‘Past The Point Of No Return’: Doctor Gives On-The-Ground Insight Into Starvation In Gaza

Mass starvation now defines life in the Gaza Strip for 2.1 million Palestinians.

Despite allowing in some additional food in response to global outrage, Israel is continuing policies that have produced widespread hunger, with U.S. support — while experts say that regardless of what else may change, thousands of preventable deaths are imminent because of how seriously Palestinians’ conditions have deteriorated. Over the coming days and months, the toll of the already-bloody war — which has killed at least 60,000 Palestinians — is likely to skyrocket.

“Malnutrition is on a dangerous trajectory,” the World Health Organization warned Sunday on social media, noting the crisis is likely underestimated because many families cannot safely reach what’s left of Gaza’s health facilities to be diagnosed and treated.

Israeli Prime Minister Benjamin Netanyahu said Israel will allow “minimal humanitarian supplies” as the country’s military, the Israel Defense Forces (IDF), continues its U.S.-backed offensive in Gaza. Echoing Israel’s narrative, President Donald Trump on Sunday blamed the situation in Gaza on the Palestinian militant group Hamas, saying it “hardened up” in talks for a truce with Israel; he did not question Israeli policies. The U.S. and Israel on Thursday abandoned negotiations with Hamas over the release of several dozen hostages, mostly Israelis, and the future of Gaza. On Monday, Trump rejected Netanyahu’s claim there is no starvation in Gaza, saying, “You can’t fake that,” but only vaguely referenced greater American assistance without offering details.

Though Israel is permitting airdrops, instituting 10-hour “pauses” in attacks on parts of Gaza, and organizing “humanitarian corridors,” those measures have limited impact and there’s no guarantee they will continue until Palestinians’ needs are met. Tel Aviv is continuing to intensely criticize the United Nations, the key player in effective aid delivery.

Meanwhile, ongoing Israeli airstrikes and shooting killed dozens of Palestinians over the past 24 hours, including children and people seeking aid. Netanyahu is still pledging “total victory” over Hamas, citing its Oct. 7, 2023, attack that sparked the war and killed 1,200 people, and does not appear open to the kind of mass surging of aid and approvals for humanitarian efforts that previously stemmed deaths among Palestinians during Israel-Hamas ceasefires for two months earlier this year and in November 2023.

HuffPost on Sunday discussed what may come next with Mark Brauner, an American emergency physician who traveled to the region for two weeks in June on a volunteer trip organized by the charity Rahma Worldwide.

Based in Eugene, Oregon, Brauner has practiced for 20 years and previously joined medical missions in Mozambique, Haiti and Mexico. In Gaza, he worked at the Nasser Hospital in Khan Younis, after many in his group, particularly non-white doctors, faced last-minute Israeli denials to their entry; he had to pay a surprise tax for bringing in his cellphone, which prompted him to quip to a border officer that his tax dollars were already funding Israel’s war; and after, those still in the company made a surreal journey from Jordan through the “beauty” of Israel, then through huge steel gates into the “absolute wasteland” of northern Gaza.

As Brauner worked, he heard explosions nearly every 10 minutes in the vicinity of the hospital, sometimes making his teeth shake, but was “buoyed” by the work ethic of Palestinian medical staff.

A month after his return, given his training and the level of desperation he saw on the ground, Brauner feels “the tipping point has already occurred” for unprecedented death by starvation in Gaza. Below is our conversation, lightly edited for clarity and length.

Let’s begin with the cumulative effect of the enforced hunger Palestinians have been enduring. There have been at least 147 deaths from starvation, including among infants with no preexisting conditions, and we’re talking about a population in which the vast majority has been forcibly displaced several times, while facing 22 months of U.S.-backed attacks. From a medical standpoint, how vulnerable is Gaza’s population now?

They are incredibly vulnerable. But they’ve really moved beyond vulnerable. The tipping point has already occurred, unfortunately, for a large number of children and infants and toddlers and adolescents — these are definable age categories where the level of starvation and malnutrition has passed the tipping point, where July already saw a large escalation in the number of deaths but August is going to be significantly higher because a lot of the children have already passed the point of no return where their physiology has eroded to the point where even refeeding could potentially cause death itself. The gut lining has started to auto-digest and it will no longer have adequate absorptive capacity for water or for nutrition. Death is unfortunately imminent for probably thousands of children.

When I left on the 26th [of June] the group of four U.S. physicians, we launched a campaign called Gaza Formula Countdown 25 and were hoping that we were going to facilitate movement of specialized formula into the [Nasser hospital complex] because there were so many children that were literally 48 hours away from not having formula. A little tiny bit of formula trickled in here and there but these are a lot of medically complex kids that required special formula, and unfortunately, many of those children are dead, including one that died, his name was Hassan … just a couple of days after we left. And then yesterday, a young girl named Zainab died from toxic enterocolitis, which is the auto-digestion process of the small intestine and the colon. These were preventable deaths.

In August and September, there are probably still going to be extremely high lethality and large numbers of deaths because children have already passed the tipping point. If we start getting in large quantities of the correct formula and the correct protein and food in general, we may be able to decrease deaths in late September, October and going forward. There’s an international gradation called the “global acute malnutrition” score or GAM — we’re already at greater than 15% [of Gaza’s 1 million children meet that criteria]. Severe acute malnutrition, between 5% and 10% of children already meet that criteria. Then for moderate acute malnutrition, 20% of the children under 5 meet this.

Beyond the acute process that’s going on, there’s no doubt that the level of malnutrition is at such a high level that it is going to probably cause chronic neurological dysfunction for a lot of children. Their vitamin B levels and specifically thiamine are so low that it causes permanent neurologic dysfunction and neuropathies and cognitive dysfunction, so their ability to learn and to be really high-functioning members of society have already been negatively affected and these are very large numbers of children.

Israel has now permitted “minimal humanitarian supplies.” We don’t know if a large surge is going to materialize, but with the supplies they are talking about and the level of vulnerability people already have, can you talk about the broader picture beyond children as well?

When I was in the emergency department, I spent most of my time in the resuscitation room where we were taking care of complex, unstable trauma patients. For adults, the average body fat percentage was probably 1%, if that; really, many of them were skeletal. We were doing emergency surgical procedures on people where all of the ribs were completely showing — there was no problem getting between ribs to put in chest tubes.

Trauma in this environment is a chronic illness so we would see people with acute severe injuries who were already healing from injuries that occurred three months ago. So we would see people that had a chest tube who on the other side you could see they had a festering wound from a chest tube they had had months earlier … due to the lack of nutrition and the lack of protein, [including] albumin, which is critical for healing wounds. Even if you’re not injured, walking around in this destroyed environment, you get cuts and scrapes all the time. So people just were covered in minor cuts and scrapes that were not healing; they had secondary infections and no clean water to wash their wounds.

We had so many family members who would show up with patients that had acute traumatic injury but the family members themselves were almost incoherent, where they were malnourished to the point where they couldn’t speak and think properly. They were stumbling and falling and passing out.

It was just so unreal to see this population that were not only experiencing traumatic injury [from gunfire or airstrikes] but were experiencing the sequela of violence by starvation that was affecting cognitive function and central nervous system function to the point where people were having a difficult time speaking. Older people were having difficulty swallowing and would choke on water because their brain stem was too floppy to coordinate swallowing. The sequela of the militarized starvation is just so pathological, it’s crazy.

Adults who experience neurological morbidity from malnutrition, their response to refeeding is highly variable; some people will have complete recovery, others will not. It’s probably multifactorial, from genetics to complex neurohormonal stuff that dictates repair.

But it’s going to require a sustained return of proper nutrition. When you get these occasional punctuated moments where they eat for three or four days in a row but then a month later are back in a starvation situation, that’s really not helpful. It could theoretically make the injury even worse or potentially more long term. When refeeding patients with severe malnutrition, they really do require consistent feeding — not these ridiculous airdrop situations that just create chaos, terror and violence.

Palestinian medical workers and journalists trying to help their community are themselves experiencing deprivation. When you were in Gaza, how were medical staff enduring this moment? Was it clear we were heading to this moment of extreme alarm? And was there any talk of the now-debunked Israeli claims of Hamas redirecting supplies?

The first real group of people we connected with were the medical students because they functioned as our interpreters a lot of the time. Some of them had been in medical schools that no longer exist; all of the records are gone, the facilities are gone, half the people are dead. Their entire medical school experience has been erased from the planet. So they were there struggling, not knowing what the future holds for them.

On a daily basis, we would hear about their families. A female medical student one day seemed depressed while we were walking down a hallway and she told me her favorite uncle, his wife and their four children were killed that night in a bomb. She was just absolutely devastated, but yet she walked four miles through dangerous corridors to get to the hospital to function as my interpreter.

I made a really strong connection with one of the internal medicine residents who was also at a hospital that was essentially erased from the earth. He was marched from the hospital and put in prison for four months and beaten daily then thrown back out on the street. He showed up at Nasser; people knew him. He is a wickedly smart, very generous person who smiled all the time and was extremely hardworking and helpful. But when we really took a few moments to sit down, his body posture would change, his face would change — there was no doubt there was deep depression.

I had a couple of nurses tell me that they’ve thought about suicide in the past. They’re such strong, beautiful people that they said: Even though I thought of this, I still feel like I need to get up and go to work and help people.

This was a residency training program but really the residents were running the show because the senior attendings are very few and far between — a lot of them have been killed or are missing. In the past, they were paid a little bit of money every three to four months but it is not enough; their families are starving.

These physicians were being fed a small amount of food once a day. Three weeks ago, that stopped. They are now completely on their own. There have been physicians and nurses who have simply passed out in the middle of the emergency department; there are people passing out during surgery. This is a completely new phenomenon in the last three weeks. When we were there, every person on our team lost between 12 and 15 pounds.

All of these physicians and nurses and environmental services people, they would work 16-18 hours, then they would walk home, sometimes an hour or an hour and a half, to get into their small tent with their family, then get up at 5 or 6 in the morning and come back and do it again. It’s just extraordinary.

I spent countless hours all over the hospital. I saw tired people with empty pockets and broken sandals; I did not see any warrior-type people and I didn’t see one weapon the entire time. Not one person that I had intimate, deep conversations with ever said anything violent against Israel and Jews. They were adamantly against Zionism and the violence but I did not hear antisemitic, violent rhetoric — and I really expected to. This just showed how incredible these people are.

Nothing but a trickle [of aid] has made it into Gaza from March to the time I left… And these so-called aid distribution points [set up under the U.S.- and Israeli-supported Gaza Humanitarian Foundation, established earlier this year and defended by Israeli troops and American military contractors] — it was like clockwork: 30-40 minutes after they started a distribution, we would just hear ambulances and cars flying in, we would receive many, many patients after these things. [The GHF denies enabling violence.]

One of the things I thought was really remarkable was how young the people were coming in from these. These were young boys who were being heroic and going to these things despite the knowledge that they were a shooting gallery. I can’t tell you how many boys between the ages of 8 and 18 I saw with a bullet wound directly between the eyes, the forehead or the side of the temple.

It was almost like they were changing the game sometimes because we’d get all head injuries, then we’d have several hours or a day of all neck injuries, or all chest. Or all groin injuries which are particularly terrible, because there are major blood vessels everywhere; people often bleed out, they usually have a fairly slow death and injure the bowel or the rectum so there are feces-soaked injuries which are extremely painful and difficult to manage. [The IDF maintains that it respects the laws of war and minimizes harm to civilians.]

I think of all the long-term PTSD the entire population is going to experience and it’s so deep and so unnatural. It’s going to take generations to recover from this poly-trauma. I think about the Israeli soldiers; so many of them are young men who don’t have a fully developed prefrontal cortex, who are still very impressionable and will do things that they wouldn’t have done had they been more mature. It’s going to hit them at some point. They’re going to realize what they did. It’s another population that’s going to experience generational trauma.

You’re organizing a campaign for Congress to review the IDF for allegations of gross human rights violations — which could trigger the Leahy Law, barring U.S. support for foreign military units that are credibly accused of such behavior. What is the progress of the campaign so far, and how are you broadly thinking about U.S. responsibility for Gaza’s suffering given America enabling Israel’s offensive under both President Joe Biden and President Donald Trump?

I just had an op-ed published in Common Dreams and we have a petition on MoveOn. We’re interested in the world understanding [the Leahy Law] because this is an important U.S. policy and all governments should have a similar policy. We’re hoping this is going to have a direct impact on U.S. voters because it should be important to Democrats, Republicans and independents alike … to trigger a comprehensive review of the entire IDF, which I think is warranted, would have a huge effect on the Israeli military. I understand the Israeli government may end up standing alone on this issue and continuing the genocide, but we’re demanding the U.S. stop its military and financial support.