Acute malnutrition is expected to worsen in all governorates, driven by seasonal diseases in high-density population settings alongside reduced assistance to children and pregnant and breastfeeding women. In Rafah, the deterioration is expected to reach critical level (IPC AMN Phase 4). Prioritizing children’s meals over adults, and the inflow of life-saving nutrition assistance, including blanket supplementary feeding of children with fortified, high-calorie foods have been crucial to reverse the deterioration of acute malnutrition. Nonetheless, the expected reduction of humanitarian assistance, soaring food prices, reduced access to fresh food, and the collapse of the health and WASH systems are expected to have a negative impact on the nutrition situation in the projected period. Among children aged 6 to 59 months, an estimated 60,000 cases of acute malnutrition, of which 12,000 severe cases, are expected between September 2024 and August 2025.

The risk of Famine between November 2024 and April 2025 persists as long as conflict continues, and humanitarian access is restricted. The extreme concentration of population in an ever-shrinking area, living in improvised shelters with intermittent access to humanitarian supplies and services, elevates the risk of epidemic outbreaks and deterioration into a catastrophe of unprecedented magnitude. Attacks on camps, shelters and infrastructure across the Gaza strip, as well as renewed evacuation orders in North Gaza in the past two weeks, are already increasing the likelihood of this worst-case scenario occurring.

Only by ensuring widespread access to adequate food, medical supplies, water, and basic services across the Gaza Strip can the risk of a rapid descent into famine be contained.

• Cessation of Hostilities: Call for an immediate, unconditional and sustained  ceasefire. 

• Humanitarian Access: Allow for humanitarian access for the provision of lifesaving, multi-sectoral assistance. Address the high severity and magnitude of acute food insecurity and acute malnutrition by allowing assistance in sufficient quality and in a sustained manner, ensuring safe movement within the Gaza Strip. It is essential to have unimpeded and safe entry of sufficient humanitarian supplies, ensuring that supply chain barriers, including security on the supply routes within the strip and storage capacities are minimized. Assistance needed is not only limited to household food assistance, but also the restoration of health services, WASH, and non-food items. Additionally, ensuring the safety and protection of humanitarian aid workers, health facilities, and shelters is crucial. Civilians must also be safeguarded with unobstructed access to essential humanitarian assistance.

• Protection and Rehabilitation of Food Systems: Protect remaining infrastructure, rehabilitate local food production, restore market system and essential services (telecommunication, electricity, financial services, etc.). Advocate for the protection of remaining productive assets and infrastructure such as markets, shops, roads, farmland, poultry farms in order to protect livelihoods and rehabilitate local markets and food systems. Allow safe access to agriculture land, horticultural greenhouses, and sea for fishing. Provide inputs and equipment such as seeds, animal feed, tools and services like basic veterinary services. Restore the function of remaining markets and bakeries, encouraging access for the delivery of commercial goods. This should be combined with cash-based interventions where feasible, in order to help strengthen cash liquidity and cash transfers.

• Prevention and Management of Acute Malnutrition: Provide acute malnutrition prevention services and treatment. Scale up the prevention of acute malnutrition by improving coverage of blanket supplementary feeding programme and infant and young child feeding programmes, including promotion of breastfeeding practices and care for non-breastfed infants. In addition, increase coverage and access to health and wash services across Gaza strip, as prevention of outbreaks of communicable diseases. Sustain efforts in inpatient and outpatient management of acute malnutrition, including monitoring of site performance and better referral between the different level of care.  Strengthen the nutrition information system to detect early the fluctuations in risk factors for acute malnutrition among vulnerable groups, and inform action to prevent a further deterioration.