More than 54,000 children aged under five in Gaza are suffering acute malnutrition, including more than 12,800 who are severely malnourished, according to a study published in The Lancet on Wednesday.
When more than 15% of the population experiences acute malnutrition, the World Health Organization classifies this as “very high” – its most severe category. In August, the overall rate of acute malnutrition among study participants in Gaza was 15.8%.
Rafah consistently had the highest acute malnutrition rate, across the 20-month study period to August 2025, reaching 32% of children in December 2024.
Acutely malnourished children are at higher risk of severe infections and premature death. If malnutrition becomes long term, the child may develop stunting (shortness for their age) and subsequent cognitive impairment.
A child with severe acute malnutrition is also up to 11 times more likely than a healthy child to die of common childhood illnesses such as pneumonia, the single largest infectious cause of death in children worldwide.
How was the study conducted?
The researchers assessed 219,783 children aged 6–59 months for acute malnutrition – also known as wasting – which reflects recent weight loss. This study size accounts for around 64% of children in Gaza in that age group.
It was conducted in 16 UN health centres and 78 medical points established in school shelters and tent encampments across the five local areas of Gaza.
According to the WHO, the gold standard of assessing the nutritional status of a child is to measure their weight (using standard hanging scales) and their height or length. It also recommends measuring arm circumference to detect acute malnutrition in community screening settings, as numerous studies have demonstrated this is an accurate way of detecting acute malnutrition.
The Lancet study measured the children’s height and weight, as well as their mid-upper arm circumference using a standard measuring tape developed by UNICEF.
However, a number of researchers have recommended increasing the diagnostic threshold, which is currently 125 mm, which would mean more children meet the threshold for malnutrition.
The researchers in Gaza calculated what is called the Z-score for each assessed child, as is standard practice. This is the number of standard deviations above or below the median of the WHO reference population. A Z-score between -2 and -3 represents moderate acute malnutrition and a Z-score of less than -3 is severe acute malnutrition.
What did the researchers find?
The monthly prevalence of acute malnutrition ranged from 5% to 7% between January and June 2024.
After around four months of severe aid restrictions, between September 2024 and mid-January 2025, the prevalence increased from 8.8% to 14.3%. The highest prevalence was seen in Rafah (32.2%).
After a six-week ceasefire and a substantial increase in the number of aid trucks entering Gaza, by March 2025, the prevalence of wasting had declined to 5.5%.
However, an 11-week blockade occurred from March to May 2025 and severely restricted entry of food, water, medicines, fuel and other essentials. By early August 2025, 15.8% of screened children were acutely malnourished, including 3.7% who were severely wasted. This equates to more than 54,600 children in need of treatment using ready-to-use therapeutic food – a paste containing high quantities of calories and other nutrients.
Boys were more likely to be malnourished than girls, which was consistent with the pre-war period. Studies across the globe have found malnutrition rates are usually higher in boys than girls.
Was the study well conducted?
This was a longitudinal (conducted over time, in this case 20 months) cross-sectional study, which means the researchers took their measurements at certain intervals (in this case, monthly).
The authors provide extensive details of the numbers of children included, in which local area, what kind of facility (a fixed medical centre or medical point), as well as age and sex.
Two-thirds of the participants were in Khan Younis and Middle governorates, with relatively low numbers in North Gaza and Rafah, which were highly affected by military activities.
The analysis was thorough, preceded by a data cleansing process which excluded values that were implausible. Standard statistical tests were applied to the data.
The paper was peer reviewed before publication.
What do the findings mean?
The Integrated Food Security Phase Classification, known as the IPC scale, defines famine as a situation in which at least one in five households has an extreme lack of food and faces starvation and destitution, resulting in extremely critical levels of acute malnutrition and death. The IPC uses the same classification of acute malnutrition as the WHO.
The IPC scale defines five phases of food insecurity. Famine (phase 5) is the highest phase of the scale, and is classified when an area has 20% of households facing extreme food shortage and 30% of children are acutely malnourished.
In late August 2025, the IPC released its fifth report on Gaza. It found for the period July 1 to August 15 2025, there was famine (phase 5) for the Gaza governorate and emergency (phase 4) for Deir al-Balah and Khan Younis. It was unable to adequately assess North Gaza because of insecurity.
The food insecurity situation in Gaza is among the worst in the world, comparable with the current situation in Sudan, Yemen and Haiti. It is a man-made disaster and can be reversed by urgent human action.
The Lancet study found spikes in acute malnutrition coincided with aid blockades. A ceasefire and a complete opening to international aid are fundamental to a resolution of the food crisis.
Michael Toole receives funding from the National Health and Medical Research Council..
