The lifeless body of 2.5-year-old Ro’a Mashi lay on a table at Gaza’s Nasser Hospital, her arms and rib cage skeletal, her eyes sunken.
Doctors said she had no preexisting conditions, yet months of food shortages and interrupted care had left her emaciated.
Her family shared the photograph with The Associated Press (AP), which was confirmed by the attending physician.
Ro’a was one of four children who died of severe malnutrition at Nasser Hospital in just over two weeks.
Fatma Mashi, her mother, recalled noticing her daughter losing weight last year, initially blaming teething.
When she brought Ro’a to Nasser Hospital in October, the child was already severely malnourished.
Repeated displacements caused by Israeli military operations interrupted her care, leaving the family reduced to a single daily meal of boiled macaroni.
Prime Minister Benjamin Netanyahu has repeatedly denied reports of famine.
Speaking to local media Sunday, he said, "There is no hunger. There was no hunger... there was certainly no policy of starvation,” dismissing international criticism as "lies” promoted by Hamas.
The United Nations paints a starkly different picture.
Nearly 12,000 children under 5 suffered from acute malnutrition in July alone, including more than 2,500 with severe, life-threatening malnutrition – the highest levels since the war began.
The World Health Organization warns these numbers likely undercount the true scale of the crisis.
After more than two months of tight restrictions, Israel recently allowed roughly three times the amount of food into Gaza compared with late May, easing access for some.
Prices in local marketplaces have fallen slightly but remain far above prewar levels, still unaffordable for many families.
Experts caution that general food supplies cannot save severely malnourished children. "Severely malnourished children require hospital care,” said Alex DeWaal, executive director of Tufts University’s World Peace Foundation. "Simply feeding them without proper micronutrient supplementation can trigger refeeding syndrome, potentially causing seizures, coma, or death.”
The Gaza Health Ministry, run by medical professionals under Hamas, reports that 42 children and 129 adults have died from malnutrition-related causes since July 1, with 106 children lost to hunger during the war.
Israeli officials counter that some child deaths involved preexisting conditions and assert there is no evidence of widespread malnutrition.
Doctors at Nasser Hospital say malnutrition is the primary factor. "Malnutrition was the main factor in these deaths,” said Dr. Yasser Abu Ghali, head of pediatrics. Among 13 emaciated children examined by AP since late July, five had no prior conditions, including three who died.
Among the cases is Jamal al-Najjar, 5, born with rickets, a disease that weakens bones and prevents proper vitamin metabolism.
Over recent months, his weight plunged from 16 kilograms to 7 (35 pounds to 15). "Of course there’s famine,” said his father, pointing to Jamal’s protruding rib cage.
Two-year-old Shamm Qudeih, weighing just 4 kilograms (9 pounds), suffers from a suspected rare genetic disorder affecting nutrient storage.
Gaza hospitals cannot test her condition locally, but with a proper high-carbohydrate diet, it could be managed. After months of delays in evacuation permits, Shamm was finally allowed to leave Gaza this week for treatment in Italy.
Dr. Ahmed al-Farra, Nasser’s general director of pediatrics, said the hospital receives 10–20 children with severe malnutrition each day, a number that continues to rise. "It won’t help the children who are severely malnourished,” DeWaal said. "They need hospital care, supplements, and therapeutic feeding, not just general food deliveries.”
Families like Ro’a’s face repeated displacement, limited access to clinics, and dwindling supplies. Their final move to the tent camps of Muwasi on Gaza’s southern coast accelerated Ro’a’s decline.
"I could tell it was only a matter of two or three more days,” Fatma Mashi said the day after her daughter died. Their five surviving children are thin but not as emaciated.
Medical experts note that children between 18 months and 2 years are most vulnerable in famine conditions.
"A very small thing can push them over,” DeWaal said, citing infections, poor nutrition after weaning, or minor illnesses that can spiral into severe malnutrition.
The looming Israeli offensive in Gaza City threatens further displacement and disruption of aid deliveries, potentially worsening the crisis.
Doctors warn that without immediate, targeted intervention – hospitalization, micronutrients, and therapeutic feeding – the most at-risk children may continue to die despite increases in the general food supply.