On October 7, 2023, about 1,200 Israeli soldiers and civilians, including 33 children, were killed in war crimes committed by both the military wing of Hamas and the Israeli Defence Force, acting under the “Hannibal Directive”. The atrocities left 5,431 people injured. Hamas and other Palestinian militant groups also captured 251 soldiers and civilians, including children and women, and took them into the Gaza strip.

The Israeli government responded with an immediate declaration of war. By mid to late April, the resulting conflict had killed 35,688 people in Israel and the Occupied Palestinian Territories (oPts), including more than 13,800 children. Around 88,175 were wounded. 

The dead and injured 

Of the children killed in Gaza, most were killed by the IDF with weapons supplied by the USA. Today, while the direct military killing continues and the death toll among children approaches 16,000, children in Gaza are also dying of acute malnutrition, diarrhoea and dehydration, and are vulnerable to a host of mainly communicable diseases.

To understand why this is happening, we look at three key health indicators in the region before the Hamas attack as a baseline and compare the general health of the people in the oPts—Gaza and the West Bank—with that of Israel. The indicators are:

Maternal mortality rate (MMR): the number of women in a given time period who die as the result of being pregnant compared with those who give birth to live babies. 

Life expectancy: how long, on average, a baby born in a particular time period is expected to live. Life expectancy is very sensitive to the number of small children who die; if many people die very young, life expectancy drops badly.

Under-5 mortality rate (U-5MR): the number of children out of every thousand born alive who die before their 5th birthday.

All three indicators reflect not only the quality and availability of health care but also the social, economic and environmental conditions in which people live. 

Health outcomes—the baseline was never normal

These differences in maternal mortality rates and life expectancy between Israel and the Occupied Territories are a dramatic indicator of the longstanding conditions of life of the Palestinian people.

Trends in the under-5 mortality rate

Again, though there was a welcome improvement all around, it is clear that, throughout that period, far more Palestinian than Israeli children did not enjoy their 5th birthdays. The blip in the line for Palestine reflects ‘Operation Protective Edge’, the devastating 2014 Israeli assault on Gaza that, according to a report from Physicians for Human Rights Israel (PHRI), killed over 2,100 people, of whom at least 70% were civilians, including over 500 children. The U-5MR for Israel is excellent; it outstrips both the US and the UK.

And nothing has changed. Another report from PHRI shows how Israel still evades responsibility for Palestinians’ health and that enormous differences in health care persisted into the COVID-19 pandemic with devastating results.

Hunger and famine in the Gaza Strip

Hunger in the Gaza Strip is not something new.  Hunger has long been an instrument of ethnic cleansing and a weapon of war for Israel. After the outbreak of the first Palestinian intifada in December 1987, Israel adopted a deliberate strategy of limiting nutritional value and creating food insecurity among Palestinians as a counterinsurgency strategy. It started small, progressively restricting the movement of people and goods.

In late 2000, the military destroyed farms, razed more than 10 percent of Gaza’s agricultural land, and uprooted more than 226,000 trees. Later, it limited fishing, one of the pillars of Gaza’s food system, to a very small bit of sea along the coastline. 

Around 2008, Israel devised a range of mathematical formulas to determine the quantity and types of food that it would allow into Gaza. In 2012, Gisha, an Israeli human rights organisation, won the release of a Ministry of Defence document based on a model produced by staff in the Ministry of Health called Food Consumption in the Gaza Strip—Red Lines. It includes tables and charts breaking down daily food consumption by sex and age and calculating the minimum caloric intake that would allow “nutrition that is sufficient for subsistence without the development of malnutrition.”

According to a 2006 report in The Observer, Dov Weisglass, adviser to Ehud Olmert, the Israeli Prime Minister, described the red line like this: 

The idea is to put the Palestinians on a diet, but not to make them die of hunger. 

IPC Acute Food Insecurity Analysis; 15 Feb–15 July 2024; Published on 18 March 2024

By October 7, the red line had disappeared. Mass starvation was now a key weapon of war. The deterioration in a few months is a mark of the worsening situation—an estimated 350,000 more people, making 1.1 million, are described as ‘People in catastrophe’, according to the scale of the Integrated Food Security Phase Classification (IPC).

The Israeli Defence Minister, Yoav Gallant, made the strategy very clear on 9 October 2023:

There will be no food, there will be no fuel… we are fighting human animals.

Destroying the healthcare system

Al Shifa Hospital before and after the recent attack.

Not content with destroying the health of the population, Israel has also been systematically destroying the infrastructure of the healthcare system. There remain 11 barely functioning hospitals out of the 36 functioning ones before the latest invasion. The destruction of Al Shifa Hospital in Gaza City would be the equivalent of destroying Groote Schuur Hospital at least. 

Global collusion

While the recent destruction of a children’s hospital in Ukraine rightfully received widespread condemnation, the same people are eerily quiet when it comes to the much greater destruction in Gaza. And it’s not just an immediate silence. The silence extends back decades, as Europe and the US have supported a regime which deliberately and systematically attacks the lives and health of the people and the children of the Occupied Territories.

Louis Reynolds is a retired paediatric intensive care specialist and a member of the People’s Health Movement of South Africa.