The tipping point has already occurred, unfortunately, for a large number of children and infants and toddlers and adolescents â these are definable age categories where the level of starvation and malnutrition has passed the tipping point, where July already saw a large escalation in the number of deaths but August is going to be significantly higher because a lot of the children have already passed the point of no return where their physiology has eroded to the point where even refeeding could potentially cause death itself. The gut lining has started to auto-digest and it will no longer have adequate absorptive capacity for water or for nutrition. Death is unfortunately imminent for probably thousands of children.
In August and September, there are probably still going to be extremely high lethality and large numbers of deaths because children have already passed the tipping point. If we start getting in large quantities of the correct formula and the correct protein and food in general, we may be able to decrease deaths in late September, October and going forward. Thereâs an international gradation called the âglobal acute malnutritionâ score or GAM â weâre already at greater than 15% [of Gazaâs 1 million children meet that criteria]. Severe acute malnutrition, between 5% and 10% of children already meet that criteria. Then for moderate acute malnutrition, 20% of the children under 5 meet this.
When I was in the emergency department, I spent most of my time in the resuscitation room where we were taking care of complex, unstable trauma patients. For adults, the average body fat percentage was probably 1%, if that; really, many of them were skeletal. We were doing emergency surgical procedures on people where all of the ribs were completely showing â there was no problem getting between ribs to put in chest tubes.
Trauma in this environment is a chronic illness so we would see people with acute severe injuries who were already healing from injuries that occurred three months ago. So we would see people that had a chest tube who on the other side you could see they had a festering wound from a chest tube they had had months earlier ⊠due to the lack of nutrition and the lack of protein, [including] albumin, which is critical for healing wounds. Even if youâre not injured, walking around in this destroyed environment, you get cuts and scrapes all the time. So people just were covered in minor cuts and scrapes that were not healing; they had secondary infections and no clean water to wash their wounds.
We had so many family members who would show up with patients that had acute traumatic injury but the family members themselves were almost incoherent, where they were malnourished to the point where they couldnât speak and think properly. They were stumbling and falling and passing out.
This was a residency training program but really the residents were running the show because the senior attendings are very few and far between â a lot of them have been killed or are missing. In the past, they were paid a little bit of money every three to four months but it is not enough; their families are starving.
These physicians were being fed a small amount of food once a day. Three weeks ago, that stopped. They are now completely on their own. There have been physicians and nurses who have simply passed out in the middle of the emergency department; there are people passing out during surgery. This is a completely new phenomenon in the last three weeks. When we were there, every person on our team lost between 12 and 15 pounds.
Nothing but a trickle [of aid] has made it into Gaza from March to the time I left⊠And these so-called aid distribution points [set up under the U.S.- and Israeli-supported Gaza Humanitarian Foundation, established earlier this year and defended by Israeli troops and American military contractors] â it was like clockwork: 30-40 minutes after they started a distribution, we would just hear ambulances and cars flying in, we would receive many, many patients after these things. [The GHF denies enabling violence.]
One of the things I thought was really remarkable was how young the people were coming in from these. These were young boys who were being heroic and going to these things despite the knowledge that they were a shooting gallery. I canât tell you how many boys between the ages of 8 and 18 I saw with a bullet wound directly between the eyes, the forehead or the side of the temple.
It was almost like they were changing the game sometimes because weâd get all head injuries, then weâd have several hours or a day of all neck injuries, or all chest. Or all groin injuries which are particularly terrible, because there are major blood vessels everywhere; people often bleed out, they usually have a fairly slow death and injure the bowel or the rectum so there are feces-soaked injuries which are extremely painful and difficult to manage. [The IDF maintains that it respects the laws of war and minimizes harm to civilians.]
Past âThe Point Of No Returnâ: Doctor Gives On-The-Ground Insight Into Starvation In Gaza
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