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A sudden influx of nutrients after famine can cause spikes in blood glucose and fatal electrolyte imbalances.<\/p>\n
Death in Gaza isn\u2019t 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<\/a>, yet in Gaza, even food can kill.<\/p>\n Since October\u2019s ceasefire, which meant Israel would allow some \u2014 but not nearly enough \u2014 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 \u201crefeeding syndrome<\/a>,\u201d 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 \u2014 and Israel has subjected those of us in Gaza to such periods on multiple occasions.<\/p>\n Israel tightened the noose of its\u00a0blockade on Gaza<\/a>\u00a0in 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 \u201corchestrated lie.\u201d Bodies began to shut down. Organs failed. Weights were slashed by half, if not more.<\/p>\n As flour and other carbohydrate-containing foods depleted, people\u2019s bodies began consuming themselves \u2014 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.<\/p>\n The crisis grew severe enough to force the Integrated Food Security Phase Classification, the world\u2019s top famine authority,\u00a0to reassess<\/a>\u00a0the manufactured \u201cstatus quo,\u201d concluding that most of Gaza\u2019s 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.<\/p>\n 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\u00a0nowhere near enough<\/a>\u00a0for a population that has been systematically starved for months.<\/p>\n 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 \u2014 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.<\/p>\n 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 \u2014 often more harmful than nourishing \u2014 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 \u2014 allowing the world to turn its back with a fleeting sense of conscience.<\/p>\n 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 \u2014 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).<\/p>\n These electrolyte shifts impact the body severely. Hypokalemia and hypophosphatemia may lead to cardiac arrhythmias \u2014 irregular heart rates \u2014 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).<\/p>\n 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, \u201cThe signs have been clearly appearing among children over the age of 5.\u201d<\/p>\n \u201cMost 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,\u201d she said. \u201cThis 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.\u201d<\/p>\n 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), \u201cfive presented with edema and tachycardia,\u201d she added. \u201cDuring 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\u2019s condition may deteriorate toward it.\u201d<\/p>\n She paused, then shared one of her patients\u2019 conditions: \u201cA 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.\u201d<\/p>\n Shaimaa emphasized the importance of raising awareness among people on how to navigate nutrition safely and stave off refeeding syndrome. She added, \u201cBut 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.\u201d<\/p>\n Hadeel Awad, a nurse working at Al-Shifa Medical Complex, said bluntly, \u201cMany of the cases admitted to the hospital \u2014 most of them under the age of 20 \u2014 present with paralytic ileus and severe abdominal pain.\u201d This was linked to \u201cthe sudden drop in prices and the flooding of markets with products, which pushed people to buy large, uncoordinated quantities without checking expiration dates.\u201d<\/p>\n \u201cThese starved people have long been deprived of basic nutrients like eggs and meat,\u201d Awad went on, pointing out that their new diet consisted largely of newly imported snack foods. She paused, then added: \u201cWe started recording an unprecedented number of new cases of diabetes mellitus.\u201d<\/p>\n She continued: \u201cI remember vividly how catastrophic the conditions were during the famine. It did not spare us \u2014 the healers who are supposed to deliver care.\u201d<\/p>\n \u201cMany people were surviving almost entirely on canned foods, loaded with preservatives, which will leave a grave impact on their health,\u201d she said. \u201cThere is a nutritional gap between the lethal famine and the ongoing irregular abundance, which paved the way for refeeding syndrome.\u201d<\/p>\n The American Society for Parenteral and Enteral Nutrition (ASPEN<\/a>) 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\u2019s ill-equipped health care system, applying such measures becomes nearly impossible, as they are layered onto myriad other unaddressed medical crises.<\/p>\n 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\u2019 homeostasis has been disrupted.<\/p>\n 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\u2019s own environment has been profoundly altered over the past two years. None of us will truly survive this unscathed.<\/p>\n 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 \u201cball,\u201d and was too afraid to touch the banana.<\/p>\n 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 \u2014 forcing them to believe that the rattling of drones is bird\u2019s chirping, that starvation is a lifestyle, and that suffering is the norm.<\/p>\n 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 \u201ccalorie count\u201d policy, aimed at\u00a0minimizing the amount of food entering Gaza<\/a>\u00a0without 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.<\/p>\n These death-making policies did not begin on October 7, 2023. They are the continuation of decades of racial colonial occupation.<\/p>\n