Childhood malnutrition care during the Gaza siege: aprospective program evaluation

BACKGROUND: Childhood malnutrition in the Gaza Strip has escalated to critical levels due to prolonged blockade, conflict-related destruction of food systems, and severe restrictions on humanitarian aid. Despite widespread acute malnutrition, little evidence exists on treatment outcomes or program performance during the period of complete siege. This study evaluates the burden of acute malnutrition and documents the effectiveness of WHO-standard outpatient therapeutic care delivered during the 2024–2025 total blockade in Gaza City. METHODS: A single-group prospective program evaluation was conducted at the Patients’ Friends Benevolent Society (PFBS) Hospital, the only operational pediatric center in Gaza City during the study period. All children aged 6–59 months screened for malnutrition between 15 June 2024 and 31 January 2025 were enrolled and followed until 29 April 2025. Anthropometric assessments included MUAC, weight, height/length, and WHZ/WLZ. Children meeting MUAC-based WHO criteria for SAM or MAM received ready-to-use therapeutic food (RUTF) through the outpatient therapeutic program. Repeated measures of MUAC, weight, and WHZ were analyzed using a Generalized Estimating Equation (GEE) model to account for within-subject correlation and uneven follow-up. RESULTS: A total of 1,415 children were enrolled; 54.3% were female, and mean age was 26.9 months (SD 13.3). At admission, 89.3% had MAM and 10.8% had SAM, with notable discordance between MUAC- and WHZ/WLZ-based classifications. Attrition was high (41.2%), driven mainly by conflict-induced displacement. Among children retained in care, significant anthropometric improvements were observed. At first follow-up (n = 910), mean MUAC increased by 1.8–2.8 mm and weight by 0.28–2.1 kg depending on follow-up duration. At second follow-up (n = 589), MUAC and weight improved significantly (p = .003 and p = .015). At discharge (n = 833), children treated for more than four weeks achieved the greatest gains in MUAC (+7.34 mm) and weight (+1.38 kg). No mortality or severe adverse clinical outcomes were recorded among the children retained in the program. CONCLUSION: WHO-standard outpatient therapeutic care achieved meaningful nutritional recovery among children who remained in the program despite extreme siege conditions. However, high attrition linked to displacement, insecurity, and restricted humanitarian access severely constrained population-level impact. These findings underscore both the effectiveness of RUTF-based outpatient management and the urgent need for protected, uninterrupted humanitarian access to prevent escalating malnutrition and mortality among Gaza’s children.