A starvation tipping point has already been reached for some in Gaza – they will not recover regardless of ceasefires and food aid. The next tipping point will occur when whole populations die regardless of help. It will not matter then who wins the blame war. History will not be kind to those who had a duty of care.
In September 1944, the Allied foothold in Europe was secure but restricted. Loss of the Netherlands would mean loss of Western Europe for Germany because the Dutch ports would increase Allied supply routes beyond destruction or recapture. The Dutch government-in-exile exhorted their citizens to resist the Germans in support of Operation Market Garden, the Allied offensive in Holland. The Dutch railway workers’ union, Nederlandse Vereniging van Spoor-en Tramwegpersoneel (NVST), declared a general strike on 17 September. The German command responded by executing or deporting rail workers, causing others to flee.
Thus, the action could not be reversed, even if there was a return to compliance. Instead, there was an extension and the entire public service failed. The German command responded by enforcing a blockade on food and fuel to the southern Netherlands. Up to this point, the Germans had defended the vital northern Netherlands. However, the starvation strategy had no aim or end point. Analysts could later claim that it was one of several poor German decisions which led to ultimate defeat.
Humans have remarkable resilience in famine. Unfortunately, we have plenty of evidence demonstrating what happens. In the early phase of caloric deprivation, the body uses up carbohydrate reserves and then switches energy sources to fat and muscle. This phase is reversible with refeeding. If starvation continues, the body will start to adapt by lowering metabolic demand and by converting muscle into glucose. Visible signs are muscle loss in the face and chest, where the ribs are easily seen. In this phase careful refeeding can rescue a person but there may be lifelong damage. In the third phase of starvation, low blood proteins cause swelling and organ damage begins to manifest. Recovery from this stage requires extensive hospital treatment and is successful only in a minority.
If caloric starvation is combined with micronutrient deprivation, the effects are worse. Silent collapse of body systems occurs. Visible signs are bleeding gums and skin sores. Sudden deaths are common with electrolyte depletion. Mental changes occur. Refeeding can worsen some of these effects so it is essential to precede relief with micronutrient supplementation, in particular with thiamine. Starvation also increases vulnerability to dehydration and the combination is invariably rapidly fatal.
The impact of starvation is often described, as above, in terms of the individual. There is also a large medical literature about mass starvation. Nearly all of this literature comes from the study of victims of human-made famines. Is this why we deserve the appellation sapiens? In the case of the Dutch winter famine, it is believed that 4.5 million people were affected but food allocation was relatively orderly even though individual daily rations were reduced to 400 kcal. Vulnerable groups such as the very young, elderly and those with chronic disease died during the famine. The majority of the 20,000 deaths occurred after relief. They died despite expert aid. They had passed the tipping point.
The situation in Gaza is far worse than Holland in 1944-45. People have less calories, less micronutrients, less water, and less organization. The first tipping point, where some individuals will not recover, has already passed. The next tipping point, when most of the population will not recover, cannot be far behind. There is variability in a human’s tolerance to starvation according to sex, age and premorbid condition. However, the variation in tolerance is only a matter of weeks. Bergen-Belsen concentration camp was liberated on April 15, 1945. Of the 60,000 captives, 25% were dead and unburied. Survivors described a surge of deaths just before liberation and further 25% died soon after.
While the Canadians fought to free the northern Netherlands, Lieutenant General Charles Foulkes, from London, Ontario, negotiated with German general Johannes Blaskowitz to permit air drops of food into the starving south. This first plane in was flown by Windsor Ontario native Bob Upcott with a mostly Canadian crew. Their unarmed Lancaster bomber flew so low that they waved to those on the ground, including German defenders. In all, Operation Manna (UK and Commonwealth) and Operation Chowhound (United States) dropped 10 million kilograms of food. Even though it was seen by the population as lifesaving, planners realized that it needed to be followed up with massive ground resupply, which became possible a week later when Blaskowitz surrendered to Foulkes, on May 5.
Israel has agreed to intermittent cessation of hostilities to allow air drops of aid. It is known that even if a massive air drop was achieved, it will not affect the outcome. A limited ground supply of aid has been started. Unfortunately, the tipping point to mass death from starvation is too close for the simple resupply of food to be effective and it will have passed by the time unrestricted aid is permitted. When emaciated corpses pile up, all arguments will lose any value. It will not matter who is to blame. All that will be asked, now and forever, is if there was a duty of care and a capability that failed.
Expert care is now required on a massive scale. Food has to be supplemented with micronutrient replenishment and fluids. Complicated medical problems will require specialist care. The medical service of the Israeli Defence Forces has the expertise and resources to lead a multinational rescue. Strategically, such an effort will do more than combat to neutralize the aspiration of Israel’s enemies to profit by appropriation of Bergen-Belsen-like images.
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