DEIR AL-BALAH, Gaza Strip — Five starving children at a Gaza City hospital were wasting away, and nothing the doctors tried was working. The basic treatments for malnourishment that could save them had run out. The alternatives were ineffective. One after another, the babies and toddlers died over four days.

In greater numbers than ever, children hollowed up by hunger are overwhelming the Patient’s Friends Hospital, the main emergency center for malnourished kids in northern Gaza.

The deaths last weekend also marked a change: the first seen by the center in children who had no preexisting conditions. Symptoms are getting worse, with children too weak to cry or move, said Dr. Rana Soboh, a nutritionist. In past months, most improved, despite supply shortages, but now patients stay longer and don’t get better, she said.

“There are no words in the face of the disaster we are in. Kids are dying before the world … There is no uglier and more horrible phase than this,” said Soboh, who works with the US-based aid organization Medglobal, which supports the hospital.

This month, the hunger that has been building among Gaza’s more than 2 million Palestinians passed a tipping point into accelerating death, aid workers and health staff say. Not only children — usually the most vulnerable — are falling victim, but also adults.

In the past three weeks, at least 48 people died of causes related to malnutrition, including 28 adults and 20 children, the Hamas-run Gaza Health Ministry said Thursday. That’s up from 10 children who died in the five previous months of 2025, according to the ministry.

The World Health Organization said Wednesday it has documented 21 children under 5 who died of causes related to malnutrition in 2025. The UN humanitarian office, OCHA, said Thursday at least 13 children’s deaths were reported in July, with the number growing daily.

“Humans are well developed to live with caloric deficits, but only so far,” said Dr. John Kahler, Medglobal’s co-founder and a pediatrician who volunteered twice in Gaza during the war. “It appears that we have crossed the line where a segment of the population has reached their limits.”

“This is the beginning of a population death spiral,” he said.

The UN’s World Food Programme says nearly 100,000 women and children urgently need treatment for malnutrition. Medical workers say they have run out of many key treatments and medicines.

Israel, which began letting in a trickle of supplies two months ago following a two-month blockade of aid and has endorsed the new Gaza Humanitarian Foundation mechanism for its distribution, has blamed Hamas for disrupting food distribution, and has pointed to some thousand trucks’ worth of aid waiting inside Gaza to be distributed.

The UN — which has refused to work with GHF, saying it violates humanitarian principles — has said more than 1,000 people have been killed near aid distribution centers since May, many of them at GHF sites. Israel says those figures are inflated, though it has acknowledged firing at crowds. It has not provided alternative numbers.

The Patient’s Friends Hospital overflows with parents bringing in scrawny children – 200 to 300 cases a day, said Soboh.

On Wednesday, staff laid toddlers on a desk to measure the circumference of their upper arms — the quickest way to determine malnutrition. In the summer heat, mothers huddled around specialists, asking for supplements. Babies with emaciated limbs screamed in agony. Others lay totally silent.

The worst cases are kept for up to two weeks at the center’s 10-bed ward, which this month has had up to 19 children at a time. It usually treats only children under 5, but began taking some as old as 11 or 12 because of worsening starvation among older children.

Hunger gnaws at staff as well. Soboh said two nurses put themselves on IV drips to keep themselves going. “We are exhausted. We are dead in the shape of the living,” she said.

The five children died in succession last Thursday, Saturday and Sunday.

Four of them, aged 4 months to 2 years, had suffered gastric arrest: Their stomachs shut down. The hospital no longer had the right nutrition supplies for them.

The fifth — 4.5-year-old Siwar — had alarmingly low potassium levels, a growing problem. She was so weak she could barely move her body. Medicine for potassium deficiency has largely run out across Gaza, Soboh said. The center had only a low-concentration potassium drip.

The little girl didn’t respond. After three days in the ICU, she died Saturday.

“If we don’t have potassium [supplies], we will see more deaths,” she said.

In the Shati Refugee Camp in Gaza City, 2-year-old Yazan Abu Ful’s mother, Naima, pulled off his clothes to show his emaciated body. His vertebrae, ribs and shoulder blades jutted out. His buttocks were shriveled. His face was expressionless.

His father Mahmoud, who was also skinny, said they took him to the hospital several times. Doctors just say they should feed him. “I tell the doctors, ‘You see for yourself, there is no food,’” he said,

Naima, who is pregnant, prepared a meal: Two eggplants they bought for $9 cut up and boiled in water. They will stretch out the pot of eggplant-water – not even a real soup – to last them a few days, they said. Several of Yazan’s four older siblings also looked thin and drained.

Holding him in his lap, Mahmoud Abu Ful lifted Yazan’s limp arms. The boy lies on the floor most of the day, too weak to play with his brothers. “If we leave him, he might just slip away between our fingers, and we can’t do anything.”

Starvation takes the vulnerable first, experts say: children and adults with health conditions.

On Thursday, the bodies of an adult man and woman with signs of starvation were brought to Gaza City’s Shifa Hospital, hospital director Mohammed Abu Selmia said. One suffered from diabetes, the other from a heart condition, but they showed severe deficiencies of nutrients, gastric arrest and anemia from malnutrition.

Many of the adults who have died had some sort of preexisting condition, like diabetes or heart or kidney trouble, worsened by malnutrition, Abu Selmia said. “These diseases don’t kill if they have food and medicine,” he said.

On Tuesday, David Mencer, spokesman for the Israeli Prime Minister’s Office, denied there is a “famine created by Israel” in Gaza and blamed Hamas for creating “man-made shortages” by looting aid trucks.

According to Col. Abdullah Halabi, head of the Israel Defense Forces’ Coordination and Liaison Administration for Gaza, the military has identified an “intense and violent campaign” by Hamas against Israel’s humanitarian aid mechanism.

“This campaign is based on lies,” he said, referring to claims of widespread starvation in Gaza. “It was created not to help Gaza’s population receive the aid, but primarily to improve Hamas’s standings in the [hostage] negotiations that are taking place over the last few days, and it is using different means, in particular the famine narrative, to improve their standings.”

Speaking to reporters on the Gaza side of the Kerem Shalom Crossing on Wednesday, Halabi said that approximately 1,000 trucks’ worth of aid are piled up inside the Strip, awaiting collection by the United Nations and aid groups.

The senior officer blamed “a lack of cooperation from the international community and international organizations.”

The UN has repeatedly claimed that COGAT has refused its requests for collection and distribution authorization, and that dangerous and complex conditions inside Gaza, including hungry crowds and gangs, made aid distribution very difficult.

Israel cut off the entry of food, medicine, fuel and other supplies completely to Gaza for some two and a half months starting in March, estimating that enough aid had accumulated in the Strip to last some two months and that allowing in more would help Hamas, which still holds 20 living hostages and the bodies of 30 more.

During that time, food largely ran out for aid groups and in marketplaces, and experts warned Gaza was headed for an outright famine.

In late May, Israel slightly eased the blockade. Since then, it has allowed in around 4,500 trucks for the UN and other aid groups to distribute, including 2,500 tons of baby food and high-calorie special food for children, the Israeli Foreign Ministry said Wednesday.

That is an average of 69 trucks a day, far below the 500-600 trucks a day the UN says are needed. The UN has been unable to distribute much of the aid because hungry crowds and gangs take most of it from its trucks.

The UN denies that Hamas siphons off significant quantities of aid. Humanitarian workers say Israel just needs to allow aid to flow in freely, saying looting stops whenever aid enters in large quantities.

The war in Gaza began on October 7, 2023, when thousands of Hamas-led terrorists invaded southern Israel, killing some 1,200 people and taking 251 hostages, of whom 50 are still held, among whom 20 are believed to be alive.