I’m a paediatrician who’s worked in Gaza – make no mistake, this is a war against children

By relentlessly inflicting violence, destruction and starvation on the people of Gaza, Benjamin Netanyahu is depriving a generation of Palestinians of their childhood, writes Dr Jane Crawley. Nowhere is safe

WCNSF is a chilling abbreviation used by aid workers in Gaza, standing for ‘wounded child, no surviving family’ (AFP/Getty)

Fatima is three years old and lives in a shelter run by the United Nations Relief and Works Agency (UNRWA) in Rafah, at the southern end of Gaza. Her parents and two older brothers were killed when their apartment in Gaza City was bombed and destroyed by the Israeli forces.

Fatima was trapped under rubble for six hours, then rescued and rushed to hospital where her left arm was amputated. She was finally discharged into the care of neighbourhood friends, but intense bombardment forced her new family to move south, first to Khan Younis and then to Rafah.

The UNRWA shelter is densely overcrowded. People are tense, and there are intermittent outbreaks of violence. There is limited access to food and clean water – and a two-hour wait to use the toilet.

In the past fortnight, Fatima has had two episodes of diarrhoea and now has a chest infection. She constantly asks for her mother, has nightmares and sleeps poorly. She is hungry, thirsty, and very frightened. She is a WCNSF (wounded child, no surviving family) – a chilling abbreviation used by aid workers in Gaza to describe the desperate plight of injured children who have lost their entire families.

The period between conception and three years of age is critical to a child’s health and development, as well as their subsequent health, emotional and social wellbeing and productivity as an adult. It is a time of rapid brain development when there is a massive increase in brain complexity and connectivity in response to the child’s interactions with their environment.

This early adaptive learning also modifies the way in which genes are expressed, so creating a blueprint for future health and behaviour during adult life, thereby impacting future generations.

To develop optimally and attain their full potential, a child needs nurturing care – to be kept safe, healthy and well nourished, to receive responsive caregiving, and to be encouraged to explore and learn from their environment.

Conversely, we also know that a relentlessly adverse environment has a negative impact on a child’s emotional and cognitive development and that this has long-term consequences. Like most children in Gaza, Fatima is deprived of all five components of nurturing care. The implications for her, and for the future of the Palestinian nation, are devastating.

More than 13,000 children have been killed in Gaza since the start of hostilities, with women and children accounting for nearly 70 per cent of the 32,000 deaths to date.

Most deaths among children have been caused by bombing and military activity, though gross overcrowding, limited access to clean water, widespread damage to sanitation systems and reduced access to immunisation mean that an increasing number of deaths are now due to infectious diseases, particularly diarrhoea and pneumonia.

Fatima is one of 74,000 Palestinians who have been injured since the start of hostilities, and her injuries are life-changing. The continuing Israeli blockade of medical supplies and fuel for hospital generators is also impeding effective medical treatment.

Malnutrition complicates nearly half of all deaths of children under five worldwide. Israel continues to block the entry of sufficient volumes of food and water into Gaza, and this, coupled with the systematic bombing of bakeries and agricultural production, means that 95 per cent of the population of Gaza is now experiencing emergency levels of food insecurity.

Children, pregnant and breastfeeding mothers, and people with disabilities are at the greatest risk of malnutrition, while infants fed with formula milk run the additional risk of diarrhoeal disease, as access to clean water is limited.

Not only is there insufficient to eat but the foods that are available are high in carbohydrates but low in protein, fat and essential micronutrients, and therefore inadequate for children who are growing rapidly.

Of 31 people who have died from malnutrition and dehydration since the start of hostilities, 27 were children. In recent nutritional surveys, 10 per cent of children under two in Rafah and 31 per cent in northern Gaza were found to be acutely malnourished, compared to below 1 per cent before the current crisis.

The longer this lasts, the worse the outcome, as there is good evidence to suggest that children who survive episodes of malnutrition or famine during childhood fail to grow adequately and attain their full developmental potential. In addition, they run a greater risk of developing cardiovascular disease or diabetes in adulthood.

Responsive caregiving helps a young child to learn, not just about their immediate environment but also about people, social and emotional relationships, and language.

Fatima is one of 17,000 children in Gaza who have been orphaned or separated from their parents during this crisis and are now cared for by unrelated adults who are themselves experiencing extreme stress.

Like 1.7 million others (75 per cent of the population of Gaza), they have been displaced from their home and are experiencing continuing violence, economic insecurity, lack of privacy, poor sanitation and potential starvation. In such circumstances, it is almost impossible to provide responsive, nurturing care to a young child.

Nowhere is safe in Gaza. Nurseries and educational facilities have been destroyed or damaged, and the people are too scared to move around. Fatima is experiencing extreme trauma and violence, and there is no place she can go to explore, play and learn.

This is a war against children. By relentlessly inflicting violence, destruction and starvation on the people of Gaza, Benjamin Netanyahu is depriving a generation of Palestinians of their childhood, and leaving scars that will ensure that Israel will never be safe in the future.

Jane Crawley is a paediatrician who has worked in global child health for more than 30 years. She has visited Gaza several times over the past eight years to teach medical students and young doctors