Photo: Erica Silverman/IRIN

A six-month-old underweight girl with her grandmother in Gaza City. Her father was a medic who was killed during the recent conflict. The child comes two times a week to local NGO Ard El-Insan for nutritional supplements

GAZA CITY, 21 April 2009 (IRIN) - Rising poverty, unemployment and food insecurity in Gaza, compounded by the recent 23-day Israeli offensive, have increased the threat of child malnutrition, say UN agencies, health ministry officials and healthcare NGOs in Gaza.

UN World Health Organization (WHO) officials are concerned by the warning signs, including rising malnutrition indicators - like increased cases of stunting, wasting and underweight children - and continuing high rates of anaemia among children and pregnant women.

A Food and Agriculture Organization (FAO)/World Food Programme (WFP) qualitative food security assessment for Gaza in 2008 and early 2009 points to increasing food insecurity compared to 2007, said FAO food security adviser Erminio Saco based in Jerusalem; and according to the Palestinian Central Bureau of Statistics (PCBS) food acquisition and energy consumption in Gaza declined by 10 percent between 2005 and 2007.

Over the past 18 months the agricultural sector has been struggling to cope with an Israeli blockade on imports and exports, causing lower productivity and reducing access to affordable fresh food, according to FAO.

Stunting

The UN Children’s Fund (UNICEF) said in January that 10.3 percent of children under five are stunted (low height for age), a steadily increasing trend over recent years.

Stunting is usually attributed to a chronic lack of protein and micronutrients, including iron and essential vitamins, according to WHO. "More than 10 percent of children in Gaza are chronically malnourished," said WHO officer Mahmoud Daher in Gaza, reporting a slight increase over 2008.

Children’s hygiene has also declined due to the lack of a consistent electricity supply since the blockade was instituted. Clothes washing and bathing has been limited, especially during the conflict, according to residents.

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In April 2008 UNICEF estimated there were about 255,000 under-five children in Gaza, with about 26,265 at risk of malnutrition, and 657 most likely to be severely wasted.

Roughly two-thirds of the population - 50 percent of whom are under 18 - is deemed food insecure, according to FAO.

Wasting and underweight

The number of under-five children suffering from acute malnutrition - wasting (low weight for height) - in Gaza almost doubled between 2006 and 2008 from 1.4 to 2.4 percent, according to UNICEF. Wasting is considered a public health problem if the affected population exceeds 5 percent, but WHO is concerned by the significant increase.

In 2008, 2.5 percent of under fives were underweight (weight for age), according to WHO in Gaza.

Anaemia

"Anaemia among children and pregnant women is high in Gaza and there are fluctuations in the rates according to availability of food and the political and economic situation in the area," said Daher.

WHO believes iron and vitamin A deficiencies have increased during and since the conflict. The results of WHO’s current anaemia assessment in Gaza are due in May, but according to Daher, 65 percent of children aged 9-12 months, and 35 percent of pregnant women are anaemic.

The UN agency for Palestinian refugees (UNRWA) has an assessment due in July, but is also concerned about the increase in anaemia cases, according to UNRWA health officer Mohammed Maqadma.

Photo: Erica Silverman/IRIN

Karram El-Essy, 10 months old and from the A-Tufah area of Gaza city, is brought to local NGO Ard El-Insan three times a week for nutritional supplements, including soup and fruit, after he was diagnosed with anaemia

There is a positive correlation between malnutrition and low meat (animal proteins) intake, low consumption of fruit, family size and income, according to UNICEF.

The amount of affordable fresh fruit and protein on the Gaza market has been significantly reduced due to the closures, according to OCHA. "The last shipment of livestock entered Gaza on 31 October 2008, and since the Hamas takeover in June 2007 livestock imports have been severely restricted," said OCHA field officer Hamada al-Bayari in Gaza.

The director of all 56 primary healthcare centres run by the health ministry in Gaza, Fouad Issawi, said cases of stunting and anaemia increased in 2008 and 2009. Since 2007 the amount of anti-anaemia drugs - like ferrous carbonate (with vitamin C) and folic acid - required by primary health clinics had increased dramatically, he said.

"There was a rise in anaemia amongst children in our centres in 2008 and [this is] continuing," said Adnan al-Wahaidi, director of Ard al-Insan Benevolent Association in Gaza, the main healthcare NGO supporting an estimated 16,000 undernourished children.

"Women with children who are underweight or wasting have been coming to the centres in greater numbers over the last few months; many of their husbands died during the recent conflict or are unemployed."

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