Mid-upper arm circumference of preschool-aged children during conflict transition in the Gaza Strip: a...

In August, 2025, preschool children in Gaza faced excessive wasting, including famine conditions in Gaza City. Following a declared ceasefire in October, 2025, supplies entering Gaza increased. However, trends in preschool child nutritional status have not been reported in peer-reviewed journals. Therefore, we aimed to assess the prevalence of wasting among children in the Gaza Strip following a declared ceasefire.

In this cross-sectional nutritional surveillance study conducted by the UN Relief and Works Agency for Palestine Refugees in the Near East, children aged 6-59 months visiting ten health centres and 27 medical points within school shelters and tented camps across the Gaza Strip for food supplements, feeding programme eligibility, vaccines, and treatments, were screened by mid-upper arm circumference (MUAC) measurement. Children with MUAC measurements of less than 125 mm were referred for therapeutic feeding. Age-sex-specific MUAC Z scores derived from WHO reference curves were evaluated to estimate semi-monthly prevalence of wasting (ie, a MUAC Z score of <-2) and severe wasting (ie, a MUAC Z score of <-3), overall and stratified by age (ie, 6-11, 12-23, and 24-59 months), sex, type of facility, and governorate. Data were collected and entered by trained staff at the time of visits directly onto a standardised Microsoft Excel template designed for MUAC screening. Trends in wasting were compared with extant online reports of the Gaza Chamber of Commerce & Industry on numbers of trucks entering Gaza (70-97% carrying food) and the World Food Programme Palestine monthly report on market prices of brown lentils, a local staple, as indicators of food availability and access. The primary outcomes were to admit malnourished children aged 6-59 months into Community Management of Acute Malnutrition programmes based on MUAC measurements and to estimate trends in the prevalence of wasting malnutrition among these children.

From Aug 1, 2025, to April 30, 2026, 78 902 unique children were screened with 101 456 MUAC measurements, including 75 687 (95·8%) children in the Khan Younis, Middle, and Gaza City Governorates. Children were evenly distributed by sex, with 39 362 (49·9%) females and 39 540 (50·1%) males. 17 158 (21·7%) children were aged 6-11 months, 20 552 (26·0%) were aged 12-23 months, and 41 192 (52·2%) children were aged 24-59 months. The prevalence of wasting declined from 15·7% (1235/7857; 95% CI 14·9-16·5) in mid-August, 2025, to 3·2% (180/5714; 2·7-3·7) by late April, 2026, including in Khan Younis from 12·8% (357/2793; 11·6-14·1) to 2·8% (58/2104; 2·1-3·5), Middle from 8·5% (242/2838; 7·5-9·6) to 3·0% (44/1451; 2·2-4·0), and Gaza City from 28·6% (636/2226; 26·7-30·5) to 4·0% (70/1738; 3·2-5·1). Wasting was more prevalent in males and initially higher in younger children but decreased to 5% or less in all groups. Wasting generally tracked trends in truck entry and lentil market prices.

Preschool child wasting declined in Gaza over 9 months from active war to 6 months post-ceasefire, despite continued military attacks and severely constrained living conditions. Comprehensive nutritional monitoring and sustained dietary adequacy are essential to protect children's health in Gaza.

UN Relief and Works Agency for Palestine Refugees in the Near East.