The UN Children's Fund (UNICEF) called on Thursday for the international community to do everything possible to prevent catastrophe in Gaza City as Israel ramps up military operations ahead of a planned full takeover.
Tess Ingram, Communication Manager for UNICEF 's Middle East and North Africa Regional Office, recently spent nine days there, describing it as "a city of fear, flight and funerals."
"The last refuge for families in the northern Gaza Strip is fast becoming a place where childhood cannot survive," she said, speaking from the enclave to journalists in New York.
Children 'fighting for survival'
Nearly a million people remain in Gaza City, where the collapse of essential services is leaving its youngest and most vulnerable residents "fighting for survival" as famine spreads and aid barely trickles in.
Only 44 out of 92 UNICEF-supported outpatient nutrition treatment centres are still functional, which means thousands of malnourished children lack access to these critical lifelines.
Meanwhile, hospitals "are on their knees". Only 11 are still partly functioning and only five have neonatal intensive care units, or NICUs.
"The 40 incubators between them are running at up to 200 per cent capacity, meaning there are as many as 80 babies fighting for life in overcrowded machines, utterly dependent on generators and medical supplies that may run dry at any moment," she said, speaking from the enclave.
'Small bodies shredded by shrapnel'
In Gaza City, Ms. Ingram met displaced families on the run once again, children who have been separated from their parents, and mothers whose children either died from starvation or who fear their offspring will be next.
"I've spoken to kids in hospital beds, their small bodies shredded by shrapnel," she said. "The unthinkable is not looming. It is already here. The escalation is underway."
Famine is 'everywhere' in Gaza City
Famine was "everywhere I looked in Gaza City", she said. "Just an hour in a nutrition clinic is enough to erase any questions about whether there is a famine," she added.
At these clinics, waiting rooms are filled with tearful parents, "children fighting the double punch of disease and malnutrition", mothers unable to breastfeed with "babies losing their vision, their hair and their strength to walk."
Like elsewhere in the enclave, whole families are surviving on one bowl of lentils or rice a day from community kitchens. Parents often go without so that their children can have something to eat.
A sad reunion
Last week, Ms. Ingram visited a stabilisation centre that treats malnourished children and was shocked to find a woman there called Nesma and her daughter, Jana.
UNICEF had evacuated the girl for treatment in southern Gaza more than a year ago and she recovered. Jana and her mother then returned to northern Gaza during the ceasefire earlier this year to reunite with the rest of their family
"Then the blockade on aid, hunger returned, and this time both of Nesma's children deteriorated." Her two-year-old daughter Jouri died from malnutrition last month and Jana "is barely hanging on".
'More children will starve'
Ms. Ingram said children like Jana "are returning to emergency wards or relapsing just weeks after finishing treatment for malnutrition because of the ongoing lack of food, safe water and other essential supplies" in Gaza.
She affirmed that "without immediate and increased access to food and nutrition treatments, this recurring nightmare will deepen and more children will starve - a fate that is entirely preventable."
UNICEF continues to respond to the crisis and in the past two weeks provided partners on the ground with enough ready-to-use therapeutic food to support more than 3,000 acutely malnourished children over the six-week course of treatment.
The agency also provided complimentary food to support more than 1,400 infants as well as high energy biscuits for more than 4,600 pregnant and breastfeeding women, among other assistance such as safe drinking water and construction of temporary learning centres.
"Our team is doing everything in their power to help children, but we could do far more, reach every child here, if our operations on the ground were enabled at scale and we were well funded," she said.
Malnutrition numbers rising
UNICEF is seeking $716 million this year for its response in Gaza, where needs are immense and childhood malnutrition continues to rise. In February, just over 2,000 youngsters were admitted for treatment. In July, the number climbed to 13,000 and by mid-August had already reached 7,200.
The agency continues to call on Israel to review its rules of engagement to ensure that children are protected, and for Hamas and other armed groups to release all remaining hostages, Ms. Ingram said.
She underlined the need for Israel to allow sufficient aid to enter, while humanitarians must be able to safely reach families where they are.
Her final plea was for the international community, especially States and stakeholders with influence, to use their leverage to end the war now: "because the cost of inaction will be measured in the lives of children buried in the rubble, wasted by hunger and silenced before they even had a chance to speak."
