Nutrition Under Siege
Breastfeeding (BF) gives children the healthiest start in life and is especially vital during emergencies. In Palestine, particularly in Gaza’s ongoing humanitarian crisis protecting, promoting, and supporting BF is a life-saving intervention. Despite a low wasting rate (1.3% in 2022), adherence to BF practices remains below WHO targets, and many healthcare workers lack the skills to manage acute malnutrition. In emergencies, the use of breast milk substitutes (BMS) must follow strictguidelines, but supply shortages and unsafe water make BMS use risky, making BF vital.
In October 2024, MSF-OCBA launched for the first time a nutrition intervention targeting infants under-six-months (U6m) of age at risk of poor growth and development and their mothers/caregivers in Gaza, in response to the consequences of the conflict. This report presents the findings and lessons learned.
Between October 2024 and December 2025 MSF teams treated 513 infants U6m and their mother/caregivers in 2 primary health care facilities supported by MSF. Feeding status at admission showed a high prevalence of mixed feeding (BF combined with formula feeding) (41%), alongside low rates of exclusive BF (11%) and important gaps in data availability (38%). Missing information, particularly on feeding status at admission and discharge, limited the ability to fully assess programme effectiveness and trends over time. It should also be noted that the program registered a high proportion of defaulters (32%) which could be related to displacement, insecurity, and service interruptions, introducing potential bias and limiting generalisability.
Interviewees reported implementation challenges related to i) the lack of knowledge on nutritional case management and ii) important barriers related to BF, such us physiological and psychological (maternal undernutrition, stress, illness); logistical (overcrowded shelters, no privacy, disruption in BMS) and misinformation (breastmilk “not enough,” stopping during fever, early water/foods). The implementation of a mother–baby safe area within primary health care centres has been reported by staff to be highly positive, providing a protected environment for BF support and counselling.
Operational challenges were driven primarily by insecurity and access constraints rather than by programme design. Supply disruptions, including shortages of ready-to-use infant formula (RUIF) and other nutrition supplies, further complicated implementation. Finally, the lack of a nutritional community-based strategy due to security risks limits to have the full picture of the reality, which staff speculated being worst of the data reported.
Despite these challenges, the programme demonstrated that targeted nutritional support for infants U6m and their mothers/caregivers can be implemented in highly unstable, conflict-affected settings. Delaying implementation until optimal conditions are in place risks excluding the most vulnerable infants at critical moments. This experience confirms that timely, adaptable interventions can mitigate harm even in extreme contexts
