Starvation as a weapon of war must stop
The Lancet
Published:April 06, 2024
The theme of World Health Day on April 7 is ‘my health, my right’, underscoring the UN’s assertion that “every human being is entitled to the enjoyment of the highest attainable standard of health conducive to living a life in dignity”. In this week’s issue, the report from Under threat: the International AIDS Society–Lancet Commission on Health and Human Rights examines the steady deterioration of the global commitment to human rights in the 21st century, with serious and increasingly damaging effects on health. Shockingly, one of the most basic of rights, access to food, remains unattainable for the 691 to 783 million people who were food insecure in 2022. In conflict zones, where nearly 60% or 158 million hungry people live, conflict has displaced populations, destroyed economies and infrastructure, and led to high prices for scarce goods. Moreover, the destruction of the food supply can be deliberately used to starve people as a weapon of war, which has been more commonplace since 2010. One stark and distressing current example: the UN High Commissioner for Human Rights Volker Türk has stated that there is a plausible case that Israel is now using starvation as a weapon of war in Gaza. Why is starving people to death increasingly occurring and why do countries and the UN allow it to continue?
According to Alex DeWaal, the Director of the World Peace Foundation, about two-thirds of the people facing hunger “live in war or violence zones”. Sudan, for example, is facing a famine due to conflict with nearly 18 million people experiencing acute food insecurity. In Ukraine, 11 million people are hungry, owing to Russia’s targeting of Ukrainian ports and grain production. Aid budgets are insufficient for delivering food aid to war zones and aid itself is dependent upon negotiations with warring parties. In Yemen in 2014, the Saudi-backed coalition effectively blockaded the ports in a country that already had widespread malnourishment. Only once widespread mortality had set in was a truce agreed upon. The inevitable outcome was that by the start of 2022, UNDP estimated that the conflict had caused more than 377 000 deaths, with 60% of these deaths the result of hunger, lack of health care, and unsafe water.
Accountability mechanisms are important, but only when heeded. One such initiative is the Integrated Food Security Phase Classification (IPC), convened by a Famine Review Committee (FRC), of leading humanitarian agencies. The FRC uses a standardised five-point scale to measure hunger, as an early warning system to begin aid before people are starving. For the Famine classification to be declared, an area must have at least 20% of households facing an extreme lack of food, at least 30% of children suffering from acute malnutrition, and two people for every 10 000 dying each day due to starvation or malnutrition and disease. Application of the scale in Gaza concluded that Gaza was above IPC Acute Food Insecurity Phase V(Catastrophe) thresholds. The FRC’s calls of Catastrophe have so far not led to sufficient aid reaching the Gazan population.
Despite attempts by combatants and countries to justify starvation of a civilian population as an outcome of war, the Nobel Prize winner in Economics, Amartya Sen argues otherwise. He said, when talking about the Great Bengal and Ethiopian Famines, that understanding starvation necessitates understanding entitlements. Existing economic systems allow some people to be entitled to food, while others are allowed to starve. This is often the case in conflict zones, where those with means might be able to barter until food aid arrives or they are able to leave the conflict zone. As a result, the most vulnerable, such as pregnant and lactating women and their babies, suffer the greatest burden in terms of morbidity and mortality.
What can be done to hold perpetrators of starvation accountable? António Guterres, UN Secretary-General, and Tedros Adhanom Ghebreyesus, WHO Director-General, have been powerful voices expressing outrage when the rules of war have been violated. They have used their offices courageously to criticise member-states that have broken international humanitarian law. But, as the International AIDS Society–LancetCommission correctly points out, the UN Security Council inconsistently addresses and rarely enforces international human rights law in conflict settings. The reality is that geopolitical rivalries prevent collective political action to stop inhumane and illegal actions by rogue governments. As wars worsen and leave deep scars in the moral conscience of the international community, health leaders must insist on the centrality of human rights to protect vulnerable and innocent populations struggling in conflict settings. The use of starvation as a weapon of war is a crime that must be prosecuted and punished to protect the most basic right of all: human dignity. Lancet
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