Starvation presents a dilemma: How do you safely re-feed survivors? : Goats and Soda The modern study of starvation was sparked by the liberation of concentration camp survivors. U.S. and British soldiers rushed to feed them — and yet they sometimes perished.

What World War II taught us about how to help starving people today

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MARY LOUISE KELLY, HOST:

Ask experts on hunger emergencies which parts of the world they worry about, and they will give you a long list of places where people are at risk of starvation - Sudan, Gaza, Haiti. Famine has been a threat to humanity since ancient times, but it was not until after World War II that scientists began to investigate what starvation actually does to a person's body. NPR's Nurith Aizenman reports. And please be aware this story contained detailed descriptions of how starvation affects the body.

NURITH AIZENMAN, BYLINE: Alex DeWaal directs the World Peace Foundation at Tufts University, and he specializes in famines. He says scientific research on the topic was sparked by what happened at the end of World War II, when Allied forces liberated the concentration camps that the Nazis had set up to exterminate Jews and kill millions of others. The survivors of these camps were emaciated.

ALEX DEWAAL: American and British soldiers had rushed to feed concentration camp inmates, and then had seen, to their dismay, that many of them actually perished.

AIZENMAN: It turned out starvation had thrown the survivors' biological functions so out of whack their bodies couldn't handle starting up regular eating.

DEWAAL: It's called refeeding syndrome.

AIZENMAN: In the years since, researchers have uncovered a lot of the reasons behind it.

DEWAAL: Blood sugar levels and electrolyte levels can wildly be volatile, and simply feeding regular foodstuffs can actually upset those balances.

AIZENMAN: Scientists also discovered some long-term impacts of extreme malnutrition by studying another grim chapter of the Second World War - a famine during Germany's occupation of the Netherlands that's often referred to as the Dutch Hunger Winter. Many of the survivors participated in follow-up studies for decades. The findings?

DEWAAL: The children who were very young when they suffered malnutrition grew up stunted. They were appreciably shorter than their elder or younger siblings.

AIZENMAN: They also showed cognitive deficits, went on to have more health problems as adults. Later, additional research on brain development helped explain why young children are so vulnerable to this kind of lasting effect. Anu Narayan is with UNICEF. She's in charge of coordinating its response to food emergencies affecting children.

ANU NARAYAN: We now know that, really, children under 2 years of age is when you're really forming most of your neural pathways.

AIZENMAN: And a young child's stomach is very small.

NARAYAN: So the frequency with which they need to eat and the quality of nutrition with each of the foods that they're eating needs to be higher.

AIZENMAN: This means that even in the earliest stages of a food crisis, as families shift from consuming vegetables and proteins towards grains that are cheaper but less nutritious...

NARAYAN: The child starts losing weight pretty rapidly.

AIZENMAN: What's called wasting.

NARAYAN: That's when we see the quietness in the children. They have become very, very quiet.

AIZENMAN: Their bodies are reserving energy for only the most basic functions. Soon, even those start to break down, often beginning with the regulation of fluids.

NARAYAN: Children's bellies will get distended. There is accumulation of fluid on their feet and their extremities.

AIZENMAN: Their immune system suffers, and the child may succumb to diarrheal and respiratory infections. They become too weak to stand up.

NARAYAN: At that stage, they absolutely need medical care.

AIZENMAN: And aid groups have gotten really skilled at providing that kind of care. DeWaal notes that in 1974, there was a massive famine in Bangladesh.

DEWAAL: Nutritionists in South Asia developed very low-cost technologies for providing therapeutic feeding salts and sugars to malnourished children.

AIZENMAN: By the 1990s, clinicians had developed sophisticated protocols for how to use them. But today, the challenge is that there's an increasing number of crises where aid workers are being blocked from providing that kind of specialized care because of ongoing conflicts. Here's UNICEF's Narayan.

NARAYAN: The largest number of children at risk is Sudan.

AIZENMAN: World experts project that in Sudan, nearly 4 million children under age 5 will suffer from acute malnutrition this year. Seven hundred and thirty thousand of them will reach the life-threatening stage. Also worrying, says Narayan, is northern Gaza because of how quickly malnutrition has spread through the population. A data team led by UNICEF estimates that more than 21,000 young children there are now acutely malnourished, with about 4,400 at a point where, without medical intervention...

NARAYAN: They will not survive.

AIZENMAN: For all the scientific progress on bringing people back from the brink of starvation, she says, when our access is limited, those are the children that we're likely to lose.

Nurith Aizenman, NPR News.

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