Without medical care to prevent refeeding syndrome, aid could trigger a deadly new crisis.
Israel has imposed man-made starvation on the population of Gaza since the aggression against the enclave began in October 2023. This campaign intensified drastically after March 2025, when the Zionist occupation implemented even harsher restrictions on the already scarce aid allowed into Gaza. Since then, hundreds of men, women, and children have died from severe malnutrition. Doctors survive on meagre crumbs of bread and oil each day, often resorting to seawater to ingest much-needed electrolytes. Journalists have become too weak to carry out their duties, and men are too frail to risk their lives at GHF sites. The population now resembles skin stretched taut over bones.
Such severe malnutrition has, unfortunately, been witnessed throughout history, and its effects on the human body are well documented. Systems shut down one by one, fatigue envelops the victims, and the body begins to consume itself to death. Chilling accounts between 1920 and 1940 in the Soviet Union paint a similar picture. Performers collapsed mid-performance, dying where they stood. People dropped dead in the streets as if simply falling asleep. Desperation reached such extremes that court records tell of a mother dismembering her unconscious husband, believing him dead, to feed their children.
What is often overlooked, however, is that recovery from starvation can be just as devastating. Ironically, one of the earliest recorded accounts of this phenomenon comes from the siege of Jerusalem in 70 CE. For five months, under the command of Titus, son of Emperor Vespasian, the Roman army cut off all aid to the then-holy Jewish city. Like Gaza’s population today, Jerusalem’s citizens were wasted, disease-ridden, and forced to eat leather. After the Romans breached the gates and captured the city, Flavius Josephus, a Jewish commander who defected to the Romans, reported that many survivors died soon after eating. Malnourished citizens would gorge themselves on food to the point of vomiting, with many dying within hours.
Following World War II, similar accounts emerged involving Japanese prisoners of war. Malnourished soldiers liberated from captivity in the Philippines, New Guinea, and elsewhere gorged themselves on calorically rich food provided by their liberators. Approximately one in five of these prisoners died because of this refeeding process. Medical examinations revealed shrunken organs, heart failure, and other severe complications. Comparable observations have been reported repeatedly in starved civilian populations after famine relief, among post-operative patients, individuals suffering from anorexia nervosa, and chronic alcoholics.
Now commonly known as refeeding syndrome, this condition describes a dangerously rapid metabolic shift from a catabolic to an anabolic state. In starvation, the body suppresses insulin and relies on breaking down muscle and fat, depleting essential intracellular ions. Once feeding resumes, insulin surges, causing glucose and electrolytes to flood into cells. This sudden cellular shift sharply lowers blood levels of phosphate, potassium, and magnesium. Insulin also promotes sodium and water retention in the bloodstream, leading to fluid overload. If untreated, these changes can cause catastrophic damage to the heart, lungs, nerves, and blood, resulting in arrhythmias, respiratory failure, and death.
It is important to emphasise that refeeding syndrome is not simply “too many calories too quickly”; it is a metabolic shock. Controlled eating alone is insufficient. Patients require carefully planned treatment, beginning with electrolyte and vitamin supplementation before feeding starts. A skilled, multidisciplinary team and routine laboratory testing are essential to ensure recovery proceeds safely. Pharmacists, psychiatrists, lab technicians, and other specialists must work in concert to nurse the malnourished back to health.
In the context of the genocide in Gaza, imagining such care is heartbreaking. The medical infrastructure there has collapsed. Doctors treat only urgent cases. Anaesthetics have all but run out, and vinegar, if found, is used to clean wounds. Children’s limbs are amputated while they are fully conscious and in pain. This is not a system remotely capable of rehabilitating two million starved people. Israel deliberately ensures this by enforcing a blockade on medical supplies and brutally targeting health workers, ambulances, and hospitals.
Tragically, we cannot rely on starving individuals to control their own refeeding. Hunger twists the mind, making a person obsessively fixated on food. The thought “this may be your only chance to eat, so eat as much as possible” becomes overpowering. In the follow up of Ancel Keys’ malnutrition experiments, it was noted that several recovered participants went on to work in the food and restaurant industry. The reality is that a severely malnourished person cannot be expected to regulate their eating once food is available.
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