The Zarouk family's descent into hunger and ill health is part of a larger story of Palestinian suffering that until now has gone largely unnoticed amid the more dramatic airstrikes and suicide bombings that have punctuated two years of fighting in the Middle East.
A study funded by the United States Agency for International Development (USAID) released Monday concluded that 1 in 5 young Palestinian children in the Occupied Territories suffers from acute or chronic malnutrition. The report said the Territories face a "humanitarian emergency" of malnutrition and related problems such as lack of affordable access to key high-protein foods.
Adib Zarouk, a father of seven, used to bring home meat, fish, and eggs when he worked as an electrician in Israel before September 2000. Now, eight months after his savings ran out, he sometimes must choose between feeding himself and his family. "I give the food to the children. They have to grow up to build their bodies," he says, leaning on a table to support himself.
His refrigerator is empty except for water, zaatar (a Mediterranean spice), and a leftover bowl of potatoes and peas.
Yusuf, Adib's 12-year-old son, says his most nutritious meal is lunch on the days that he attends a camp run by Yasser Arafat's Fatah movement. Then he has eggs, bread, and juice during a break in paramilitary exercises. Yusuf bites his fingers and turns his head away when spoken to. His brown eyes are dull. "I feel sore in the stomach. I get tired sooner when I play. I cannot concentrate when I go to school," he says.
Mr. Zarouk says his son has lost about 11 pounds in the past eight months. Suzane, his 9-year-old sister, has also lost weight.
With its statistics and graphs, the USAID report has put the malnutrition of families like the Zarouks on the table as a new dimension of the Middle East conflict, one that may generate international pressure on Israel to alter its policies of closure and containment of Palestinians.
International humanitarian workers say that to address the emergency, the Sharon government should ease its tight army strictures on the West Bank and Gaza Strip. But the army says the economically devastating strictures tightened on Sunday after deadly Palestinian attacks are necessary to thwart rising terrorism.
The preliminary results of the study, undertaken by CARE International in collaboration with Johns Hopkins University, showed that 9.3 percent of Palestinian children up to 5 years of age suffer from acute malnutrition, meaning they weigh less than they should for their age or height groups.
In Gaza, where the population is poorest, the rate of acute malnutrition is 13.2 and in the West Bank the rate is 4.3.
The World Health Organization says a 10 percent rate of acute malnutrition constitutes a serious humanitarian problem. The Gaza rate is on a par with Nigeria and Chad, though the situation in the Palestinian territories can be improved with much greater ease, according to Earl Wall, country director for CARE International.
"This is not a situation of massive starvation, but one of malnourished kids who won't grow to their full height or achieve what they need to in school," he says. "They will have greater risk of infection, their bodies will be less able to withstand measles, mumps, and colds, their intellectual achievement will be lower."
"If we could make the war go away, this problem would go away overnight," Mr. Wall adds. "It's such a small place, there are no natural impediments. There is an infrastructure of roads and telephones."
The report faults Israeli border closures, road closures, checkpoints, and the military conflict for shortages of high protein foods such as fish, chicken, and dairy products among wholesalers and retailers.
Fifty-two percent of wholesalers and 48 percent of retailers reported a shortage of infant formula.
More than half the Palestinian population surveyed reported having to decrease their food consumption for more than one day during a two-week period, with 65 percent of respondents saying this was due to lack of money and 35 percent saying it was due to Israeli curfews. Fifty-three percent of households said they had to borrow money and 17 percent had to sell assets to buy food. Thirty-two percent of all households reported they were buying less bread, potatoes and rice.
Yael Dayan, a Knesset legislator from the Labor Party a partner in Prime Minister Ariel Sharon's coalition says: "There are many other reasons besides Israeli policies for this situation. This is a result of the policies of the Palestinian Authority. They need to stop the terrorism. The military measures are aimed only at protecting the lives of Israeli citizens."
But Israeli analysts including former chief of military intelligence Shlomo Gazit say the strictures are also intended to create hardship for the Palestinian civilian population and to pressure it into what Mr. Gazit described as less extreme political positions.
The Israeli newspaper Ha'aretz wrote Sunday that a staff for "Economic Warfare Against the Palestinians" has been operating inside Mr. Sharon's office.
The Zarouk family's descent from a secure diet into malnutrition is the story of tens of thousands of Gaza Strip and West Bank laborers who worked in Israel before the Palestinian uprising but have had sporadic or little work since Israel banned the entry of most workers, citing the need to prevent terrorist attacks. Internal strictures and economic collapse inside the West Bank and Gaza Strip have also contributed to the soaring unemployment.
Israel is committed to increasing the number of workers who can enter Israel and to easing the hardship of the civilian population, says Ophir Haham, a military administrator.
Majida Zarouk, Adib's wife, explains that lack of adequate food has affected her breastfeeding of their 9-month-old baby, Ahmad. "I'm eating a lot less than before and my breast has less milk.
"I feed the younger ones first and give what is left over to the older ones. I feel ill from not having food for myself and from seeing the children not have food," she adds. "The children do not understand, they keep crying and crying. They cry because they are hungry."