As the humanitarian crisis in Gaza deepens, medical professionals and aid organisations continue to raise alarms over widespread starvation, severe malnutrition among children, and limited access to critical healthcare.
Since the escalation of conflict in October 2023, the Gaza strip has faced prolonged restrictions on food, water, and medical supplies, prompting international concern about the deliberate obstruction of aid and the long-term public health consequences.
In this interview, British emergency physician Dr. James Smith shares his insights based on firsthand experience working in Gaza’s hospitals and his recent attempts to return.
He discusses the challenges faced by healthcare workers, the medical implications of prolonged starvation, and the complexities involved in reintroducing nutrition to malnourished populations.
Dr. Smith also addresses the professional and institutional consequences faced by medical practitioners who speak out about the situation in Gaza, and reflects on the broader role of the global health community in responding to such crises.
Dr. Smith, thank you for joining us. I understand you recently tried to return to Gaza. Can you describe what happened?
Yes, I attempted to return twice — in May and June of this year — and on both occasions, the Israeli military denied me entry. This isn’t unusual. Over half of medical professionals trying to access Gaza are rejected, often without explanation. These denials usually come the day before travel from Jordan, making it extremely difficult for small humanitarian teams to operate. Many convoys end up traveling with empty seats.
From your previous time working in Gaza’s hospitals, what stands out most to you?
The conditions were unlike anything I’ve experienced. Even with strong media coverage, the reality on the ground was far worse — constant bombardment, widespread shortages, and attacks on medical infrastructure. Every protected category — civilians, healthcare workers, journalists — was impacted. I spoke with seasoned humanitarian professionals who said they had never seen such sustained violence at this scale.
Let’s discuss the current starvation crisis. How serious is the situation?
Extremely serious. We saw early signs of malnutrition in January 2024. A month prior, Human Rights Watch warned that Israel was using starvation as a method of warfare. The intentionality is clear — Israeli officials publicly stated within days of the October 2023 escalation that aid, including food and water, would be blocked.
Throughout 2024, the situation deteriorated. The IPC — an international food security monitoring body — issued repeated warnings about the risk of famine, particularly in northern Gaza. Yet access to aid remained tightly restricted. It appears to be a calculated strategy: enough aid to avoid a technical famine declaration, but insufficient to prevent mass suffering.
What are the longer-term health consequences of this for children?
The first 1,000 days of a child’s life are critical. Malnutrition during this window can result in long-term stunting, cognitive delays, and increased vulnerability to chronic diseases later in life.
In the immediate term, a malnourished child has a weakened immune system and is highly susceptible to infections. It’s not usually malnutrition alone that causes death — it’s malnutrition combined with illnesses like diarrhoea or respiratory infections.
What are the medical considerations when reintroducing food to individuals after prolonged periods of malnutrition or starvation?
Refeeding must be done cautiously. Severely malnourished individuals can’t just return to eating normal meals—it puts them at risk of refeeding syndrome, a dangerous condition where sudden nutrient intake causes electrolyte imbalances, which can lead to cardiac issues or even death.
Proper treatment involves medically supervised nutritional rehabilitation: gradual caloric reintroduction, electrolyte monitoring, and specific micronutrient supplementation. Without these, refeeding can do more harm than good.
Can these effects—especially in children—be reversed with treatment?
Some effects can be reversed, particularly if intervention comes early. But many of the developmental and physiological impacts of prolonged malnutrition can be permanent. There’s also evidence of intergenerational consequences—the health of future children can be affected by a parent’s malnutrition. So yes, we’re looking at damage that could extend well beyond this generation.
There have been reports of professional repercussions for doctors who speak publicly about Gaza. Have you faced this personally?
I have. After publishing in a medical journal, I was temporarily suspended from clinical practice. I’ve been the subject of misleading press coverage and formal complaints, usually accusing me of antisemitism or condoning terrorism—both completely unfounded.
Even when dismissed, these complaints are exhausting and disruptive. But more troubling is the broader culture of silence in the medical community. Many healthcare workers have faced retaliation for simply speaking out or showing solidarity.
Do you think UK medical institutions have failed in their responsibilities?
Absolutely. Palestinian doctors trained in the U.K. have been killed while applying their skills in Gaza, and their institutions have remained silent. That silence is not neutral—it reflects systemic anti-Palestinian bias and an unwillingness to confront the political realities of this crisis.
We have to ask what it means to be a healthcare professional during a time of mass atrocity. Our institutions are expected to speak out in moments of injustice — yet many have failed to do so.
What role should the global health community and international agencies be playing right now?
Humanitarian aid is essential in the short term, but it’s not the solution. As former UN High Commissioner Sadako Ogata once said, “There are no humanitarian solutions to humanitarian problems.” What we’re seeing in Gaza is not a natural disaster — it’s a man-made political crisis, and it requires a political response.
The global health community claims to stand for equity and justice, but its response to Gaza has largely been silence. A few individuals have spoken out, but institutions have failed to meet this moment with the urgency and moral clarity it demands.
Finally, what do you think the public and policymakers most misunderstand about the humanitarian conditions in Gaza?
That this is not a natural or accidental crisis. Famine and starvation today are always man-made. In Gaza, we are witnessing deliberate deprivation—manufactured scarcity—intended to maximize suffering.
This is not just a humanitarian emergency in the present. It’s a multi-generational crisis that will have long-lasting effects on physical and mental health, social structures, and the future of an entire population. And that’s what makes it so deeply unjust.
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