Why is hypothermia killing Gaza’s children?

Babies are at higher risk of dying from severe cold as they generate less heat than adults. Hunger compounds the risks.

In just a week of cold weather enveloping Gaza, six babies across the enclave have died from hypothermia.

As Israel continues its attacks on Gaza and its hospitals, its restrictions on what can enter the Palestinian territory mean that access to winter aid and medical intervention also remain limited. Israel’s war on Gaza has killed more than 45,500 people, most of them children and women.

Here’s what you need to know about the condition that has killed several infants, and that threatens a population of 2.3 million people, most of whom are displaced from their homes, and are surviving in the bitter cold with inadequate food and drinking water.

Hypothermia, which literally means below normal heat, is a condition that occurs when the body loses heat faster than it can produce it.

The body typically maintains a fixed, warm core temperature of about 37 degrees Celsius (98.6 degrees Fahrenheit) using various mechanisms, such as metabolic heat production, which includes digesting food or moving muscles.

The core temperature must be maintained at about this level, between a narrow range of 36.1C (97F) and 37.2C (99F), depending on the individual, time of day, and activity level. This allows vital organs, such as the brain and heart, to continue functioning properly.

However, when the body can no longer compensate for the heat loss and internal temperatures drop dangerously low, the body enters a state of hypothermia.

Hypothermia depends on the body’s core temperature rather than the outside temperature as one can develop it even in milder cold, not just freezing conditions.

The severity of the condition depends on how low the internal temperature drops:

What happens to the body depends on the severity and stage of hypothermia.

During initial cold exposure, the body begins to lose heat through the skin. Wind or water accelerates this process by removing the thin layer of warmth around the body.

To conserve heat, blood vessels in the skin constrict, reducing blood flow to the surface. This keeps more heat near vital organs but causes fingers, toes and other extremities to feel cold and numb.

To generate more heat, the body begins to shiver, and breathing and the heart rate increase to pump warm blood to the vital organs and support metabolism.

What is hypothermia?

However, mild confusion, clumsiness and fatigue may kick in as the cold begins to affect the brain and muscles.

As exposure to cold continues, heat loss outpaces the body’s internal attempts at heat generation and moderate hypothermia sets in. Shivering stops as muscles run out of energy, and a feedback loop worsens the situation: as metabolism slows, the body produces even less heat.

The brain’s ability to function deteriorates, leading to unconsciousness. The cold disrupts the heart’s electrical system, causing irregular rhythms that can lead to cardiac arrest.

Without rapid medical intervention, vital functions may fail entirely, resulting in death.

Yes, hypothermia can be stopped if timely steps are taken.

Recovering from moderate to mild hypothermia includes moving the person to a warm, dry environment, removing any wet clothing, and covering them with blankets to warm the body.

Warm, non-alcoholic beverages can help if the person is conscious.

Severe hypothermia, however, often requires medical intervention. This includes passive rewarming with heated blankets, or active rewarming techniques such as administering warm intravenous fluids or blood rewarming.

Blood rewarming involves drawing blood from the body, typically through a large catheter, warming it with a specialised machine, and reinfusing it in the body.

Infants face a higher risk as their bodies lose heat more rapidly than adults.

This is because their bodies are shaped differently. Compared with adults, they have more skin (surface area) for their size (body mass). This means they lose heat faster through their skin, especially in cold environments. Since their small bodies can’t produce heat as efficiently as adults, they are at a higher risk of getting too cold.

They also may not exhibit obvious signs of cold stress, making it harder to recognise hypothermia.