In Gaza, we’re struggling to reintroduce food to the starved

Displaced Palestinians wait in long lines for a charitable meal under crowded tents in Khan Yunis, Gaza, on October 21, 2025, as food scarcity worsens under Israel’s ongoing siege. (ABDOLRAHMAN RASHAD / MIDDLE EAST IMAGES)

In a lesson learned from Nazi concentration camps, a sudden influx of nutrients after famine can cause spikes in blood glucose and fatal electrolyte imbalances.

By Hend Salama Abo Helow, Reposted from Truthout, January 21, 2026

Death in Gaza isn’t limited only to drones, gunfire, artillery shelling, infectious diseases, or the grinding famine. It can come, too, from the very act of eating, after a prolonged period of starvation. Malnutrition has already claimed hundreds of lives, yet in Gaza, even food can kill.

Since October’s ceasefire, which meant Israel would allow some — but not nearly enough — aid trucks to enter our besieged Strip, people in Gaza have desperately been eating, whenever possible, what they had been deprived of previously. Yet, as a result, many have developed “refeeding syndrome,” which is a serious medical condition. It is treatable, but it is fatal if not properly managed. Refeeding syndrome occurs when food is suddenly reintroduced after a prolonged period of starvation — and Israel has subjected those of us in Gaza to such periods on multiple occasions.

Israel tightened the noose of its blockade on Gaza in March of 2025, after breaking a ceasefire that had gone into effect in January. Under the new blockade, Israel prevented aid trucks from entering with food supplies and urgent medical equipment, pushing already exhausted civilians to the brink of total collapse. As time passed, the signs of famine spoke louder than any rhetoric attempting to debunk it as an “orchestrated lie.” Bodies began to shut down. Organs failed. Weights were slashed by half, if not more.

As flour and other carbohydrate-containing foods depleted, people’s bodies began consuming themselves — using stored fat and proteins, which has led to profound muscle loss, respiratory distress, and immune suppression. This was not an isolated plight. It was a humanitarian catastrophe, with its parameters widening day by day.

The crisis grew severe enough to force the Integrated Food Security Phase Classification, the world’s top famine authority, to reassess the manufactured “status quo,” concluding that most of Gaza’s population had reached phase 4 malnutrition and could potentially enter the final phase by September 2025. The warning called for immediate, tangible intervention to halt the irreversible consequences.

Daily entry of at least 600 food trucks and unrestricted access for medical supplies and equipment were among the measures debated during U.S.-brokered ceasefire negotiations, and reportedly accepted in the deal in October. Yet, in the months following the ceasefire, an average of no more than 200 trucks have been allowed to enter per day. This is nowhere near enough for a population that has been systematically starved for months.

The permitted trucks carry secondary products such as soft drinks, instant noodles, chocolate bars, cigarettes, and coffee, many of which are listed on global Boycott, Divestment, and Sanctions (BDS) Movement lists because their companies explicitly support funding genocide and sending weapons to Israel.

This is not incidental, but rather an intentional approach from Israel to make up for the economic losses that have resulted from the global BDS movement, by depriving a famished population of necessities — adequate sources of proteins, carbohydrates, and fats. Flooding markets with snacks instead of grains, eggs, fruits, and vegetables is not an oversight; it is another form of systemic annihilation.

People who had been deliberately starved for so long could not, in the immediate aftermath of the fragile truce, distinguish what was healthy and how to appropriately reintroduce it. They ran out to markets, in fear of any sudden escalation and another bout of deprivation, filling their baskets with whatever was edible.

The random, uncoordinated reintroduction of food into already fragile bodies — often more harmful than nourishing — can lead to numerous severe health complications. It may also result in rapid, unhealthy weight gain over a short span of time, which, in turn, could create the illusion that starvation no longer exists in Gaza — allowing the world to turn its back with a fleeting sense of conscience.

But rarely does international media look beyond the seeming abundance of food, or toward the dangers it may impose. When the body has fasted for so long, its metabolic adaptation shifts: Intracellular electrolytes become profoundly depleted, and the body turns to gluconeogenesis — producing urgently needed glucose from non-carbohydrate sources. Once refeeding begins, the sudden influx of nutrients causes a sharp rise in blood glucose levels.

In response, the body increases insulin secretion as a countermeasure. This insulin surge drives phosphorus, potassium, and magnesium rapidly into the cells, resulting in hypophosphatemia (reduced phosphate levels in the blood), hypokalemia (reduced potassium levels in the blood), and hypomagnesemia (reduced magnesium levels in the blood).

These electrolyte shifts impact the body severely. Hypokalemia and hypophosphatemia may lead to cardiac arrhythmias — irregular heart rates — as well as weakness, profound fatigue, hypotension, renal failure, pulmonary edema, and respiratory distress, which can be fatal. Hypomagnesemia, in turn, may result in losing body equilibrium, convulsions, and depression.

In addition, thiamine deficiency is deeply linked to refeeding syndrome, contributing to mood disturbances, cardiac dysfunction, memory impairment, and ophthalmoplegia (paralysis of eye movements).

I spoke with Shaimaa Bashir, a clinical nutritionist working with one of the NGOs in the field, about refeeding syndrome and its possible progression in Gaza. She said that, recently, “The signs have been clearly appearing among children over the age of 5.”

“Most emergency nutritional interventions during starvation focused mainly on children under 5, by providing supplementary and therapeutic food, and then placing them on diet plans once food started to flow,” she said. “This may, in one way or another, expose the children older than 5 to be at higher risk of falling into refeeding syndrome, compared to less than 5.”

Among 17 cases admitted to the Stabilization Center (a specialized unit run by the NGO that Bashir works with that is designed to treat unstable malnourished patients), “five presented with edema and tachycardia,” she added. “During diet planning, we focus on preventing the patient from falling into refeeding syndrome in advance, and we reduce the amount of food delivered if we suspect the child’s condition may deteriorate toward it.”

She paused, then shared one of her patients’ conditions: “A child with severe acute malnutrition, and another health complication, presented in the ICU. He could not tolerate oral feeding, so we introduced nutrition parenterally through TPN [an intravenous feeding method known as Total Parenteral Nutrition] and gradually increased the amount. But once we felt the condition was progressing toward refeeding syndrome, we stopped that plan and reduced the intake immediately.”

Shaimaa emphasized the importance of raising awareness among people on how to navigate nutrition safely and stave off refeeding syndrome. She added, “But we are not only witnessing growing concerns about a refeeding syndrome outbreak; we are also reporting daily on breaking high numbers of patients with celiac disease and malabsorption. This is nothing comparable to what we saw before the genocide.”

Hadeel Awad, a nurse working at Al-Shifa Medical Complex, said bluntly, “Many of the cases admitted to the hospital — most of them under the age of 20 — present with paralytic ileus and severe abdominal pain.” This was linked to “the sudden drop in prices and the flooding of markets with products, which pushed people to buy large, uncoordinated quantities without checking expiration dates.”

“These starved people have long been deprived of basic nutrients like eggs and meat,” Awad went on, pointing out that their new diet consisted largely of newly imported snack foods. She paused, then added: “We started recording an unprecedented number of new cases of diabetes mellitus.”

She continued: “I remember vividly how catastrophic the conditions were during the famine. It did not spare us — the healers who are supposed to deliver care.”

“Many people were surviving almost entirely on canned foods, loaded with preservatives, which will leave a grave impact on their health,” she said. “There is a nutritional gap between the lethal famine and the ongoing irregular abundance, which paved the way for refeeding syndrome.”

The American Society for Parenteral and Enteral Nutrition (ASPEN) has established guidelines that doctors can use to help patients carefully conserve calories, replenish their electrolytes, and ensure constant monitoring of vital signs. Yet, in Gaza’s ill-equipped health care system, applying such measures becomes nearly impossible, as they are layered onto myriad other unaddressed medical crises.

I myself, a genocide survivor and medical student, am not immune from the growing rise of health crises. These are not incidental outcomes; they are structural consequences of two years of ruthless carnage, the inhalation of toxic residues, phosphorus bombs, pollution, and famine. The war may have ended in headlines and behind closed negotiations rooms, yet many wars are still unfolding. Our bodies’ homeostasis has been disrupted.

Back in January, when I first bit into a Snickers chocolate bar after more than a year and a half of deprivation, I developed an allergic reaction and have not tasted it since. Weeks ago, when I reintroduced milk into my diet after a long shortage, I developed another allergy. It seems my body’s own environment has been profoundly altered over the past two years. None of us will truly survive this unscathed.

My 3-year-old nephew, Jawad, who was only a few months old when the genocide began, never had the chance to know what normal life looked like, nor what nutritious food tasted like. When his parents brought fruits home shortly after markets were flooded again, he threw the apple away, thinking it was a “ball,” and was too afraid to touch the banana.

Israeli propaganda has maimed entire generations, inflicting life-long diseases on both the elderly and the young. For children, it has reshaped the mindset itself — forcing them to believe that the rattling of drones is bird’s chirping, that starvation is a lifestyle, and that suffering is the norm.

Although the starvation policies, and the continued denial of nutritious food, perpetrated by Israeli forces have inflicted devastating effects today, these tactics were first employed long ago. In the aftermath of the 2008-2009 war, Israeli forces used a “calorie count” policy, aimed at minimizing the amount of food entering Gaza without allowing the population to starve to death outright. It was never meant to sustain life. It was meant to harm, to erase, to kill, to torture, and to dehumanize Palestinians.

These death-making policies did not begin on October 7, 2023. They are the continuation of decades of racial colonial occupation.

Hend Salama Abo Helow is a researcher, writer and medical student at Al-Azhar University in Gaza. She is also a writer with We Are Not Numbers and has published in the Washington Report on Middle East Affairs, Institute for Palestinian Studies, Mondoweiss and Al Jazeera. She believes in writing as a form of resistance, a silent witness to atrocities committed against Palestinians, and a way to achieve liberation.

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