Mohammed’s skeletal arms stick out of a romper with a grinning emoji-face and the slogan “smiley boy”, which in a Gaza hospital reads as a cruel joke. He spends much of the day crying from hunger, or gnawing at his own emaciated fingers.
At seven months old, he weighs barely 4kg (9lbs) and this is the second time he has been admitted for treatment. His face is gaunt, his limbs little more than bones covered in baggy skin and his ribs protrude painfully from his chest.
“My biggest fear now is losing my grandson to malnutrition,” said his grandmother Faiza Abdul Rahman, who herself is constantly dizzy from lack of food. The previous day the only thing she ate was a single piece of pitta bread, which cost 15 shekels (£3).
“His siblings also suffer from severe hunger. On some days, they go to bed without a single bite to eat.”
Mohammed was born healthy but his mother was too malnourished to produce breast milk, and the family has only been able to get two cans of baby formula since.
The ward at the Patient’s Friends Benevolent Society hospital is crowded with other skeletal children, some doubled up on the 12 beds. There are only two functioning paediatric teams left in Gaza City, and up to 200 children turn up daily seeking treatment.
Dr Musab Farwana spends his days trying, but often failing, to save them. Then he goes home to share meals that are too small with his own hungry sons and daughters.
The whole family are losing weight fast, because his salary buys almost nothing, and he doesn’t want to risk the deadly race for supplies handed out by the Gaza Humanitarian Foundation after another medic, Dr Ramzi Hajaj, was killed trying to get food at one site.
Gaza has never been hungrier, despite several warnings about impending famine over the course of nearly two years of war. Over just three days this week public health officials recorded 43 deaths from hunger; there had been 68 in total before that.
Faiza Abdul Rahman who has stayed in Gaza City throughout the war, said even the time of most intense controls on food entering northern Gaza last year were not as bad. “We faced hunger before, but never like this,” she said. “This is the hardest phase we’ve ever endured.”
Testimony from residents and doctors, and data from the Israeli government, the Gaza Humanitarian Foundation and the UN and humanitarian organisations shows food is running out.
Empty shelves are reflected in soaring prices, with flour selling for more than 30 times the market rate at the start of the year.
Even money or influential employers can no longer protect Palestinians. “Humanitarian organisations are witnessing their own colleagues and partners waste away before their eyes,” more than 100 aid groups working in Gaza, including MSF, Save the Children and Oxfam warned in a joint statement this week.
The journalists union AFP said on Monday that for the first time in the news agency’s history they risk losing a colleague to starvation. On Wednesday the head of the World Health Organization, Tedros Adhanom Ghebreyesus, said a “large proportion” of Gaza’s population was starving. “I don’t know what you would call it other than mass-starvation – and it’s man-made.”
For months Israel has choked off food shipments. The total amounts allowed in since the start of March are well below starvation rations for the 2.1 million population, and Palestinians are already weakened by the impact of prolonged food shortages and repeated displacement.
“For nearly two years, children here have suffered from famine. Even if some days they felt full, it’s not just about being full, it’s about receiving the nutrients the body needs. And those are completely absent,” said Farwana, the paediatrician.
Those years of malnourishment make them more vulnerable to other diseases, and their low immunity is compounded by the severe shortages of basic medical supplies, which Israel has also blocked from entry.
“Often, I feel devastated because there’s something so simple the child needs to survive, and we just can’t provide it,” he said. Three severely malnourished patients died in intensive care this week, one of them a girl who would have probably survived if doctors had been able to give her intravenous potassium, normally a basic medication, and now impossible to get hold of in Gaza.
“We tried to give her oral alternatives, but due to her malnutrition and resulting complications, she had poor absorption.”
“These cases haunt me, they never leave my mind. This child could have gone back to her family and lived a normal life. But because one simple thing wasn’t available she didn’t survive.”
Israel imposed a total siege on Gaza from 2 March. When the prime minister, Benjamin Netanyahu, lifted it on 19 May he claimed the government was acting to prevent a “starvation crisis”, because some of the country’s staunchest allies told him they would not tolerate images of famine.
In fact the Israeli government simply shifted course to draw out the starvation crisis, letting in only minimal quantities of aid so that Gaza’s descent towards famine progressed a bit more slowly.
The Israeli government announced plans to channel all aid through a secretive US-backed organisation that runs four militarised distribution points.
Hundreds of people have been killed trying to get food handed out at sites Palestinians describe as “death traps”, which have handed out supplies that meet only a fraction of Gaza’s needs.
By 22 July, GHF had been operating for 58 days but the food it had brought in would only have sustained the population of Gaza for less than a fortnight, even if it was distributed equally.
On Tuesday Umm Youssef al-Khalidi was preparing to try her luck at a GHF distribution centre for the first time. She had avoided them for months because her youngest child is two and her oldest 13 and her husband is paralysed and confined to a wheelchair.
“We have been silencing our hunger with water,” she said. “My fear for my family is greater than my fear for myself. I fear something bad will happen to me, and I’ll leave them without anyone to care for them.”
But her family went without food for four days last week, and when they broke the fast, eight of them had to share a bag of rice and two potatoes given to them by a passing stranger.
The children were excellent students before the war, who always won scholarships. Now they spend their days sitting on the edge of the street under a bombed mosque in al-Wehda neighbourhood in Gaza City, where the girls try to sell bracelets rather than just begging.
Their is little demand for cheap jewellery in Gaza today, and although sometimes a passerby takes pity on the gang of skinny kids with dirty faces and tattered clothes, soaring prices means it buys little food.
“My children have become skeletal, skin and bone,” Khalidi said. “Even the slightest effort makes them dizzy. They sit down again, asking for food, and I have nothing to give. I can’t lie and say I’ll bring them something when I know I won’t be able to.”
So she had decided that in the grim calculus of risks for her family, the hope of getting a little food finally outweighed the risk of losing the adult who held their lives together.
Her husband’s phone had been stolen earlier in the war, so they would have no way to communicate over the long hours that she would spend trekking to the GHF site, then racing to try to get food, and walking back. The family would just have to wait and hope.
“I have no one else to send,” she said. “It’s painful to watch them suffer, and their health gets worse every day they go without food.”