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Yet numerous experts warned that not all consequences of famine can be undone. “People don’t realize that one doesn’t just recover from starvation,” Dana Simmons, a historian and the author of “On Hunger: Violence and Craving in America, from Starvation to Ozempic,” said. For the severely malnourished, simply starting to eat normal meals again can cause sickness—even death. And survivors of starvation are at risk of chronic diseases and mental-health conditions for decades after they regain access to food. “You’ve stunted a generation,” Nathaniel Raymond, the director of the Humanitarian Research Lab at Yale, told me. Ruth Gibson, a scholar at Stanford’s Center for Innovation in Global Health, spoke in even starker terms. “Can this be reversed?” she said. “The answer is, it can’t be.”
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Another surprise [in a volunteer study] was that, when Keys allowed volunteers to start eating again, their condition worsened. This effect had occasionally cropped up in the historical record: Flavius Josephus wrote about it in the year 70, after the Romans besieged Jerusalem, and a Florentine physician observed it during a 1496 famine. The Warsaw doctors likewise wrote about patients whose hearts failed after they were fed; when Allied soldiers liberated the concentration camps, large numbers of emaciated people died after being given high-calorie foods such as chocolate. “Why, when you are starving, would food cause your death?” Alison Culkin, a consultant dietician at St. Mark’s Hospital in London, said. “It was counterintuitive.”
The phenomenon became known as refeeding syndrome.
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I asked da Silva whether Gazans who suddenly regain access to food will be at risk of refeeding syndrome. “How could they not?” he said. Kahler, the MedGlobal pediatrician, was gravely concerned. “Kids could die,” he said. “They’ll refeed them, their insulin will pour out, and they could die.” The best way to prevent refeeding syndrome, my sources said, is for health-care workers to intensively monitor high-risk groups, which include people who have lost a lot of muscle or fat, or who have eaten less than half of what they need for a month or more. According to the American Society for Parenteral and Enteral Nutrition, medical professionals should perform blood tests on anyone in these categories, first before they eat and again every twelve hours for the first three days. Oral rehydration salts or an I.V. drip can bolster electrolytes. Vital signs should be checked every four hours for the first day. Feeding should start at very low levels, beginning with a hundred grams of liquid glucose—the equivalent of half a cup of sugar. But all of this will be extremely difficult in a place where most health-care facilities are in ruins.
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Since the nineties, a number of studies have examined the long-term impacts of starvation on fetuses in the womb. “These effects are measurable eighty years later,” Tessa Roseboom, a biologist at the University of Amsterdam who has been studying the Hunger Winter for thirty years, told me. ...
Daniel Ramirez, a demographer and research associate at Penn State, used a similar study design to measure the impact of starvation on those who were children during the famine. “I found effects for education, income, occupation, functional limitations, depression,” he said. Children who had survived starvation ultimately completed fewer years of education, had a lower chance of attending college, and were twenty per cent more likely to fall below the poverty line. “The body has memory,” Ramirez told me.
In 2018, Heijmans and L. H. Lumey, an epidemiologist at Columbia University, published a paper showing that the famine had altered the expression of genes associated with growth and metabolism. In times of scarcity, these changes could help a person survive, but after the famine they seemed to contribute to chronic diseases such as diabetes. “If as a fetus there is scarcity, you are being programmed to deal with it,” Heijmans said. “We see the effects of this tragedy on the DNA sixty years later.”
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Amawi worried about the risk of refeeding syndrome. “In reality, implementing a gradual refeeding program in Gaza is very difficult right now, because hospitals are operating with extremely limited capacity,” he wrote. “Many lack medical staff, essential supplies, and even the special therapeutic foods needed for cases of malnutrition.” He didn’t think that doctors and humanitarian workers would be able to follow recommended protocols; they need large numbers of outside health-care workers, cardiac monitors, I.V. kits, and hospital beds. “As for ordinary people, most are unaware of the risk of refeeding syndrome,” he told me. “They will just provide whatever food is available to ease the hunger, even if it’s not nutritionally ideal.”
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https://www.newyorker.com/news/the-lede/what-comes-after-starvation-in-gaza
#Gaza #genocide #starvation