A new type of video has started circulating online from the Gaza Strip: such footage shows families baking “bread” made from birdseed, eating weeds and giving newborns dates to suck on in lieu of milk. A growing number of children in the region have died of malnutrition or dehydration, including a two-month-old baby. On a single day more than 100 people were killed while trying to get food from aid trucks to feed their family.
Palestinians in Gaza started to experience chronic hunger within weeks of Israel’s besiegement of the Palestinian territory in response to the October 7 attacks on Israel, in which Hamas killed around 1,200 people and took 253 as hostages. Ensuing Israeli strikes have killed more than 30,000 Palestinians, according to Gaza’s ministry of health.
As weeks of blockades on food and other aid have turned into months, starvation has reached historic proportions. One recent report by the Global Nutrition Cluster, a United Nations Children’s Fund (UNICEF)–led partnership of humanitarian organizations, found that in December 2023 and January 2024, nine in 10 children under the age of two and more than nine in 10 pregnant and breastfeeding women surveyed had consumed two or fewer food groups in the previous day, a situation considered “severe food poverty.” Nearly two thirds of households were eating just once a day. In the northern Gaza Strip, one in six babies and toddlers were acutely malnourished, the report found. Aid organizations say the numbers today are likely to be far worse—and that the rapid onset and complexity of Gaza’s food crisis is unprecedented.
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“The Gaza Strip is poised to witness an explosion in preventable child deaths,” said Ted Chaiban, deputy executive director for humanitarian action and supply operations at UNICEF, in a recent statement. “If the conflict doesn’t end now, children’s nutrition will continue to plummet, leading to preventable deaths or health issues which will affect the children of Gaza for the rest of their lives and have potential intergenerational consequences.”
There are 2.2 million people living in the Gaza Strip, nearly half of whom are children. Nearly 160 million other people worldwide are facing hunger, including millions in Somalia, Afghanistan and Sudan.
The short-term health consequences of food scarcity have been studied extensively. In children, an especially vulnerable group, severe acute malnutrition can lead to muscle wasting, stunted growth and medical complications, including sepsis, meningitis, diarrhea and severe anemia. Worldwide, nearly half of all deaths of children less than five years of age are linked to malnutrition.
A growing body of research is finding that even if these children return to normal nutrition levels, a period of acute malnutrition can lead to long-lasting damage later in life—and may impact future generations.
One new study in southern Africa found that even 48 weeks after children recovered from acute malnutrition, they continued to show signs of inflammation in the gut and throughout their body, making them more likely to be readmitted to a hospital and die. Childhood malnourishment is also linked to developing problems, including cardiovascular disease, hypertension and metabolic disorders as an adult.
People who were exposed to famine while in utero are the most vulnerable, particularly if the malnutrition occurred in early gestation, when organs first start to form.A foundational 1976 study of 300,000 men who were born during or shortly after the Dutch Hunger Winter of 1944 to 1945 found that those exposed to hunger in the first half of pregnancy were more likely to be obese later in life than those who weren’t exposed or who were exposed later in their gestation. More recent research has drawn similar conclusions. For example, one study found that men who had developed in utero during the Dutch famine were more likely to live a shorter life and to develop health problems such as cardiovascular disease compared with those born right after the famine.
“What you experience before your birth can affect your health decades later. It’s a huge, long shadow,” says Bas Heijmans, an epigeneticist at the Netherlands’ Leiden University Medical Center.
The mechanism for these long-lasting effects may be epigenetic, whereby certain biological processes activate or deactivate different parts of the genome. The most studied way this occurs is through DNA methylation. Famine influences this process: research on the Dutch Hunger Winter, for example, has found that even six decades later, people who had been developing in utero during the famineshowed differences in their DNA methylation compared with siblings who were born later.
“It may well be that these changes in epigenetics explain why your body remembers the famine decades later,” Heijmans says—or possibly why your offspring’s body might do so. Recent “third-generation” research, much of it focused on the Great Chinese Famine of 1959 through 1961, has found that the children of parents who were exposed to famine prenatally had higher risks of hyperglycemia, poorer cognitive function andobesity. Some researchers argue that such intergenerational mechanisms might be responsible for the striking rise of diseases such as type 2 diabetes in China—though some, including Heijmans, have argued that these data were misinterpreted. They say that many of these studies fail to account for the difference in age between famine-exposed subjects versus postfamine controls; the controls have been, on average, three to five years younger.
Not all studies have found a “grandchild” effect. For those that do, the effects tend to be weaker in the third generation than for the generation that was directly exposed to famine in utero. Most evidence peters out beyond the third generation. In other words, while the offspring of the person who was exposed prenatally might be affected, there’s little evidence that the offspring’s children will be.
“Intergenerational epigenetic inheritance is fairly well accepted. Particularly if a woman is pregnant and exposed [to hunger], there’s good evidence that her offspring can have epigenetic changes, and those changes can persist for decades,” says Sarah Watkins, an epigenetic epidemiologist at the University of Bristol in England. “But when you get to transgenerational effects—so three generations or more where there isn’t direct exposure—it is very controversial.”
One main problem is that researchers haven’t found a “solid molecular mechanism,” she says: a biological explanation for how such information would be passed down. Furthermore, there are reasons to think our biology protects us against this type of multigenerational memory. After an egg is fertilized, our epigenetic marks are wiped. They’re erased once again in the fetus’s germ cells, which eventually form gametes.
As a result, many researchers argue that any epigenetic multigenerational changes aren’t the result of these changes themselves being passed down. Rather, it could be that anything a pregnant individual is exposed to also affects not only the fetus but—because female fetuses already carry the ovaries and eggs that can lead to their future children—their grandchildren, too, at least along the maternal line.
Other scientists, however, remain convinced that there’s more going on. They point to research that has found that fathers’ environmental exposures before conception also affect their offspring.
It’s not clear exactly what could be causing these apparently inherited risks. One theory is that the “erasure” of epigenetic marks may not be complete. “There are some sites in the genome which don’t get wiped—they seem to escape these waves of demethylation and remethylation. So that’s one potential mechanism by which it could be maintained,” Watkins says. The other argument is that wiped DNA methylation changes might be restored later. But, she says, when it comes to humans, “it is all still sort of hypothetical.”
Researchers admit that this is a thorny topic to study. “With famine, you get social breakdowns. So it gets incredibly difficult to maintain the records to identify who was exposed,” says Aryeh Stein, a professor of global health and epidemiology at Emory University, who researches child nutrition and its consequences for adult health. “You know very little about the detail of the circumstances of the pregnancy, and you know very little about what happened to that person throughout childhood.”
Because famine often occurs alongside other traumas, such as war and displacement, it’s also hard to untangle cause and effect: Are these epigenetic changes the result of food shortages, other environmental stresses or a combination?
Even so, scientists say, the research is clear on a crucial takeaway: early-life deprivation and trauma, including hunger and war, have long-lasting, sometimes catastrophic effects—ones that are both tragic and, because they’re human-made, avoidable. “There is no excuse for acute famine because there’s enough food in the world,” Stein says. “It just needs to get to the people.”