Ep 191 Famine: More than starvation

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I must admit, I write this piece while starving.

Too hungry to think clearly.

Too weak to sit upright for long.

I do not feel ashamed because my starvation is deliberate.

I refuse my hunger even as it decays me.

I can survive no other way.

Famine is no longer a threat.

It is here.

Some days my stomach cramps as I try to revise a single paragraph.

My fingers feel dry and achy, parched from lack of fluids.

Hunger is loud.

I read, but hunger is shouting in my ear.

I write, but the maw snaps with every keystroke.

I wonder, how can I keep my mind sharp when my body has gone so thin and dehydrated?

The hunger starts with a rumble, and it spreads so quickly.

My legs barely carry me to the nearest internet cafe.

There, I try to keep up with work and commitments, charge my devices, and catch a brief connection to the outside world.

But with a heavy laptop bag on my shoulder, the journey feels less like a short walk and more like crossing a desert.

One day, in particular, I had been working non-stop, pushing through dizziness and exhaustion.

By the time I reached the stairs to my apartment, my legs were barely holding me up.

My blood sugar had crashed.

I collapsed just as I reached my bedroom.

I was rushed to the nearest GP, where I was given an IV to stabilize me.

The next morning, I was back at work, not because I had recovered, but because I felt I could not afford to stop.

The urgency to bear witness outweighed the need to rest.

This is not about ego.

It's about refusing to disappear, about resisting the slow erasure that comes with war and famine, about insisting that our thoughts and our work continue, even when it must be done in the ruins.

In Gaza, to be an academic to day is to refuse to be reduced to a statistic.

There are days when continuing feels impossible.

The body simply gives out.

Reading leaves me lightheaded.

Concentration slips away.

Teaching becomes a battle to remain coherent.

The most basic truth remains difficult to say say aloud.

We are hungry, not by accident, but by design.

When did naming that become taboo?

This is not just about hunger.

It is about being forced to fight for survival in silence.

To generate knowledge in the context of hunger is to think through pain, to teach students who have not eaten and still tell them their voices matter.

To insist against all odds that Gaza still thinks, still questions, still creates.

That, in itself, is an act of resistance.

I can't.

It is so horrific

what is happening.

Yes.

It's really hard to have words.

Yeah,

I don't have them.

Like, I can't articulate everything that, yeah.

Yeah.

That firsthand was excerpted from a really incredible article that I encourage everyone to read that was titled Too Hungry to Think, Too Weak to Sit Upright, Concentration Slips Away: The Struggle to Stay Focused as an Academic in Gaza by Ahmed Kamal Junina.

And it was published in The Guardian on August 19th, 2025.

We'll link it in our show notes and on our website as well.

Hi, I'm Erin Welsh.

And I'm Erin Alman Updike.

And this is this podcast Will Kill You.

Welcome to the second episode in our two-part series on starvation and famine.

Yes, we're back with part two.

This week, we are continuing our discussion of starvation, famine, hunger, and malnutrition, words that have been used a lot lately in discussions surrounding the ongoing genocide and famine that's happening in Gaza, as well as the conflict that's raging in Sudan.

So in these two episodes, we are addressing the distinct meanings of each of these words.

And we started out in last week's episode going through the like physiological and psychological impacts of starvation.

So if you haven't listened to last week's episode, it's not entirely necessary for this one, but it will help provide a lot of the context for understanding the starvation component of famine.

And this week, we are discussing famine, you know, its definition or definitions, what it means to declare a famine, what causes famine, how famines have changed throughout history, and what is happening currently with the famine in Gaza and the food insecurity crises in other regions of the world.

Yeah.

And as with last week's episode, we have quite a lot to cover.

So we are jumping right in, right after this short break.

As you took us through last week, Erin, the physiological effects of starvation or undernutrition or malnutrition go way beyond simply not having enough to eat and enough energy to function properly.

Every single part of our bodies is impacted.

Our immune systems, leaving us more vulnerable to infections, our hormones affecting our reproductive systems, our organs leading to premature heart failure, our minds leaving us foggy and depressed and apathetic.

And just as we can't isolate starvation's impact on one part of our physiology and ignore its other effects, we can't pretend that mass starvation happens in a vacuum, that one day the crops failed and there simply wasn't enough food, that the cost of famine comes solely down to the direct physiological effects of starvation multiplied by the number of people impacted.

That's not the way that it works.

No.

The causes and consequences of famines are far more complex than that.

And ultimately, each famine is unique, deserving of its own focused examination.

But looking back at the vast history of famines, which have been with us for all of our species' time on this earth, we can draw out some general patterns to help us understand the present and the possible future.

This is an enormous area of scholarship, like absolutely enormous.

And there are people who have dedicated, many people who have dedicated decades of their lives to the study of famines.

And I really struggled with how to approach this episode and also like feeling like I can't, like I'm not capable of doing this.

But I thought, you know, should I tell the story of just one famine?

Should I talk about famines in history?

And ultimately, what I decided to do was to break this down into five chapters, definition.

causes, consequences, trends, and the future of famine.

It's an oversimplified attempt at trying to understand famine and contextualize what we're seeing.

And this is far from exhaustive coverage of a massive and massively important topic, but fortunately there are some, there's some additional reading that I can point you towards.

So for this episode, just wanted to shout out sources in advance.

I mostly relied on a few books, so the book Mass Starvation, The History and Future of Famine by famine scholar Alex DeWaal, Famine, A Short History by Cormac Ograda, Poverty and Famines, an essay on entitlement and deprivation by Nobel Prize-winning economist Amartya Sen, and Red Famine, Stalin's War on Ukraine by Anne Applebaum, as well as a handful of papers.

So let's get started.

Chapter 1, Definition of Famine.

What is famine and why is it important to define it?

Famine exists at the extreme end of a spectrum of food scarcity.

Simply put, a population experiencing famine is not able to access adequate food, leading to an elevated death rate.

It is an event, a deviation from normal life.

Throughout human history, different cultures and languages have used many different words to signify a famine.

The ancient Roman orator Cicero used praesens caritas to mean present dearness or dearth,

and futura fames for future famine.

Fames or

I'm not sure how you say it is where famine comes from.

It's F-A-M-E-S.

And so it's a Latin word for hunger or starvation.

It's like the word famished, for instance.

In ancient Egypt, the word for famine

is one that combines both hunger and plague, which is, I think, relevant in the context of how infectious disease occurs alongside.

Oh, yes.

The Italian word for famine, carestia, means dearness.

So like things that are scarce and expensive and difficult to obtain.

Okay.

In medieval England, the word dearth was used to refer to famine as well as dearness.

And the German word for famine, hungersnot, I'm probably really butchering that pronunciation.

It refers to hunger associated with scarcity of food.

Some famines have their own specific name.

There's the Holodomor with death by hunger in Ukraine, 1932 to 1933, the skull famine in India, 1790 to 1791, the Great Hunger or Black 47 for the 1845 to 1852 famine in Ireland, Metunya or the Scramble in Tanzania, 1917 to 1920, and that's just to name a few, like many, many famines have their own names.

Until very recently, there was no formalized agreed-upon definition of famine.

People didn't need one to recognize it as it was happening.

They didn't need to understand the physiology of starvation to recognize its effects in themselves, their children, their neighbors.

They didn't need a formal death toll to grasp the magnitude of devastation.

But as we've discovered in recent decades, having a standard threshold beyond which we can declare famine is crucial for decision-making and delivering aid, especially as humanitarian aid organizations have grown.

In the early 2000s, the Integrated Food Security Phase Classification, or IPC, system was developed by the Food and Agriculture Organization of the United Nations, and it consists of five phases.

So,

going from phase one, which is none or minimal, and that means that households are able to, quote, meet essential food and non-food needs without engaging in atypical and unsustainable strategies to access food and income, end quote.

And I'm not going to read the definitions of each of the other phases until phase five, but phase two is stressed, phase three, crisis, phase four, emergency.

And in phase five, which is catastrophe/slash famine, quote, households experience an extreme lack of food and or cannot meet other basic needs even after full employment of coping strategies.

Starvation, death, destitution, and extremely critical acute malnutrition levels are evident.

For famine classification, area needs to have extreme critical levels of acute malnutrition and mortality.

End quote.

So these phases are determined at the household level, whereas famine is an area-wide classification.

So how many households are experiencing extreme food scarcity?

The threshold for famine is one in five households, or 20% in a specific area, facing a complete lack of food and other basic needs.

Starvation is evident, with more than 30% of children acutely malnourished, households are destitute, and death rates exceed 2 per 10,000 per day, measured as excess mortality.

So it's not just like how many people are dying.

It's how many people are dying above the baseline.

The average.

I feel like what is so, thank you for walking through all of that classification.

We will link to those, by the way, for people who want to read all of it.

Yes.

That level, like that classification is so extreme.

Yes.

And I feel like that is like an important thing to just highlight.

Like we're talking about 20% of households not having any access to food,

30% of people experiencing severe acute malnutrition.

Like children, yeah.

That's really extreme.

It is extreme.

So

a lot of places in the world currently are in level four, which is emergency, but not famine.

And like that is also very extreme.

It is extreme.

Yeah.

Like the word, I think the word

famine is not used lightly by these organizations.

This is a very deliberate decision to say this is a famine.

And there are criteria that must be met.

And I also want to just make a note here about excess mortality, because I think

there tends to be this idea that famine means frank starvation, your death by starvation.

And it's not excess mortality includes, and I'm quoting from Alex DeWaal here, quote, anyone who died of any causes above the baseline.

It includes deaths from communicable diseases, often the single biggest cause of death, exposure and exhaustion, and in some instances, violence as well.

Including all of the deaths can be justified because famine is not just an aggregate of individual cases of starvation.

It is a far-reaching social disruption that involves epidemics of infectious diseases, movements of desperate people, crime, and an array of other social disorders.

End quote.

Famine is more than starvation on a large scale.

Yeah.

Period.

Way more.

Way more.

The IPC classification of famine is very specific and technical, and that is by design.

It makes no reference to the cause of famine.

It is politically agnostic, which is really important when it comes to delivering humanitarian aid.

A declaration of famine, as outlined by those clearly defined criteria, allows humanitarian aid protocols to be enacted.

It frees up resources and funds to deliver aid, and it draws international attention and action to the crisis, hopefully before it's too late.

Although if a famine is declared, it already is too late for many people.

A lot of people.

The IPC system for declaring famine is crucial for acknowledging the need for public action.

But it's not really something that we can use to identify or describe historical famines, which often lack the demographic data to determine something like excess mortality.

Like, how do the estimated 600,000 deaths from the 967 CE flood in Egypt translate into additional mortality?

How much of that is above the baseline?

For the 209 to 203 BCE famine in China that killed 80 to 90% of the population, what was that baseline population?

Whoa.

Yeah.

We needed just a different approach for studying historical famines.

And in 2004, Howe and Devereaux proposed intensity and magnitude scales for characterizing famine.

And the magnitude scale is what seems to be the most often used for historical famines.

And it comes down to like total deaths, not as a proportion of the population or over a set time period.

A great famine is one that has killed at least 100,000 people.

And a catastrophic or calamitous famine, I've seen both used, is one that has killed over 1 million.

Between the years 1870 and 2010, at least 116 million people died in over 50 great and catastrophic famines.

A truly staggering number, 116 million people.

Jeez, Harry.

In just over, you know, and in just in 140 years.

But the vast majority of those 100 million deaths happened before 1980.

What changed?

I'll get there in a bit, but first, let's talk about the causes of famine.

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So, chapter two, causes of famine.

Why do famines happen?

Food shortage from crop failure, other disruptions in the food supply, rising food prices, armed conflict, political will,

more things, sometimes all of the above, a blend of things.

I think there's often a tendency to think of famine as a natural force, you know, drought or floods, fire, agricultural pests, fungal epidemics, volcanic ash blotting out the sun, destroying any available food and bringing starvation to the land.

And historically, that may have occasionally been the case.

There may have been famines that were caused directly by

sequential crop failures, solely crop failures.

But today, and I think for centuries you could argue, famine is exclusively man-made, started or perpetuated by political decision, whether mismanagement or malice.

Not, as Thomas Malthus claimed in 1798, an inevitable outcome of uncontrolled population growth.

Nature correcting itself by bringing down a population to a more appropriate level.

Yeah, Malthus.

Yeah, there's in Alex DeWaal's book, he he refers to it as like the Malthus zombie, I think.

It's like this idea, this concept that just won't die, that somehow food will be the only limiting factor.

It won't be.

There will be many things before food or contributing, and we're not even close to that.

That's a whole separate discussion.

Anyway, Malthus was.

Should we do a whole episode on how we haven't reached carrying capacity?

Oh, okay.

No.

No, no.

No.

But yeah, you know, governments have used Malthus's prediction as an excuse for inaction.

In a number of famines in India, for instance, in the Great Irish Famine of the 1840s, during that famine, or during all these famines, the English government kind of just shrugged and went, well, you know, what do you expect?

Leaving millions to die.

It was sort of this like, well, this is what Malthus said would happen.

You brought it upon yourselves.

You brought it upon yourselves, yeah.

Nothing we can do.

And in those famines, food was not the limiting factor.

Ireland and oftentimes India was still exporting food as forced by England or preventing its delivery in India, even if India wasn't actively exporting.

Famines do not happen, as Malthus claimed.

Our planet is capable of producing enough food for the global population.

You know, whether climate change will play a role in shifting that is a question that remains to be seen.

It probably will, but we are not there yet.

We're not there.

We are not there yet.

We have not been there historically.

We are not there currently in the year 2025.

Which doesn't mean that climate, we shouldn't worry about climate change.

That's,

but it's just so many reasons.

It's not Malthus.

Yeah, Malthus.

Famines happen because people will them to.

In his book, Mass Starvation, DeWaal makes note of the word to starve and its multiple meanings.

A person can starve and they can also be starved.

Hunger is a very effective weapon and tool of conquest.

It's deadly.

It's demoralizing.

It's disruptive.

It completely reshapes and erodes every aspect of your life.

Whatever the goal, submission, humiliation, suffering, genocide, many governments have and continue to wield starvation to accomplish those goals.

Like during many colonial conquests by European governments, like the Armenian Genocide perpetrated perpetrated by the Ottoman Empire in the early 20th century, like the Holodomor in 1932 to 1933, which was intended by Stalin to destroy Ukrainian identity and culture, like the Nazis used repeatedly during World War II, including during the Nazi hunger plan, which was not enacted fully, but intended to kill a calculated 30 million people.

Like the U.S.'s World War II Operation Starvation was actually named that, where they, I'm 100% serious.

They dropped mines into Japanese harbors to disrupt food shipments.

And it actually.

Intentionally, to cut off food supply.

Or during the Vietnam War, when they killed all the crops, defoliation with napalm, ecocide, like Israeli leaders who use hunger as a weapon and prevent aid from being delivered.

During the 2008 to 2009 Israeli siege of Gaza, an advisor to the Israeli prime minister is reported to have said, quote, the idea is to put the Palestinians on a diet, but not to make them die of hunger, end quote.

I see that quote.

Again, outright starvation deaths during famine are rare.

People are far more likely to die of infectious disease or other causes, all of which still constitute famine deaths.

Even if the goal isn't outright genocide or submission, and a famine begins because of, you know, say harmful government policy and subsequent denial, or just like crop failings and then subsequent denial and inaction.

Right, inaction.

Yeah.

Right.

What that reveals is that those in power simply did not care enough to do anything.

During the 1943 Bengal famine that killed two to three million people in India,

oh my gosh.

Which India at the time was still under British control, Britain denied that there was any food shortage.

They blamed it all on people people allegedly hoarding food, meanwhile, requisitioning food themselves for the war effort.

And then they refused to provide relief or allow any transport of food into India because they were worried about it being intercepted by

Axis forces or enact any standard famine relief measures.

They didn't do anything.

So, according to scholar Lizzie Collingham, quote, it is difficult to reach any conclusion other than that racism was the guiding principle which determined where hunger struck.

⁇

And this famine, which the scholar Amartius Sen lived through and then inspired him to write some of his ideas about

the economics and the impacts of poverty and famine, I think this it shows, as he pointed out, how important it is to ask the question,

is there no food to buy?

Or is it that there's no money to buy food?

Or is it that you are prevented from buying food?

These are very crucial differences.

Malthus would probably say that famines happen when there's no food to buy.

There's just no food.

There's no food.

But in this modern era, and likely during Malthus' time, food is never the limiting factor.

It's about access and who prevents access.

There's a classic metaphor to describe the vulnerability of a peasant throughout history.

It was created by Richard Tawney in 1966.

And it's this metaphor of a peasant standing up to his neck in water so that even the slightest ripple can drown him.

And thinking about what causes those ripples or waves and what determines the height of the water in the first place, I think that can be helpful in thinking about famine.

Maybe a ripple is a bad croppier.

Maybe he's knocked down because of his religious beliefs or just ethnic identity.

Maybe a wave comes in the form of an an exorbitant tax or a case of dysentery.

When an entire population is up to their necks in water, that can make them extremely vulnerable to a famine, and that famine can have devastating consequences.

Chapter 3.

Consequences of Famine.

What happens during and after a famine?

Like we talked about last week, starvation profoundly impacts the body and the mind, making people more vulnerable to a whole host of other dangers like infectious disease or exposure.

And we talked about that largely in the context of purely starvation.

Your immune system weakens, leaving you open to infection, for example.

What famine does is amplify those dangers 1,000 fold.

So like the men in the Minnesota starvation experiment undoubtedly had weakened immune systems, but they had access to warm water, clean clothes, medical care, fresh fresh food.

They had a safety net that simply does not exist in a famine.

So let's say, for example, that a person who's living in famine conditions is exposed to typhus.

Typhus ravages their weakened immune system.

And since hot water and clean clothes are out of the question, the infected lice carrying the typhus bacterium will spread to every member of the household, leaving all of them too weak to cook with what little food they may have.

And let's say one person is well enough to venture out to get food.

Maybe they'll be shunned out of fear of the disease.

Or maybe they manage to get food, but it's spoiled or it barely resembles food.

It has almost no nutritional content.

If they recover from typhus, food poisoning or dysentery could deliver the death blow.

When political conflict drives famine, Many people are forcibly displaced and camps set up to house them can be hotbeds of infection.

You mentioned crowding and how there tends to be crowding and famine.

That's just like, it facilitates the spread of infectious disease to an astonishing degree in combination with malnutrition.

I feel like we have touched on that in almost every single infectious disease episode we have ever covered.

Yep.

Yes, yes, yes.

Cholera, typhus, typhoid, measles, malaria, influenza, these are all frequent occurrences in famines.

And as we've been saying saying multiple times, infectious disease is one of the biggest killers.

Famine deepens vulnerabilities and it magnifies social inequalities.

Those who are immunocompromised to begin with are often the first to die and they make up the greatest proportion of deaths.

So throughout history, this tends to be the oldest and the youngest.

In DeWaal's study of the Darfur famine in 1984 to 1985, he estimated that two-thirds of the deaths were children under 10 and half of the deaths were children under five.

It's also depressing, Erin, that in so many of the statistics, when they're measuring, like we talked about last week, severe acute malnutrition and things, the tiniest of babies, like

newborns to six months olds, often aren't even included in those statistics because we don't have like ways to measure them reliably and things.

So it's,

it's just so heartbreaking.

It is.

Yeah.

Yeah.

This pattern of the oldest and the youngest being the most likely to die,

it doesn't always hold.

So for instance, if there are people who are like certain populations who are targeted, there might be a deviation from that.

But in general, like I think you could generalize by saying that famine strikes those who are not deemed worthy of consideration.

not deemed worthy to live.

Here's a quote from DeWaal.

Quote, famines strike selectively.

It is the poor and politically excluded who are its first and principal victims, commonly its only ones.

Starvation relentlessly hunts out outsiders and marginalized minorities, or, to phrase it more accurately, those in power administer famines so as to target these people.

In a large number of the famines in our catalog, including all the most recent cases, the victims have been constituencies identified as subversives or enemies of the state.

Today's resurgence of xenophobia and resource nationalism across the world bodes ill for the politics of feminogenesis.

End quote.

Ah, yeah.

This is heavy, Erin.

I know.

Beyond the physical effects of starvation, those in a famine also grow increasingly apathetic.

beyond despair.

They disengage or become asocial.

Survival just shuts everything else out.

The cost of famine is often reported as the number dead.

But just as starvation is merely one component of famine, the death toll in a famine represents just one devastating outcome.

What about the lives forever altered?

The trauma, the lasting physical harm, the cognitive impairments, the drop in birth rate, the horror of watching your family, your friends, your neighbors perish while the world just just looks on or turns away.

The damage that famine causes spans generations.

Adults that were exposed to famine while in the womb are at higher risk of certain diseases like type 2 diabetes, as well as mental health issues.

A famine is an event.

It has a start and an end, murky though they may be.

But that event stays with those who lived through it for the rest of their lives.

Even if, like those who lived through the Holodoma or the Great Leap Forward famine in China in the 1950s, you are forbidden from discussing it.

How can it be forgotten?

One visitor to Ukraine a decade after the famine in 1932 to 1933 reported that, quote, 10 long years had been unable to erase those murderous traces and to disperse the expiring sounds of the innocent children, women, and men, of the dying of young people enfeebled by famine.

The sad memories still hang like a black haze over the cities and villages and produce a mortal fear among the witnesses who escaped the starvation.

End quote.

And those two famines that I just mentioned, the Holodomor and the Great Leap Forward, those mark the two most extreme famines of the 20th century.

They killed 3.3 million and 32 million people, respectively.

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Many modern scholars of famine believe that the age of catastrophic famines like these, that number in the millions or multiple millions, they believe that it might be over.

Is it?

Like, what patterns are we seeing?

Chapter 4.

Trends in famines.

How have famines changed over time?

Famine has always been with us.

The story goes that when many human societies gradually began their transition from hunting and gathering to agriculture and livestock, food production went up, infectious disease went up, and dietary deficiencies went up due to overdependence on certain staple foods like grains.

The sedentary lifestyle may have sheltered agrarian societies from fluctuations in food supply.

You know, whether they were truly more sheltered than hunter-gatherer societies, it's up for debate.

Interesting.

But at the same time, their dependence on crops may have also made them more susceptible to sequential crop failings.

So for instance, repeated crop failure and livestock disease led to the great European famine of 1315 to 1317 that killed 10% of the population.

And this is just a few decades before the Black Death would carry off 30% more.

Can you?

I just, yeah.

The age of European colonialism, beginning in the 1490s and lasting at least through World War I, led to many famines, either as a direct result of the upheaval and violence imposed on those populations, remember, hunger is a weapon, or indirectly as imperial conquest destroyed the buffers that people had in place to protect against famine.

So, like when European governments would force people to farm European crops rather than indigenous plants that they had been growing.

The severity of these colonial era famines was deepened by the fact that the colonizing governments rarely provided any sort of relief.

The lives of those who suffered did not matter.

So for instance, there was an enormous famine in South Asia following the British East India Company's conquest of Bengal in the 1770s that led to the death of one-third of the population.

This famine was not the exception.

It was the rule.

And famines like these followed into the late 1800s and early 20th century.

The causes were multifaceted and dependent on the region.

So there might be like severe drought, crop blight, foods, disruption of economic structure by colonialism, culture erasure via colonialism, a combination of everything.

But what followed seemed fairly consistent, the lack of any relief.

Instead of easing the tax burden, colonial governments continued to extract brutal taxes under the threat of violence.

Instead of stopping the export of food from a country starving to death, the export continued.

Instead of providing adequate food and relief programs in an effort to stop or slow the famine, government handed out quantities of food that matched the rationing in Nazi concentration camps.

So it'd be like, here's 400 calories.

Yeah.

Over the first few decades of the 20th century, the age of colonial famines was supplanted by those created by totalitarian regimes.

So the Holodomor in Ukraine, which I've mentioned a few times now.

Raphael Lemkin, who was the person to coin the term genocide in 1944, he considered this famine to be genocide by starvation.

The Nazi hunger plan, which was intended to kill 30 million quote-unquote useless eaters in Eastern Europe and the Soviet Union via starvation.

Japanese-occupied occupied territories like Burma, Indonesia, and Vietnam all suffered mass starvations since food was prioritized to feed the occupier.

But even these famines would pale in comparison to the great leap forward famine in China between 1958 and 1962, which killed at least 25 to over 30 million people.

the largest famine in history.

I mean, I don't know how you can even begin to wrap your mind around numbers like that.

No, you can't.

You can't.

And while environmental factors contributed somewhat to this famine, the lion's share of the blame goes to Mao Zedong's policies.

Farmers were forced to leave their farms to work in factories to try to match the economic growth of what they're seeing in some of the other, in some Western countries, for instance, like steel factories.

And this actually was, the Great Leap Forward Famine was a situation where outright starvation was actually often the cause of death for many, and silence was the rule.

The true scope of this famine wasn't realized for 20 years after it ended due to censorship policies.

So no one knew.

And then it was just like the numbers just kept growing and growing.

A few more catastrophic totalitarian famines with over 1 million deaths occurred in the last decades of the 20th century in Cambodia and North Korea.

But then the trajectory of famines began to shift.

More often, famines were occurring in sub-Saharan Africa.

Drought played a role, but the leading driver was war, associated, of course, with like armed conflict, poverty, harmful economic policies, and displacement.

Ethiopia, Sudan, Somalia, Darfur, the DRC, and other regions have all experienced these famines.

The 1983 to 1985 famine in Ethiopia that killed 600,000 people was among the first to draw an international humanitarian aid response.

You know, like Bob Geldoff and Bandaid, the song Do They Know It's Christmas, which like is just the most.

You don't know that song?

I don't know that song.

Oh, God.

It's like, do they know it's, it was sung.

It was like, so it created a lot of money.

It like, you know, brought in a lot of money for humanitarian aid, but the lyrics of that song are so

condescending.

No.

Do they know it's Christmas?

First of all, Ethiopia is one of the places of like the oldest Christian religions, like sects in the world.

Anyway,

yeah.

Okay.

Many of which are dying.

Yeah.

Yeah.

Well, I mean, it's like

Band Aid and these songs like,

yeah, do they know it's Christmas, et cetera, they were instrumental in raising awareness and in raising money for humanitarian aid response.

There is, this is a really like complicated humanitarian aid in general and the shifts in humanitarian aid responses and crisis over chronic food insecurities, what draws more money.

There's a lot of complications there.

It's a hodgepodge of messy mess.

It is.

But it did mark a huge turning point in terms of how famines were considered on the international scale, on the

international politics.

And

so the expansion was crucial to help relieve the famine in Ethiopia and in subsequent crises.

But yeah, there's another quote from DeWaal where he says, quote, it is not driven by the needs of the hungry, but by the political demands of its donors, chiefly Western governments, end quote.

And some governments have used aid, not necessarily through like these international humanitarian aid programs, which tend to be more apolitical, but different governments have used aid as like a carrot, you know, on the stick to accomplish certain political goals.

So in the U.S.

the U.S.

withdrew aid from Bangladesh in the 1970s until they agreed to fall in line with U.S.

politics.

And by the time they reinstituted aid, it was too late.

Like there was no point to it.

Yeah.

And now we just don't have any U.S.

aid.

Oh, exactly.

Exactly.

And so, and this is also not to discount the countless lives that humanitarian aid has saved or the famines that it has directly averted.

Averted.

And like the IPC system,

much humanitarian assistance is apolitical, so resources can get to people who most desperately need it.

By the end of the 20th century, international reporting on famines and the development of a professional international humanitarian aid system meant that we had the ability to recognize famine and do something about it, as long as there was also the will.

So, chapter 5, the future of famine.

Is the end of famine in sight?

Asking that seems like a ridiculous question when there is literally a famine happening in Gaza, when there have been famines in Somalia, South Sudan, Sudan in the past 20 years.

But it is a valid question.

When you look at a graph of famine deaths over time starting in 1870, there is a noticeable sharp downward trend starting around the 1980s.

Why have famines declined in magnitude?

And by magnitude, I mean fewer people dying overall compared to the centuries earlier multi-million death toll famines.

Right, right.

It's a combination of different things.

Public health advances, humanitarian aid responses, and political action and will.

So think again of that metaphor of the guy who's standing up to his neck in water.

The water level has on average around the globe declined thanks to things like economic growth, improvements in agriculture, functioning markets, and public health.

These factors might reduce how vulnerable an entire population is to famine or the number of vulnerable individuals.

They might help reduce deaths due to communicable or other preventable diseases.

They might help in getting aid more quickly to a population because there's awareness of that.

Right.

Agricultural productivity has increased.

You know, the impacts of the Green Revolution haven't been all positive, and increased productivity doesn't necessarily translate into more access to food, but it has helped.

Thanks to global trade, local food shortages can more easily be remedied.

Again, the global food supply is not the limiting factor here.

Maybe one day climate change will put us, bring us closer to the edge, but it hasn't yet.

We have the tools to prevent, to minimize, to end famine.

So maybe the more appropriate question is, why does famine still happen?

Why has the threat of famine actually increased within the last five years with more people living with severe hunger and malnutrition?

While the globe on average might have the water level lowered, averages can be deceiving.

And there are still millions of of people standing up to their necks in water.

And this is also not like geographically evenly distributed, right?

So a lot of the biggest famines throughout the 20th century tended to take place in Asia.

And that's not the case now.

Now, most of the food crises are happening in the Middle East and Sub-Saharan Africa.

And so in these most vulnerable regions, there are still millions of people who are at risk of drowning, using this metaphor again, with a ripple caused by a job loss, a drought year, violent conflict, an escalation of hatred against people of your religion or ethnicity, rising food prices, forced migration, hostility to refugees, extreme weather events.

And I think most worryingly is the apathy that seems to be on the rise, humanitarian aid giving way to nationalism.

Quoting again from Mass Starvation by Alex DeWaal, quote, and this was written in 2017.

Over the last 30 years, we have assumed benevolent governance, that the default option in the international order is to promote humane values and act against needless human suffering.

That era may now be passing, and the default setting for global politics may return to the older premise that far away human suffering, including mass starvation, can be tolerated or ignored.

End quote.

So that was 2017.

And I mean,

his prediction has come true.

To go from George Bush having a no famine on my watch policy, literally that was like the policy.

This is the first George Bush?

No, this is George W.

Second.

Sorry.

Yeah.

Okay.

to Donald Trump slashing U.S.AID, which has played a huge role in famine prevention and relief.

I mean, George Bush is a war criminal.

This just shows like how far things have fallen.

Right.

Yeah.

Yeah.

I mean,

it shows how wanting to reduce human suffering, it used to be a given.

Like that was like, of course you want to reduce.

It wasn't even that it was political.

It was like...

Every person was like, this is, you couldn't, I just,

it wasn't one side wanted to reduce human suffering and the other side wanted to promote it.

That's what it is now.

You know, maybe suffering sometimes does seem like an openly declared goal.

But even if it's not that,

suffering is permitted.

It is acceptable with this administration.

And that's not just with this administration, but in many places around the world.

It's what we've seen happen, currently happening in Gaza.

Famine was officially declared on August 22nd of this year, not caused by food shortages, but food and other aid being withheld by the Israeli government.

Not just food also, but clean water, housing, sanitation, healthcare, and fuel.

Everything just broken down, leading to the intentional, preventable deaths of thousands of people in Gaza.

So I guess to go back to the question of whether the end of famine is here, the answer seems to be no.

No.

It is theoretically within our grasp, but there is a widening gulf between that theoretical possibility and the reality that we face.

And what separates those two is political will, shame, a conscience, the conviction to do the right thing.

Can we bridge that gap?

I mean, I want to say yes, but how we can begin to is another question.

Yeah, Erin, I don't know what else to say.

So I'm going to turn it over to you to update us on the goings on in the world today.

Yeah.

I

am going to kind of bring us up to speed with specifically the two areas that the IPC has

said that there are two areas in the world that have met famine criteria right now, essentially.

But like we talked about in last week's episode,

Food insecurity and malnutrition overall are not uncommon globally.

The World Food Program, which is a humanitarian aid organization that is one of the largest, the World Food Program estimated in the middle of 2025 that over 300 million people were facing acute food insecurity, like just in the short term, 70% of which are the direct result of conflict and violence.

And the World Health Organization and FAO recently put out a report that estimated that over 600 million people experienced hunger overall in 2024.

So this is obviously a very widespread problem and especially a problem in areas where we see conflict and violence.

Even in places that we maybe think of as

not facing food insecurity initially.

Right.

So for example, in Ukraine, where war has been raging for nearly four years now, at least one-third of residents in areas of high conflict are still reliant on humanitarian food aid for subsistence.

So even in areas where we haven't seen or we haven't met criteria for famine, there is a lot of parts of the world that are experiencing severe food shortages and insecurity.

To wrap us up for this episode, I want to focus on the two places in the world that have currently met the IPC threshold for famine, and that is Sudan and Gaza.

And just like we have seen in most of the modern famines that you walked us through, Erin, prior to this classification of famine, many people living in Gaza and Sudan prior to this declaration were already facing food insecurity.

And that plays a huge role in how we got to where we are today.

So starting with Sudan.

The world's largest humanitarian crisis is currently happening across all of Sudan.

There is a conflict there, and I'm not going to get into like the drivers of these conflicts and things.

That's way beyond my scope.

But it had been ongoing for several years and escalated in April of 2023.

So since April of 2023, at least 12 million people have been internally displaced, over half of those children.

And the World Health Organization actually, their estimate was slightly different than IPCs, and they estimated 10.5 million internally displaced and 4 million people displaced across borders into neighboring countries.

And this internal displacement, as well as external, like displacement outside of your countries, has led to lack of work opportunities so that families have no reliable income.

Food in this region has become substantially, like exponentially more expensive, in part due to scarcity.

And that scarcity is very multifactorial.

There have been years of low crop yields.

There has been flooding, but there are also checkpoints in place.

There's difficulties in transporting food.

There is ongoing conflict in these areas, like a truly horrific amount of conflict.

And this has also made it even more difficult for humanitarian aid to reach the areas that are at most at need.

Right.

The other thing that I just want to mention

that the IPC includes in, you can read these reports where they go through all of the details of how they came to this conclusion when they say that they meet the criteria for famine in these areas.

They also look at food utilization

because in these areas, including in Sudan right now, even when food is available, there are difficulties in actually using or consuming it or being able to, like your body being able to utilize what you have consumed.

Okay.

And this is because of a lot of different reasons.

There's damage to, let's say, water facilities so that you don't have access to clean water to be able to cook your food or clean your, you know, things to be able to cook your food with.

There's been outbreaks of diarrheal diseases, including, as of April 2025, in Sudan, a cholera outbreak of over 60,000 cases and at least 1,600 deaths.

And that cholera outbreak is not limited to Sudan.

It has actually also spread to South Sudan, where there have been at least 1.1 million people who have fled into South Sudan from Sudan.

And the cholera outbreak there has affected an additional 54,000 people and caused over a thousand deaths.

So this is like really huge.

And that obviously, on top of just causing disease, makes it difficult for people to absorb any food that they are actually eating.

So overall, in Sudan right now, we don't have a reliable way to quantify the extent of mortality that all of this has caused.

We don't really have reliable data that is coming out of there right now.

But the most recent report that was published was published by the IPC in December of 2024 and projected out through May of 2025.

Okay.

And at that time, they estimated that five different areas within Sudan were experiencing famine, that IPC Phase 5 classification,

which was nearly 640,000 people at least.

And over half the population, an estimated 24.6 million people across Sudan were facing at least category three or four very high levels of acute food insecurity.

So even before the escalation of this conflict, the global malnutrition rates in children under the age of five in Sudan were estimated at around 13%.

And now in many of these areas, they're up to 30%, which is again what classifies it as famine.

Right.

And the World Health Organization estimates that in Sudan, 5 million children and pregnant people are acutely malnourished.

And over 700,000 kids under the age of five will have, meet criteria for severe acute malnutrition this year.

It's pretty horrific.

And it is still ongoing.

Most of the reports

have not been updated.

I assume that we will have updated reports maybe by the time this comes out.

I'm not really sure, but the projections were even grim.

Like they were very grim.

We're recording this, by the way.

I don't know if we said this in any episode, but on September 11th.

September 11th, 2025.

So that's the most recent data that we have on all of these.

In Gaza.

The most recent IPC report, as you mentioned, Erin, was updated August 22nd of 2025.

And I actually want to start out by reading an excerpt from this particular report because the intro is actually pretty striking.

They start out with: quote:

This report marks the fifth time the Famine Review Committee has been called to review an analysis on the acute food security and nutrition situation in the Gaza Strip.

Never before has the committee had to return so many times to the same crisis, a stark reflection of how suffering has not only persisted, but intensified and spread until famine has begun to emerge.

Yeah.

So in this report, they outlined that famine, the famine conditions have been met at least by the time of this report in August in Gaza governant.

And they projected that by the end of September, so by the end of this month that we are recording, it will likely have spread to several other governments in the south across Gaza Strip, affecting an estimated 640,000 people already

and and at least 1 million people facing emergency or IPC Phase 4 levels of food insecurity.

In The Guardian, there was an article that came out earlier in September that reported that in the last two weeks of August alone, 7,000 children under the age of five were hospitalized specifically to treat severe acute malnutrition.

How many?

7,000 kids.

And they actually estimated that by the time that they calculated the rest of the numbers from August, it could have been up to 15,000 children hospitalized.

And remember that we try not to hospitalize children.

That's only when they are extremely ill, right?

Yeah.

Already by July of 2025, the food system that had existed in Gaza had collapsed.

And I think, obviously,

it is an understatement to say that the the history of the conflict of Palestine and Israel goes back farther than I am going to get into.

We don't need to get deep into the scope of that conflict, but we do need to understand a little bit of the context just prior to this.

Right.

And that is that since at least 2007, the Gaza Strip was already under a blockade

in which Israel had essentially all of the borders of Gaza Strip restricted.

There was restrictions and total control on importations into Gaza Strip.

That included food, medicine, gas, all supplies.

Everything under control of somebody else that,

yeah.

Yeah, exactly.

And that was already in place for the last 16 years prior to this.

in part because of those importation restrictions and because of how densely populated Gaza Strip is.

It's one of the most densely populated areas areas in the world.

There's an estimated 2.1 to 2.3 million residents.

There's maps if you haven't looked at like what the size of Gaza Strip is compared to other major cities, but I have a link to maps online.

But in part because of how densely populated this region was and is, and because of these controls on importations, residents in Gaza prior to this current conflict primarily relied on imported food.

And there was already a very high prevalence of malnutrition.

An estimated 90% of preschoolers were not getting adequate daily energy intake

prior to 90% was the numbers that I saw.

And this is most of this data is coming from very recent reports, but that was actually from an article in a peer-reviewed journal.

So it's like a, not just a news article.

And before these last two years, 75% of the people living in Gaza depended on UN food assistance.

So that is similar to how I said that in Sudan there was a widespread prevalence of malnutrition prior to this.

The same was true in Gaza, right?

And that's an important context to understand the current situation and how things got so severe so quickly.

It also is the case that prior to this conflict, residents of Gaza had access to about 21 liters of drinking water per person per day, which is a little more than what the World Health Organization recommends should be provided to everyone in emergency situations, but is not enough to be able to engage in things like agriculture, sanitation, cleaning, all of that.

You need upwards of 70 plus liters per person per day.

But despite all of that, prior to this, there was still domestic production of things like eggs, fish, meat, oils.

Right now,

there is no capacity for domestic production.

So, Gaza is entirely dependent on outside food.

Much of the cropland, over 90% of it, was damaged, and only 1.5% of it is actually undamaged and also accessible.

And all of the animals that were used for food-sheep, cattle, goats, poultry-like the statistics on how many of them have survived is horrific.

And fishing has also been severely restricted because access to coastal areas is very restricted right now.

So, from March till May, there was actually no food at all that entered Gaza.

And since that time, the amount has fallen far short of the bare minimum that is required to keep people alive.

And as we discussed both last week and this week, when someone has been under conditions of extreme malnutrition for a long time, their body needs more in order to make up for that difference.

So even the bare minimum would not be sufficient at this time.

And we're not even getting that, at least as of September 2025.

And in the face of such desperate conditions, there have been more and more instances of the few times that food has been allowed in, that food is not necessarily even making it to much of the population because there has been either intercepting or, in many cases, violence, including from Israeli forces at these food distribution sites.

There have actually been 2,339 fatalities among aid seekers, people trying to get food at militarized distribution sites just since May of this year.

And even in the cases where food is available, prices have risen exponentially.

And when you combine that with the fact that almost the entire population of Gaza has been displaced multiple times, many of them have no ability to work.

They cannot access that food.

There has also been limitations on access to water, to cooking gas, to utensils.

And many of the humanitarian aid food packages that have been delivered are composed of foods that you have to cook in order to make edible.

Right.

Rice.

Yeah.

Super.

Yeah.

Yeah.

It's like saying that the situation is dire doesn't quite, honestly, saying that it is famine doesn't even quite

get at this the real truth of the situation, right?

Right.

And like you mentioned, Erin, the deaths due to starvation are a very small part of what we are seeing.

And yet, at least 361 human beings, 361 Palestinians have died due to malnutrition and starvation alone, including 130 children as of September 10th, 2025.

I will also point out that that number is over 100 more people than the estimate I saw from August.

And that does not capture the toll that starvation has on the body.

No.

No.

And the other huge complicating factor in Gaza specifically has been the intentional targeting of the healthcare infrastructure.

94% of hospitals have been damaged or destroyed.

Medical supplies were also withheld and not able to cross borders for many months, and they are still in short supply.

So even as the food situation may may improve, hopefully, we don't know yet,

there is still a very real risk of refeeding syndrome for so many people, especially kids in Gaza, given how long they have been subject to undernutrition and the fact that we have limited hospital availability to treat them.

It's

yeah.

And if anything, Like you mentioned, Erin,

the current genocide happening in Gaza, the conflict that is raging across Sudan, spreading into South Sudan, food insecurity across so much of this globe.

It is very likely that things will get worse given that the U.S.

has dismantled USAID, which used to provide quite a lot of humanitarian relief.

And not just in times of conflict, but we have seen other disasters in recent months, like the earthquake in Afghanistan.

There was a recent landslide in Sudan, which barely got reported on.

There was an earthquake in Myanmar.

There's a very long list of places where aid is just not making it in.

And it's not just funding cuts.

It's also the dismantling of the capacity building that had existed to be able to do the kind of humanitarian work that is needed.

Aaron Powell, Jr.: Well, and I think that the other thing, too, is that the ultimate goal of many of these aid organizations is to create infrastructure so that it's not a emergency response situation time and time again, and that you can actually prevent emergencies before they happen.

And yeah, the dismantling of USAID has been, has been so

devastating.

People are dying.

Like it's, I just,

yeah.

It's a

yeah.

I am amazed at all of the incredible people who are out there doing the work, doing the humanitarian work, working with Doctors Without Borders, working with World Central Kitchen and the World Food Program and so many others.

Reporting on this, letting the rest of us know.

I mean, this is because this is the type of, these famines in general are often, because they are man-made,

silenced.

And so the people who are risking their lives to deliver aid in whatever capacity and to let the rest of the world know is just, it can't, it's, it's unbelievable.

Yeah.

The horrific.

So if you would like to read a lot more about the history of famines and also the current situation that is ongoing across the world, but especially in Sudan and Gaza.

We have a lot of sources for you because we did not come up with this on our own.

Oh my God.

I mean,

yes,

I have a bunch of books that I shouted out at the beginning.

I'm going to shout out again, Alex DeWaal's Mass Starvation, The History and Future of Famine, published in 2017.

Another paper published in 2024, more recently, The History and Future of Famine.

also by Alex DeWaal, then by Tezanos Vasquez, Why Do Famines Still Occur in the 21st Century?

A Review on the Causes of Extreme Food Insecurity, published 2025.

And published in 2021, Weiserman and Luszczak, Prenatal Famine Exposure and Adult Health Outcomes, an Epigenetic Link, just to kind of trace the generational trauma that famines can cause.

And also, the IPC website has incredible resources, infographics.

I mean, it is just a wealth of information.

I've linked to a few infographics specifically, but there's plenty more there.

I also have the links to the two most recent IPC reports that I was quoting from.

So the one from August 2025, that was the Famine Review Committee's report on the Gaza Strip.

And then the one from December 2024, that was the Famine Reviews Committee on Sudan.

There's a few other ones as well, too.

And I also have a bunch of World Health Organization public health situation analysis reports as well, where I got a lot of those numbers from, as well as UN news reports.

I also, because I usually try and rely on,

you know, peer-reviewed journal articles, which are hard to find when things are ongoing, but I did find at least a few.

There was one that I really enjoyed that was published, of course, this year in 2025 by Hasun et al.

from Sustainable Futures that was titled The Implications of the Ongoing War on Gaza for Food Sustainability.

And there were several others.

So we will, as always, post the link to our sources on our website, thispodcastwillkillyou.com, thispodcastwillkillU.com,

under the episodes tab.

We will.

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You, you know, allow us to do this.

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Well, until next time, wash your hands.

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