Almost 55,000 children in Gaza are estimated to be acutely malnourished, far more than have so far been identified as victims of the potentially lethal condition, a study published in the Lancet, the respected international medical periodical, has revealed.

The study, published on Wednesday, and led by the UN Relief and Works Agency for Palestine Refugees (Unrwa), offers a month-by-month breakdown through much of the two-year conflict, and shows for the first time a clear link between Israeli restrictions on supplies entering Gaza and levels of malnutrition among children.

Almost 55,000 children could be malnourished in Gaza

Israel has repeatedly denied blame for any hunger in Gaza, saying that it allows adequate food into the territory and claiming that the humanitarian agencies there are ineffective.

The research comes amid cautious optimism that indirect talks between Hamas and Israel under way in Egypt could lead to an end to the war.

The 21-point plan under discussion in Sharm el-Sheik, the Red Sea resort, was announced last week by Donald Trump. It calls for a ceasefire, the return of hostages still held by Hamas and a surge of aid into Gaza “without interference … through the United Nations and its agencies, and the Red Crescent”.

Dr Akihiro Seita, the Unrwa director of health and an author of the study, said more malnourished children would die unless there was an end to hostilities and “unimpeded, competent, international humanitarian nutritional, medical, economic and social services”.

The study found two years of war had led to “enormous nutritional consequences” for tens of thousands of children across Gaza.

Researchers used measurements of the circumference of the arms of 220,000 children aged between six months and five years old in Gaza between January 2024, and August 2025, when famine was declared in parts of Gaza by a UN-backed panel of independent experts.

In January 2024, 5% of children screened showed evidence of wasting, rising to nearly 9% six months later, researchers found. After Israel imposed severe aid restrictions from the end of 2024, the prevalence of wasting had almost doubled by January 2025.

When a six-week ceasefire allowed more aid to enter Gaza, wasting declined significantly before Israel imposed a tight 11-week blockade in March. Though these restrictions were eased in May 2025, levels of wasting among screened children soared to nearly 16%, with almost a quarter of these suffering severe acute malnutrition, the most dangerous form of the condition.

Among the estimated total population of Gaza, this is equivalent to more than 54,600 children up to six years old who need emergency nutrition and medical care, including 12,800 severely wasted children, the researchers said.

Israel has accused Hamas of looting much of the aid reaching Gaza, but has not provided evidence of any significant amount of theft by the Islamist militant organisation. Cogat, the Israeli agency that controls the entry of aid into Gaza, also accused Hamas of deliberately preventing civilians accessing aid by firing rockets at aid distribution sites.

Palestinians, including children, wait with pots to receive hot meals distributed by charity organisations on 25 September. Photograph: Anadolu/Getty Images

Between May and July, more than 1,400 Palestinians were killed seeking humanitarian assistance in Gaza, 859 in the vicinity of sites run by the US- and Israel-backed Gaza Humanitarian Foundation and 514 along the routes of food convoys, according to the UN, which said that most of the killings were committed by the Israeli military.

Aid agencies say Israeli restrictions prevent much of the aid getting into Gaza, and conditions created by the war and Israeli strategic decisions have made it almost impossible for them to operate.

Dr Masako Horino, nutrition epidemiologist at Unrwa and lead scientist for the study, said that evidence from before the war indicated that children in Palestinian refugee families in the Gaza Strip were already “food insecure” but were only marginally underweight.

“Following two years of war and severe restrictions in humanitarian aid, tens of thousands of preschool aged children in the Gaza Strip are now suffering from preventable acute malnutrition and face an increased risk of mortality,” Horino said.

Leading child health experts and paediatricians said the study was particularly “notable and important” because it was the first major medical study to reveal the extent of malnutrition among children in Gaza after two years of war.

Writing in a comment piece in the Lancet, Zulfiqar Bhutta, Jessica Fanzo, and Paul Wise, who were not involved in the research, said: “It is now well established that the children of Gaza are starving and require immediate and sustained humanitarian assistance. The study by Horino and colleagues provides some of the most definitive evidence to date of this effect.”

Bhutta, of the Hospital for Sick Children in Canada, Fanzo, of Columbia University and Wise, of Stanford University, also praised the researchers for using scientific evidence “to show grievous, preventable harm to children”.

“These temporal data strongly suggest that restrictions on food and assistance have resulted in severe malnutrition among children in the Gaza Strip, a reality that will undoubtedly impact their future health and development outcomes for generations.”

Although attention has mostly focused on the short-term outcomes of starvation, there should also be “serious concern” over its long-term health effects, which included “inordinately high risks of non-communicable diseases”, they added.

On Tuesday, Cogat said it “continues to support international organisations facilitating food delivery and production for Gaza’s civilian population”.

The study found that in Rafah, the southern city in Gaza, there was a fourfold increase in wasting malnutrition after Israel launched a massive offensive into the city and levelled it. There was then a sharp decline in April 2025 after the short-lived ceasefire.

In Gaza City, prevalence of wasting malnutrition rose more than fivefold from March 2025, reaching almost 30% in mid-August 2025.

James Elder, a spokesperson for Unicef, said last week that there was “a lot of panic, a lot of very hungry people” in Gaza City.

“It is very difficult to describe the levels of desperation there. There are tens of thousands of children. About two-thirds of people just can’t leave. There are pregnant women eating a meal a day. More aid trucks are coming in but it is a fraction of what we need,” Elder said.

Unrwa, which was founded in 1949 to provide essential services for Palestinian refugees who had fled or been expelled during the wars surrounding the foundation of Israel, has been accused by Benjamin Netanyahu, Israel’s prime minister, of being “perforated by Hamas” and banned by Israel. Unrwa denied the allegations and was cleared by UN investigators.