children’s essential needs during prolonged aggression can be situated within Nixon’s framework of “slow violence,” which describes a gradual and often normalized harm — typically driven by environmental degradation, deliberate neglect, and policy inaction [78]. Documented patterns in Iraq, Kuwait and Syria support this framework. After the Gulf War (1990–1991), a nationwide cross-sectional study was conducted in Iraq and found a five-fold increase in age-adjusted mortality due to diarrhoea [79]. In Kuwait, a significant increase in congenital heart diseases was found among infants born directly after the Gulf War, proposing environmental pollution and psychological trauma as possible contributing factors [80]. In Syria, the past decade of conflict and displacement has had a long-term impact on children’s health and development. Over 650,000 children under the age of five are stunted because of chronic malnutrition which could cause irreversible damage to their physical, psychological, and cognitive development [81].

Apart from the particular challenges of malnutrition, infrastructure failure, and environmental damage, the everyday fight for essential needs represents the wider lived reality of Gaza’s residents. Gazans interviewed convey that each day turns into a struggle for existence—a relentless endeavor to obtain food, water, shelter, and security in the face of severe hardship. These accounts resonate with the findings of research by the International Rescue Committee (IRC) [39, 40] which illustrate how the ongoing necessity to focus on urgent survival tasks diminishes chances for education, leisure, and community involvement. The ongoing stress related to this survival-focused way of life has been connected to worsening mental health effects, such as anxiety, depression, and post-traumatic stress [31, 33]. This ongoing battle is not a standalone occurrence; it is closely related to the other aspects of the crisis. The exhaustion of essential resources contributes directly to the cycle of malnutrition and health issues, while the ongoing struggle for survival weakens community unity and strength. In this manner, the everyday battle for essential needs appears as both a sign and a catalyst of the larger humanitarian crisis, establishing a self-reinforcing loop of hardship that is hard to disrupt without extensive intervention.

When viewed collectively, the experiences recounted by Gazans present a stark, on-the-ground depiction of a crisis that is intricately connected to established policies of deprivation. The testimonies act as a strong addition to the quantitative information offered by international organizations [3, 6, 8, 11, 20, 35, 52], as well as to the analytical perspectives of researchers [14, 31, 32]. The combination of these varied sources of evidence shows that the crisis in Gaza is not merely a series of isolated events but a deliberate, multi-faceted approach aimed at attacking the essential elements of human existence—food security, healthcare access, environmental protection, and opportunities for development.

Legal and ethical factors further emphasize the seriousness of this situation. International humanitarian law, outlined in the Geneva Conventions and further explained by the ICRC [13], explicitly forbids the intentional use of starvation and the elimination of vital services as tactics in warfare. However, the evidence indicates that these prohibitions are consistently being breached in Gaza. The intentional attack on food resources, medical facilities, and water systems not only violates international standards but also prompts significant inquiries regarding the responsibility of those involved. These violations have extensive consequences, as they cause immediate suffering to the civilian population and undermine the long-term possibilities for peace and stability in the area.

The evidence gathered in this study leaves no doubt that Gaza’s child-health disaster is the direct outcome of an ongoing genocide [82, 83]; every other measure is secondary to ending the assault itself. Only with an immediate, verifiable cease-fire and the lifting of movement and import restrictions can the spiral of hunger, disease, and psychological injury begin to reverse. Once violence stops, an unimpeded humanitarian corridor must deliver food rations that meet minimum survival requirements, therapeutic nutrition for wasted infants, essential paediatric medicines, fuel, and water-treatment chemicals. Simultaneously, the ban on so-called “dual-use” items has to be rescinded so that damaged water-sanitation systems, hospitals, and oxygen plants can be rebuilt without delay.

After emergency access is secured, mobile child-health and mental-health teams staffed by paediatricians, nutritionists, WASH engineers, and trauma specialists should operate inside displacement shelters to provide point-of-care diagnostics, catch-up immunisations, and evidence-based psychological first aid. Restoring routine sentinel surveillance for acute malnutrition, infectious-disease incidence, and trauma symptoms will allow real-time targeting of scarce resources and transparent reporting to donors and rights bodies. Reconstruction agreements must codify the inviolability of schools, clinics, and water infrastructure, with automatic referral to international tribunals for violations, while longer-term recovery should prioritise school-feeding programmes, micronutrient support for pregnant and lactating women, unconditional cash transfers for orphaned households, and trauma-informed teacher training.

Author contributions

B.H. prepared the theoretical background and conclusion sections; F.M. prepared the methodology section; and A.M. prepared the discussion and analysis sections. All authors have read and approved the final version.

Data availability

No datasets were generated or analysed during the current study.

Declarations

Competing interests

The authors declare no competing interests.