GAZA CITY, Gaza Strip (AP) — In some tents and shelters in northern Gaza, emaciated children are held in their parents' arms. Their tiny arms and legs dangle limp. Their shoulder blades and ribs stick out from skeletal bodies slowly consuming themselves for lack of food.
Starvation always stalks the most vulnerable first. Kids with preexisting conditions, like cerebral palsy, waste away quickly because the high-calorie foods they need have run out, along with nutritional supplements.
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Omniya Mahra, holds shirtless for a photo her sons Oday, 4, left, and Mohammed, 3, who suffer from malnutrition and a genetic nerve disorder, at the Friends of the Patient Hospital in Gaza City, Tuesday, July 29, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Yazan Abu Ful, a 2-year-old malnourished child, sits with his father for a picture at their home in the Shati refugee camp in Gaza City, Wednesday, July 23, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Saif Hijazi, 13, who suffers from severe malnutrition and was partially paralyzed by shelling lies on a bed to have his picture taken at the Shifa Hospital where he is being treated in Gaza City, Monday, July 28, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Shahinaz al-Dibs cares for her 14-year-old son, Mosab, at Shifa Hospital in Gaza City, Thursday, July 31, 2025. He is largely paralyzed and only partly conscious after suffering a serious head injury on May 7 when an airstrike hit near their tent, and is now malnourished due to the hospital’s lack of supplements and nutrient formula. (AP Photo/Jehad Alshrafi)
Yazan Abu Ful, a 2-year-old malnourished boy, stands shirtless for a photo at his family's home in the Shati refugee camp in Gaza City, Wednesday, July 23, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Samah Matar poses for a photo with her son Yousef, 6, who suffers from malnutrition and cerebral palsy, at a U.N.-run school in Gaza City, Saturday, July 26, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Seven-month-old Salem Awad, suffering from severe malnutrition, lies on a mattress for a picture at his family's tent in Gaza City, Monday July 28, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Samah Matar poses for a photo with her sons Yousef, 6, in her arms, and Amir, 4, who suffer from malnutrition and cerebral palsy, at a U.N.-run school in Gaza City, Saturday, July 26, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
But after months of Israeli blockade and turmoil in the distribution of supplies, children in Gaza with no previous conditions are also starting to die from malnutrition, aid workers and doctors say.
Over the past month, 28 children have died of malnutrition-related causes, according to the Gaza Health Ministry, though it's not known how many had other conditions. The ministry, part of the Hamas-run government, is staffed by medical professionals and its figures on war deaths are seen by the U.N. and other experts as the most reliable estimate of casualties.
Salem Awad was born in January with no medical problems, the youngest of six children, his mother Hiyam Awad said. But she was too weak from lack of food to breastfeed him.
For the first two months of Salem's life, there was a ceasefire in Gaza, and more aid entered, but even then it was hard to find milk for him, his mother said. In March, Israel cut off all food from entering the territory for more than 2 ½ months.
Since then, Salem has been wasting away. Now he weighs 4 kilograms (9 pounds), his mother said. “He just keeps losing weight. At the hospital, they say if he doesn’t get milk, he could die,” she said, speaking in the family’s tent in Gaza City.
Israel has been allowing a trickle of aid into Gaza since late May. After an international outcry over increasing starvation, it introduced new measures last weekend it says are intended to increase the amount of food getting to the population, including airdrops and pauses in military operations in some areas. But so far, they have not had a significant effect, aid groups say.
Food experts warned this week the “worst-case scenario of famine is playing out in Gaza.” The U.N. says the impact of hunger building for months is quickly worsening, especially in Gaza City and other parts of northern Gaza, where it estimates nearly one in five children is now acutely malnourished.
Across Gaza, more than 5,000 children were diagnosed with malnutrition this month, though that is likely an undercount, the U.N. says. Malnutrition was virtually nonexistent before the war. Doctors struggle to treat the children because many supplies have run out, the U.N. says.
Israel denies a famine is taking place or that children are starving. It says it has supplied enough food throughout the war and accuses Hamas of causing shortages by stealing aid and trying to control food distribution.
Humanitarian groups deny that significant diversion of food takes place. Throughout nearly 22 months of war, the number of aid trucks has been far short of the roughly 500 a day the U.N. says is needed.
The impact is seen most strongly in children with special needs — and those who have been grievously wounded in Israeli bombardment.
Mosab al-Dibs, 14, suffered a heavy head wound on May 7 when an airstrike hit next to his family's tent. For about two months, he has been at Shifa Hospital, largely paralyzed, only partly conscious and severely malnourished because the facility no longer has the supplies to feed him, said Dr. Jamal Salha.
Mosab's mother, Shahinaz al-Dibs, said the boy was healthy before the war, but that since he was wounded, his weight has fallen from 40 kilograms to less than 10 (88 to 22 pounds)
At his bedside, she moves his spindly arms to exercise them. The networks of tiny blue veins are visible through the nearly transparent skin over his protruding ribs. The boy's eyes dart around, but he doesn't respond.
His mother puts some bread soaked in water — the only food she can afford — into a large syringe and squirts it into his mouth in a vain attempt to feed him. Most of it dribbles out from his lips. What he needs is a nutrient formula suitable for tube feeding that the hospital doesn't have, Salha said.
At a school-turned-shelter for displaced people in Gaza City, Samah Matar cradles her son Yousef as his little brother Amir lies on a cushion beside her — both of them emaciated. The two boys have cerebral palsy and also need a special diet.
“Before the war, their health situation was good,” said Matar. They could get the foods they needed, but now “all those things have disappeared, and their health has declined continually.”
Yousef, 6 years old, has dropped from 14 kilograms (30 pounds) before the war to 9 kilograms (19 pounds) now. His 4-year-old brother, Amir, has shrunk from 9 kilograms to under 6 (19 to 13 pounds), she said.
This is a documentary photo story curated by AP photo editors.
Omniya Mahra, holds shirtless for a photo her sons Oday, 4, left, and Mohammed, 3, who suffer from malnutrition and a genetic nerve disorder, at the Friends of the Patient Hospital in Gaza City, Tuesday, July 29, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Yazan Abu Ful, a 2-year-old malnourished child, sits with his father for a picture at their home in the Shati refugee camp in Gaza City, Wednesday, July 23, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Saif Hijazi, 13, who suffers from severe malnutrition and was partially paralyzed by shelling lies on a bed to have his picture taken at the Shifa Hospital where he is being treated in Gaza City, Monday, July 28, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Shahinaz al-Dibs cares for her 14-year-old son, Mosab, at Shifa Hospital in Gaza City, Thursday, July 31, 2025. He is largely paralyzed and only partly conscious after suffering a serious head injury on May 7 when an airstrike hit near their tent, and is now malnourished due to the hospital’s lack of supplements and nutrient formula. (AP Photo/Jehad Alshrafi)
Yazan Abu Ful, a 2-year-old malnourished boy, stands shirtless for a photo at his family's home in the Shati refugee camp in Gaza City, Wednesday, July 23, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Samah Matar poses for a photo with her son Yousef, 6, who suffers from malnutrition and cerebral palsy, at a U.N.-run school in Gaza City, Saturday, July 26, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Seven-month-old Salem Awad, suffering from severe malnutrition, lies on a mattress for a picture at his family's tent in Gaza City, Monday July 28, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
Samah Matar poses for a photo with her sons Yousef, 6, in her arms, and Amir, 4, who suffer from malnutrition and cerebral palsy, at a U.N.-run school in Gaza City, Saturday, July 26, 2025. In Gaza, malnutrition is often worsened by preexisting conditions and compounded by illnesses linked to inadequate health care and poor sanitation, largely the result of the ongoing war. (AP Photo/Jehad Alshrafi)
