I Study Famine. The Conversation About Gaza Has Been Very Confused.
On April 5, a Reuters article mentioned in passing that there was famine in Gaza. Soon after, they issued a correction: “Gaza suffers widespread hunger, not famine.” An error had been made. Famine was “imminent,” the correction read, but did not yet exist. Just six days later, though, on April 11, several news outlets reported that according to the administrator of the U.S. Agency for International Development, Samantha Power, famine in Gaza had likely already begun.
Campus protests and the crackdowns on them, the intercepted missile and drone strikes from Iran, and the Israeli response to that attack have overtaken the famine conversation in most American media. But in the coming weeks, there will still be continued debate about whether the term “famine” accurately describes the situation in Gaza. And as the long history of famine suggests, the hand-wringing over the use of the word misses the point. This distinction between “widespread hunger” and “famine”—and whether famine is “imminent” or already underway—tells us little about the reality on the ground and what should be done about it.
Three points can help make sense of the conversation. The first is that the threshold for declaring famine is arbitrary. There is no clear line between when famine is imminent and when it begins. The second point is that famine is best understood not as an event, but as a process with mass mortality as its culmination. The third point is that declarations of famine are always contested. Indeed, when asked about Power’s comments, White House press secretary Karine Jean-Pierre insisted that famine was “imminent.”
The arbitrary threshold for declaring famine can lead to misunderstanding about the severity of the humanitarian plight. Since the mid-2000s, the authoritative way to measure food insecurity and malnutrition has been the Integrated Food Security Phase Classification System (IPC). According to the IPC’s five-part classification scheme, Phase 5, the famine phase, occurs when a population suffers from three simultaneous conditions: when it reaches a crude mortality rate of 2 per 10,000 per day, when 20 percent of households cannot obtain enough food, and when 30 percent of children suffer from acute malnutrition.
Extreme suffering and mortality, though, can occur without a famine designation from the IPC. Because the separate thresholds must all be cleared, the bar for declaring a famine is high. In fact, in its two-decade history, the IPC has attributed only two famines: one in parts of Somalia in 2011 and the second in areas of South Sudan in 2017. This does not mean these are the only occasions in which people have died due to lack of food. During extended food crises over the past decade, Yemen and Ethiopia have suffered tens of thousands of deaths each under IPC Phase 4 “emergency” conditions without sliding into Phase 5. Sudan is currently facing a food crisis that threatens to be more deadly than the one in Gaza because the affected population is larger, but the IPC has not designated famine there either.
Those situations, though, shouldn’t be thought of as anything less than extraordinarily severe. The IPC framework is critical for identifying and responding to food crises, but we need to be careful how we interpret the information it provides. The lack of an “official” famine designation should not be taken as a sign that everything is fine. Assigning excessive meaning to an arbitrary measure misunderstands the nature of famines. In reality, there is no objective moment when imminent famine becomes famine proper. If the mortality rate is only 1.8 per 10,000, or if “only” 25 percent of children suffer from acute malnutrition, does this make any practical difference? What if some of the thresholds are exceeded but others are not?
The questions underscore how famine is much better understood as a process, rather than a static moment once certain thresholds are surpassed. Around 40 years ago, the Indian journalist Amrita Rangasami made the kind of brilliant point that seems obvious only in retrospect: Mass mortality is not famine itself, but its result. “I regard mortality as only the biological culmination of the starvation process,” she wrote. Though mortality is the stage of famine that draws the most attention, it is a lagging indicator. When people die, it is a sign that things have already gone very wrong.
There is ample evidence that the famine process has been underway in Gaza for months. Food prices have skyrocketed. Wasting among children (abnormally low weight-to-height ratio) has been observed. People are relying on dirty water that causes gut infections. Diarrhea, a major killer of children during famines, is prevalent. The risk of epidemic disease with the capacity to kill hundreds or thousands is high due to immune systems weakened by hunger, the movement of refugees, and the simultaneous collapse of sanitation and health systems. Inhabitants of Gaza have for more than a month been engaging in coping strategies associated with famine: consuming foods normally reserved for animals, eating in secret, spending extraordinary time and effort looking for food, or harvesting wild plants to stave off hunger. These are not only symptoms of immediate distress; they are also early warning indicators of mass starvation.
Once initiated, the famine process cannot easily be reversed. Even if sufficient food is provided, it will be a challenge to distribute it to those in need. Medical conditions resulting from food deprivation require specialized care. Ultimately, a famine cannot end without restoring the physical, social, and economic infrastructure that constitutes a society. Because this takes time, responding to famine only once mass mortality has reached a critical point is something like diagnosing a patient’s fatal cancer only once its growth has become irreversible.
Authorities often go to great lengths to deny that famine is happening. In my research on 19th- and 20th-century famines, I have seen food crises that killed hundreds of thousands referred to as “shortages,” “difficulties,” or “near-famine conditions.” In 1943, British colonial administrators in Bengal fastidiously avoided the word, speaking euphemistically of “the India food question.” Three million people died. We can expect contemporary officials to play a similar rhetorical game.
The question is not merely semantic. If it were, it wouldn’t be so fraught. There is emotional and political weight to famine. It is a point of no return and a terrible indictment of those in positions of power. It is not targeted. In fact, young children are particularly vulnerable to death and long-term health problems resulting from malnutrition. It is a war crime under international law. Almost always, those who refuse to say “famine” do so not out of analytic rigor, but to obscure the decisions, policies, and intentions that drive starvation. It is a way for those who allow or cause famines to maintain impunity.
If we consider that the threshold to declare a famine is arbitrary, that famine is a process that unfolds over time, and that the use of the word has always been a matter of dispute, the true nature of the situation in Gaza becomes clear: The famine process has long been underway.
Right now, even an immediate cease-fire and unimpeded humanitarian action could not immediately reverse this process. Mortality could, however, be mitigated with a massive influx of food. The amount would have to be large enough to bring down famine prices and account for the devastation of agriculture, transportation, markets, humanitarian distribution networks, and livelihoods—all the things that ensure food security in normal times. It would require authorities to allow a flood, and not just a trickle, of aid into Gaza.
We will continue to see heated discussion about whether what is happening in Gaza should be called a famine. From a humanitarian perspective, this question misses the point. Whether or not it meets the official criteria for Phase 5 of the IPC scale—and it appears that it now does—famine exists in any ethically relevant sense of the word. It has already killed people, and will kill more. Just how many more depends on what happens now, not when the death rate reaches its peak.
