Q&A: In Gaza City, extreme heat and hunger create deadly mix

LONDON - More than half a million people in Gaza are enduring famine, a global health monitor said on Friday, adding that widespread starvation is likely to spread over the next month.

The Integrated Food Security Phase Classification system said 514,000 people - nearly a quarter of Palestinians in Gaza - are experiencing famine and that was due to rise to 641,000 by the end of September.

Israel dismissed the report as "false and biased".

U.N. Secretary-General António Guterres described the famine as "a man-made disaster, a moral indictment – and a failure of humanity itself".

Context spoke to Caroline Willemen, project coordinator for Doctors Without Borders, or Médecins Sans Frontières, in Gaza City after the famine announcement.

What does the declared famine look like in Gaza City?

I've been here nearly two months and for over a month we've been seeing very worrying increases in the malnutrition programme that we have as part of our primary healthcare centre here. We are now at over five times more patients on that programme than we had in May. It's only children between six months and five years, and pregnant and lactating women. We are talking about 1,650 patients in total on the programme. We see both moderate acute malnutrition and severe acute malnutrition. We do not do in-patient treatment of the most severe patients, but we do see patients that we desperately have to refer to in-patient treatment and often struggle finding beds.    

Are you able to get enough supplies to treat these people?

At the moment, we have a bit more breathing space. Until very recently, it was a constant struggle, always thinking how soon will we run out. Now we have been able to secure some more supplies so it's less of an immediate worry. 

The number of patients is also increasing, not only because more patients enrol, but also because they are so slow in being discharged because they are not gaining enough weight.

I will say the situation in the market has improved a little bit in the last few weeks, but the food is not reaching everyone and people who do not have access to cash, which is many people, will still not be able to get food. Also, for people with money, it's very expensive. 

This links to the mass casualty incidents we're seeing. There are trucks from the World Food Programme entering the Zikim border crossing (in northern Gaza) and desperate people continue to go there. They know very well the risks they take, but if you don't have food, you don't have food. 

Last week, I spoke to a 14-year-old boy who had been shot in the leg at the Zikim crossing. A month ago, his 11-year-old brother was killed in a similar incident. And now the 14-year-old has a shattered upper leg. The kids go without telling their parents because they are hungry and it is the only solution they have. 

Another patient was a 30-year-old father of two very young children who said he could only feed them a few spoonful's of soup for two weeks so he went to Zikim. He was shot in the back and in the arm and his arm was amputated.

So people go to get food and they come back missing a limb if they come back at all. That says a lot about the desperation that still exists even if we do see some food in the market.     

Given that we are expecting Israel to expand operations around Gaza City, how does hunger and malnutrition affect doctors' ability to treat other injuries? 

The medical team tells me (patients) are not healing as quickly as they should be healing because their bodies are lacking nutrients to be able to heal.

And there is increased displacement because the increase in strikes has already started. People are tired and hungry and mass movement will be extremely difficult in a place where transport hardly exists. There's hardly any fuel. You see the donkey carts, you see people sitting on the hoods of cars.     

How is extreme heat affecting the people?

We've had two heatwaves including last week. It's a huge issue for access to water. When it gets that much hotter it's not possible to give enough water to people. 

And with the hunger comes weakness and with the extreme heat comes weakness. My colleagues are affected too. When it's that hot they come to work not having slept and often they come not having eaten, or not having eaten enough. The healthcare workers are affected in the same way as everybody else.

Does today's announcement give you any hope for change?

In all honesty, it's very difficult to be hopeful because we have been shouting about this for weeks and not only MSF. It is good to have another scientific voice, but so far we have seen very little result. What we need first and foremost is an immediate and sustained ceasefire. 

We need aid as well, but the ceasefire would reduce the number of new patients, would mean that people don't live in fear and then yes, they need food, water and everything else. 

This interview has been edited for clarity and brevity.

(Reporting by Clar Ni Chonghaile; Editing by Jon Hemming.)