The humanitarian crisis in the Gaza Strip continues to worsen, particularly for children. Last month, UNICEF declared that the number of children being admitted to hospitals in Gaza for acute malnutrition had risen by fifty per cent between April and May. “Of the 5,119 children admitted in May, 636 children have severe acute malnutrition (SAM), the most lethal form of malnutrition,” the statement explained. “These children need consistent, supervised treatment, safe water, and medical care to survive—all of which are increasingly scarce in Gaza today. The number of children with SAM has surged 146 per cent since February.”
A temporary ceasefire between Israel and Hamas earlier this year led Israel to permit more aid to enter Gaza, but, since then, Israel has either cut off all aid or allowed in just a trickle. Moreover, Israel has largely replaced the previous aid-delivery system, which operated in part through the United Nations, with a new system, run by a private organization called the Gaza Humanitarian Foundation, in which Palestinians are forced to trek to one of four locations to receive food. Israeli forces, and private American contractors who are guarding the sites, have fired weapons at Palestinians as they approach; more than six hundred Palestinians have been killed while collecting aid, according to the United Nations.
I recently spoke by phone with James Elder, UNICEF’s global spokesperson, who just returned from the Strip. Elder has previously worked in countries including Angola, Zimbabwe, Libya, and Sri Lanka. During our conversation, which has been edited for length and clarity, we discussed the wounded children he spoke to in Gaza, the risks people are now willing to take in order to find food, and how parents are trying to cope with unimaginable loss.
When were you last in Gaza?
I was last in Gaza in June, and I was there for two weeks. It was my fifth mission to Gaza since the horrors of October 7th. In a typical emergency, my job is to go and see the situation, report on it, and share what UNICEF is doing. But, in Gaza, ninety-five per cent of it is to bear witness. I spend entire days in hospitals and camps simply listening to people and hearing the situation. I learned very early on in November or December of 2023 that it was much more important to spend my time sharing the grave violations that are occurring consistently to children rather than speaking about what our program is doing. In terms of what’s happening, there has been a great degree of disinformation and a great degree of credibility given to statements that have been found to be completely false. So it’s been very important, I think, to simply bear witness, and I have met hundreds of children and families.
How would you say your visit in June was different from your previous visits, if it was different?
Yes, it was, even though I didn’t expect it to be. It was different for several reasons. One is the wounds I saw on children. There were burns on little girls and boys, fourth-degree burns I didn’t know existed. And shrapnel riddled through a body. Shrapnel is designed to go through cement, and what it does to a child’s body is horrific. On one previous trip, I saw a bus of children who spent two days trying to get from the north to the south after being held at Israeli checkpoints, and I walked in the bus, and all I could smell was children’s burning flesh. It doesn’t leave you. And one of the things that struck me this time was that I wasn’t just seeing these children—I was hearing them. There is such a horrendous lack of painkillers that when I’d be in a hospital—and hospitals are wall to wall with people with wounds of war—you’d hear the children and their screams. So I certainly noticed that as a person, parent, human.
The other thing was food and water. Whenever you have warnings of famine, there is big international pressure, and Israel loosens controls so more aid can come in. But then international pressure wanes and the restrictions are tightened again. Once you have famine, people are dying en masse. But there is starvation where a child’s body is degrading and the immune system is starting to collapse, and that’s happening—so children’s bodies aren’t waiting for that technical definition.
We are now so far below the emergency threshold for water. It is in critical shortage now, and it is controlled entirely by Israel. Since electricity to Gaza was cut after the horrors of October 7th, diesel became essential to treat and distribute water, but there’s been a hundred-plus-day blockade on fuel coming into Gaza. We’ve got to a point where, if that doesn’t change or if the electricity isn’t turned back on, which would solve a lot of problems, you’ll start to see children dying of thirst. Water was something that really, really struck me, because it’s absolutely political, not logistical. If Israel allowed fuel or turned on the power for these desalination plants, that problem would be solved. That’s a level of stress on a population I saw that I hadn’t seen before.
The most lethal crisis isn’t just hunger or thirst—it’s the brutal collision of both. And those deaths are often not recorded; when children are severely malnourished, they’re eleven times more likely to die from common childhood illnesses. They’re often not getting to a hospital—first because the hospitals are full of people with wounds of war, and, second, if you just look at the south, there is one fully functioning hospital, and it’s in an evacuation zone. It’s almost impossible to get to unless you’re in an ambulance, because you have to walk through an evacuation zone, which is militarized.
What have you learned about children starving to death?
Starving to death is dying of severe acute malnutrition, and there is a number, but, honestly, I’m not sure how reliable it is. [The director of Gaza’s field hospitals told NBC News last month that more than sixty-six children had died from hunger and malnutrition since the war began.] The problem is that, for the vast majority of children, if you die, if you are severely, acutely malnourished and you die, it’s very unusual to have “starved to death.” You’ve died because of diarrhea, basically, or acute watery diarrhea, which is very, very commonplace now, particularly given the restrictions on water and food. You’re killed by something that a healthy child’s immune system wards off very, very easily.
What are your conversations like with these kids’s parents? Is there anger? Sadness? How would you characterize it?
I would say that anger is infrequent. There’s an immense vulnerability. And they’re holding their medical-evacuation forms, meaning that they were approved for medical evacuation from Gaza. But there are thousands of children who need medical evacuation from Gaza. I mean, literally thousands. So they’re holding this piece of false hope in their hands. There’s a grace and generosity in speaking to me, but there’s an absolute sadness.
There’s a level of powerlessness that I’ve noticed for a long time. I noticed it more than a year ago when a parent would explain to me that their child had realized that this parent could no longer protect them, and what a horrifying moment that was. These parents know that they’ve lost the ability to keep their children safe, so that powerlessness cuts deep into people. You sit and you listen and you talk, and it’s a little girl or a little boy, and they are trying to be brave in some way, or they’re in a coma and the parent’s trying to. And in doing so, the parents, sometimes fathers in a very paternalistic environment, are in tears.
One woman sort of grabbed me when I was walking out of the hospital and wanted to tell her story, and the look in her eyes was just definitive despair. She wanted nothing. She just needed to tell her story. She had spent nine years conceiving, and her son and her husband had just been killed. And so she didn’t know what she wanted. There is nothing to do in those situations. Culturally, you can’t hug someone, so there is nothing other than to listen.
Many times, people are explaining what had happened to a child, and I realize that’s not the parent because the parents were killed in a strike. I’m having this explained by a neighbor or an aunt or an uncle. I’ve met more than a dozen children who lost everyone. I don’t mean mom and dad—I mean cousins, aunts, uncles, grandparents.
What stories have you heard of people trying to approach these new aid sites? What decisions are people making about whether to even try to approach them given the amount of violence going on?
That was one of my main focusses, if not the focus. I deliberately did seek out people at first, and then I realized I didn’t have to seek them out. Everyone had a story. But, initially, I did, because in the very early days it was clear to the United Nations why this couldn’t work. When I went in, the aid sites had only just started and already we were getting reports of mass-casualty events, of all the things we feared. If people are going from A to B, and A is starvation and desperation, and B is where the food is, but it’s a militarized zone, then there can be a justification for people to be shot—because it is a militarized zone. It’s ludicrous.
There was a little boy named Abed Al Rahman. He was thirteen, and he had been given money by his dad to go and buy bread. He had gone out to the streets and seen people starting to move. There was real chaos and misinformation. People were not sure what was open or closed. And he wasn’t finding bread, so he just followed people [to a G.H.F. distribution site]. He said he was corralled into a sort of caged area and was only there for an hour or two, but then, before he got anywhere near aid, there was shooting in the sky, from what he called quadcopters. He ran, and a tank shell was fired. And what he had through his body, particularly his stomach and pancreas, was shrapnel from a tank shell. Now, that, to me, was incredibly important, because only one party to the conflict has tanks. So this little guy was extraordinary. He sat up. His parents wanted to do a video. He had a medical-evacuation form, and he was screaming in pain. His elder brother every now and then tried to adjust his legs, trying to do anything to alleviate the pain. That was the first child I met. On the day I left Gaza, that little boy died. He died of those wounds. He died because he didn’t have the medical equipment in the hospital and wasn’t evacuated.
At one point, I met three young guys, all brothers who’d been to a site seven times and had never received aid. They explained very, very clearly that they would go down into the aid areas, and then chaos would break loose. Families would always have discussions on this. I met at least half a dozen families who would have quite democratic discussions. And it was always a young guy who wanted to go, and his family was saying, “No, no, you will be killed.” Some of them would sneak out at night. I did meet one guy who had been successful. It took him thirty-six hours to get home because he thought he would get mugged with the supplies that he had.
This thirteen-year-old kid had originally set out to get the bread elsewhere, though? Is that what you meant?
Yeah. So, a market still exists. I could see tomatoes. The tomatoes would cost fifteen to twenty times what they’d cost in New York City. And, of course, people haven’t earned an income in forever, and there’s a shortage of cash, so it’s not available to ninety per cent of the population. But this boy took it upon himself. He had money to buy bread and ignored his dad’s instructions because, “I’m going to come home with a box of food.” And it was horrific, because he was telling the story. It was being translated to me, of course. And there was his dad in tears. He’s listening to his son explain, “I just wanted to help my family.” And now he’s looking at his son. He’s looking at his son twelve days away from being dead. And he is just breaking into tears.
I had one guy whose English was good say to me that he went to a site and waited, and a drone came overhead and shot a few people nearby him, and he could see them. He said, “I see people bleeding, see people dead . . . but we did everything we were told. Why did they do that?” Now, it’s not my position to say why. People have given me an answer, which is that they did it because they can.
I also met a twenty-three-year-old woman who went to an aid site. She had bad rips from the barbed wire in her leg and her chest because she got pushed into it somehow in the early days, very early days of when they opened, and she got nothing. But she’s the oldest in her family, and her father has a heart condition. I said, “But you’ll go back again?” She said, “Yes, just please don’t let me die of an empty stomach.” And people are genuinely taking many, many more risks now.
How did you get into Gaza, and where did you stay, and how long were you there?
Yeah, so, you go into Amman, Jordan, and then it’s an early-morning bus that goes across the King Hussein Bridge. You go into Israel and then go on a bus through one of the crossings into Gaza. And there you go through more security checks, and you are met on the other side, in my case, by my agency and an armored vehicle. And then you go in a convoy. Now you’re in Gaza. The only control there is the I.D.F. You’re told the road is safe and that they won’t strike. And then you start the drive through Gaza, which is always pretty harrowing. You go initially through wasteland, and then it’s quite apocalyptic—three hundred and sixty degrees of just devastation. On and on and on and on it goes.
And then, suddenly, there are dots in the distance, and then there’s a thousand people all around the vehicles doing that universal symbol of hand to mouth. I’ve had kids lift their shirts in tears, tapping on the window, showing their ribs. Once they see U.N. vehicles, they’re hoping there’s a convoy behind it. But, strikingly, we were never threatened. Kids might jump on your vehicle. I’ve always thought, At what point does this society just fall apart? But, no, there’s always someone there to push people away and let you go through. Still, it can take hours and hours. It takes twelve to fifteen hours to go a couple hundred miles if you start from Jordan.
It’s indulgent to talk about yourself. But it would also be completely naïve to say we feel safe. It’s very clear. Everyone has learned in Gaza that aid workers, journalists, certainly children are never safe. And there’s a guilt to that at night. There’s guilt when I put a pillow over my head at 1:00 A.M., and I finally need to sleep, and I’m trying to drown out the bombardments, which are relentless.
What did you eat?
In the mornings you’ll get a bit of porridge, and then you don’t eat during the day, and then in the evening there’s a cook—whatever he’s found, basically. It can be pretty simple. It might be a lentil soup.
There is talk that there might be another ceasefire soon, but nothing you have said makes me think that these wounds won’t last a very long time.
I wasn’t there during the ceasefire, but people talked about it and I thought they were teasing me at first. They talk about how, on Day One of the ceasefire, they were going to cafés. So the ability to bounce back is there. Now, having said that, we are in uncharted territory when it comes to trauma. There’s nowhere else in the world where UNICEF has ever said that every single child needs mental-health support.
We do a lot of trauma work in Gaza, and the professionals there remind me that you don’t call it P.T.S.D. in Gaza because there’s nothing post—there’s always new traumas coming. They give children skills to deal with nightmares at night. A little girl would explain how she’d pretend she was in her grandfather’s garden and try to smell the basil to help her with nightmares. But as the child psychologist would say, they’re not just nightmares. They’re also a reality. Sometimes it’s a memory of fleeing your home at two in the morning and seeing your mom get shot.
I was also really conscious of the ninety-eight-per-cent literacy rate there. People say the primary thing is to get kids in school, more often than anyplace I have ever been. That’s a real fear. Now you’ve got the utter devastation of an education system of children. A little girl said to me, “Look at me. I used to be beautiful, but now all I do all day is chase water trucks around.” ♦
