Devi Sridhar, The Guardian The news from Gaza feels too painful to watch.

Videos of immediate violence capture TV and social-media audiences: within seconds, entire hospitals are destroyed and buildings fall to the ground.

We are watching death in real time.

In my last piece on Gaza, I highlighted the records being set: considering its short duration, it has been the deadliest war in modern history for children, for journalists, for healthcare workers and for UN staff.

But there are parts of the on-the-ground situation that are harder to convey in short clips.

The thing I hear most when I speak to colleagues in humanitarian organizations is that they are worried about starvation. They say that, right now, Gaza has the highest proportion of people living with food deprivation anywhere in the world.

Before 7 October, when the war started, acute malnutrition was largely nonexistent in Gaza.

Since then, among children in northern Gaza it has increased to 15% – that’s one in six children under the age of two – while it is 5% in Rafah in southern Gaza.

UNICEF has highlighted that 90% of children under five eat fewer than two food groups a day, which is defined as “severe food poverty”, while roughly 90% are affected by an infectious disease, including 70% with diarrhea.

A lack of nutrition and high rates of infectious disease cause a deadly cycle in children: hungry children are more likely to fall sick and have weak immune systems given their fragility, while diarrhea causes weight and water loss in already thin children.

The word being cautiously used is famine, which could come within weeks.

That is, widespread severe shortages of food causing illness and death in a short time period.

The UN has repeatedly said that a quarter of the population already faces starvation, while the entire population of 2.3 million lives with food shortages.

Famine is usually declared when three conditions are met.

First, when 20% of the population suffers extreme food shortages.

Gaza is already past this threshold.

Second, when acute malnutrition among children exceeds 30%, and third when two deaths for every 10,000 dying per day are due to food shortages and malnutrition.

Given the deteriorating humanitarian relief situation and limited food supplies entering the country, famine looks inevitable without urgent international intervention.

This is not a famine caused by drought, crop failure or environmental shocks.

This is not famine happening because rich countries are not paying attention.

It is completely preventable and due to the isolation of Gaza, especially the north, from food delivery trucks and humanitarian aid.

On 20 February, the UN World Food Program had to stop deliveries to the north of Gaza because conditions were unsafe for staff.

What we are seeing is a deliberate blockade of emergency food supplies in the region, which is on the brink of seeing thousands of children starving to death.

In a previous article, I looked at projections from other related crises to understand the potential level of excess deaths in Gaza from disease and preventable health causes.

We know that in conflict more deaths are usually due to disease and health conditions rather than direct violence itself.

Looking at the situation in late February, I asked a close colleague in the US who works in this area what would be the most comparable war situation.

“Rwanda?” I asked.

He responded that there was no previous conflict “that used bombing, snipers, starvation all at once with such intensity.” Again, and again we return to the debates over whether genocide is an appropriate word.

From a public health perspective, arguments about what term to use distract from the daily urgency of the Gaza situation.

The crisis on the horizon is another word, famine, which will happen unless a ceasefire is agreed so that humanitarian food trucks can enter Gaza.

This will also require a lifting of the total blockade of the Gaza Strip: the “Israel defense” minister, Yoav Gallant, said several months back, “We are putting a complete siege on Gaza … no electricity, no food, no water, no gas – it’s all closed.” This “collective punishment” approach clearly violates international law.

While you may find the news hard to keep reading, think of the people in Gaza, the children especially, who are being starved of food, deliberately.

The constant pain in the abdomen, the lethargy, the slow depletion of all fat stores, then muscle, then body tissue.

This may not make the evening news or TikTok because it’s less visible than bombs and doesn’t fit into short clips.

But it’s the reality of life in Gaza for most and, tragically, the biggest threat they face in the coming days