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As scientists and members of the Standing Together for Nutrition Consortium (ST4N) who have been Standing Together For Nutritionduring recent crises, we use evidence of the impact of crises on nutrition to advocate for the people most affected.1–3Now, in the face of the world’s indifference, we are compelled to speak out about the horrifying human-made famine unfolding in Gaza and other conflict areas, including Sudan, South Sudan, and Yemen.4–9 Widespread starvation is deliberately used as a weapon of war,10 at a scale that we never thought possible.11I t is a moral failure that in 2025 more than 1·2 million people are living in Integrated Food Security Phase Classification (IPC) phase 5 (catastrophe) famine conditions—the most extreme food insecurity level according to the gold-standard IPC.12 These famines are not only claiming lives today, but they are also inflicting irreversible intergenerational trauma and damage.13–16 Undernutrition in early childhood, particularly during the first 1000 days of life, disrupts physical growth, weakens immune systems, and impairs cognitive development.17 Wasted children are about 12 times more likely to die before their fifth birthday than children with a healthy weight.18 Those children who do survive famine will bear the impacts for life: stunted growth, chronic diseases, and reduced educational and economic potential. Evidence from the Dutch famine birth cohort and other famine-based studies shows that prenatal exposure to undernutrition impacts cardiometabolic health, mental health, and cognitive function at age 50 years and older.19 The economic cost of malnutrition, through lost human capital and increased health-care expenses, can reduce nations’ gross domestic product by 3–16%.20 Additionally, the biological impacts might persist across generations through epigenetic changes, perpetuating a cycle of poverty and poor health.17,21 The science of malnutrition and the solutions are known. Treatment of severe acute malnutrition, access to nutritious foods, clean water, nutrient supplements, and medical care are not radical ideas—they are proven strategies that save lives and rebuild communities.22 Yet in Gaza and other conflict zones, humanitarian organisations are systematically obstructed to an extent we have not seen before. Aid is blocked, health infrastructure is targeted, and families are left to face starvation, constituting grave violations of international humanitarian law.23Undernutrition is not only a consequence of war, it is also the seed for future conflict.24Desperation breeds instability. If an entire generation is allowed to grow up hungry, traumatised, and without hope, we all are complicit in setting the stage for further suffering. Careful data collection and scientific evidence to inform policy making are important. But this is not a moment for analysis, this is a moment for action. ST4N is calling for the nutrition, medical, public health, and scientific community to support a call to action on ST4N’s website.25Using hunger as a weapon of war must stop. Aid must flow today. Every child—every person—has the right to the nutrition they need to survive and thrive. Immediate, sufficient, unimpeded, and unconditional humanitarian access is urgent; it is the only path to avert further famine-related deaths and suffering. To delay humanitarian assistance is to deepen the crisis; to act is to break the chains of complicity. Saskia Osendarpa saskia.osendarp@micronutrientforum.org ∙ Lawrence Haddadb ∙ Cecilia Fabrizioa ∙ Caroline Andridgec ∙ Robert E Blackd ∙ Molly E Browne ∙ Elizabeth Bryanf ∙ Bruce M Campbellg ∙ Mary D’Alimontec ∙ Jessica Fanzoh ∙ Derek Headeyf ∙ Rebecca Heidkampd ∙ Abbe McCarterc ∙ Purnima Menonf,i ∙ Kristina Michauxa ∙ Stella Nordhagenb ∙ Lais Miachon Silvaa ∙ Roosmarijn Verstraetenj ∙ Zulfiqar A Bhutta We are all members of the Standing Together for Nutrition Consortium (ST4N). SO and LH are co-founders of ST4N. SO, LH, BMC, JF, EB, MEB, and ZAB are members of the ST4N Steering Committee and CF is the ST4N Program Lead. SO, CF, and LMS report funding from Global Affairs Canada. BMC is a consultant to the Global Centre on Adaptation and Clim-Eat. SO, CF, KM, and LMS are employees of the Micronutrient Forum, which hosts ST4N and led the development of this Comment. RH is a consultant to the Micronutrient Forum. RV is a researcher at the European Commission’s Joint Research Centre (JRC); the JRC is a public research body under the European Commission, and RV reports institutional support for work in supporting the Technical Advisory Group for Nutrition in Integrated Food Security Phase Classification (IPC); RV is a scientific expert supporting the IPC’s Technical Advisory Group as well as the Nutrition Working Group. ZAB reports an institutional grant from the Larsson Foundation for evaluating breastfeeding support for women and children in conflict and humanitarian settings and is the Founding Coordinator for the BRANCH consortium Bridging Research to Action for Women and Children in Conflict and Humanitarian Settings 2017–2023. All other authors declare no competing interests. Source: The Lancet References 1. Osendarp, S ∙ Ruel, M ∙ Udomkesmalee, E ∙ et al. The full lethal impact of massive cuts to international food aid Nature.2025;640:35-37 Crossref Scopus (1) PubMed Google Scholar 2. Osendarp, S ∙ Akuoku, JK ∙ Black, RE ∙ et al. The COVID-19 crisis will exacerbate maternal and child undernutrition and child mortality in low- and middle-income countries Nat Food.2021;2:476-484 Crossref Scopus (118) PubMed Google Scholar 3. Osendarp, S ∙ Verburg, G ∙ Bhutta, Z ∙ et al. Act now before Ukraine war plunges millions into malnutrition Nature.2022;604:620-624 Crossref Scopus (64) PubMed Google Scholar 4. Integrated Food Security Phase Classification (IPC) Gaza Strip. IPC Alert: worst-case scenario of famine unfolding in the Gaza Strip. Issue 133 https://www.ipcinfo.org/ipcinfo-website/countries-in-focus-archive/issue-133/en/ Date: July 29, 2025 Date accessed: July 29, 2025 Google Scholar 5. 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Mohamed, A ∙ Homeida, A Hunger in the shadow of conflict: analyzing malnutrition and humanitarian challenges in Sudan Confl Health.2024;18:50 Crossref Scopus (5) PubMed Google Scholar 9. Perez Duque, M ∙ Alburhomy, A ∙ Ahmed, A ∙ et al. Acute malnutrition and food insecurity in Yemen, 2021: evidence from a two-stage cluster randomised survey in a protracted crisis PLOS Glob Public Health.2025;5, e0004331 Crossref Scopus (0) PubMed Google Scholar 10. Ashour, Y ∙ Abu-Jlambo, A ∙ Abuzerr, S Starvation as a weapon of war in Gaza: violation of international law Lancet.2025;405, 2044 Full Text Full Text (PDF) Scopus (0) Google Scholar 11. Bhutta, ZA ∙ Dominguez, GB ∙ Wise, PH When is enough, enough? Humanitarian rights and protection for children in conflict settings must be revisited BMJ.2024;386, e081515 PubMed Google Scholar 12. Integrated Food Security Phase Classification (IPC) IPC-CH Dashboard https://www.ipcinfo.org/ipcinfo-website/ipc-dashboard/ Date: 2025 Date accessed: July 23, 2025 Google Scholar 13. Jamaluddine, Z ∙ Abukmail, H ∙ Aly, S ∙ et al. Traumatic injury mortality in the Gaza Strip from Oct 7, 2023, to June 30, 2024: a capture-recapture analysis Lancet.2025;405:469-477 Full Text Full Text (PDF) PubMed Google Scholar 14. Fieldhouse, R First independent survey of deaths in Gaza reports more than 80,000 fatalities Nature.2025;643:311-312 Crossref Scopus (0) PubMed Google Scholar 15. Dercon, S ∙ Porter, C Live aid revisited: long-term impacts of the 1984 Ethiopian famine on children J Eur Econ Assoc.2014;12:927-948 Crossref Scopus (0) Google Scholar 16. Ampaabeng, SK ∙ Tan, CM The long-term cognitive consequences of early childhood malnutrition: the case of famine in Ghana J Health Econ.2013;32:1013-1027 Crossref Scopus (70) PubMed Google Scholar 17. Victora, CG ∙ Adair, L ∙ Fall, C ∙ et al. Maternal and child undernutrition: consequences for adult health and human capital Lancet.2008;371:340-357 Full Text Full Text (PDF) Scopus (2619) PubMed Google Scholar 18. Olofin, I ∙ McDonald, CM ∙ Ezzati, M ∙ et al. Associations of suboptimal growth with all-cause and cause-specific mortality in children under five years: a pooled analysis of ten prospective studies PLoS One.2013;8, e64636 Crossref Scopus (343) PubMed Google Scholar 19. De Rooij, SR ∙ Bleker, LS ∙ Painter, RC ∙ et al. Lessons learned from 25 years of research into long term consequences of prenatal exposure to the Dutch famine 1944–45: The Dutch famine Birth Cohort Int J Environ Health Res.2022;32:1432-1446 Crossref Scopus (0) PubMed Google Scholar 20. Hoddinott, J The economics of reducing malnutrition in sub-Saharan Africa Global Panel on Agriculture and Food Systems for Nutrition, 2016 https://glopan.org/sites/default/files/Global_Panel_Working_Paper.pdf Date accessed: July 27, 2025 Google Scholar 21. Behrman, JR ∙ Calderon, MC ∙ Preston, SH ∙ et al. Nutritional supplementation in girls influences the growth of their children: prospective study in Guatemala Am J Clin Nutr.2009;90:1372-1379 Full Text Full Text (PDF) Scopus (112) PubMed Google Scholar 22. Keats, EC ∙ Das, JK ∙ Salam, RA ∙ et al. Effective interventions to address maternal and child malnutrition: an update of the evidence Lancet Child Adolesc Health.2021;5:367-384 Full Text Full Text (PDF) Scopus (199) PubMed Google Scholar 23. Quell, M Majority of countries argue Israel violated international law in last historic hearing at UN court AP News, Feb 26, 2024 https://apnews.com/article/israel-palestinians-icj-court-hearings-gaza-hamas-18680f6ce9d8508d59c006780e23b346 Date accessed: July 27, 2025 Google Scholar 24. World Food Program USA Winning the peace: hunger and instability https://www.wfpusa.org/wp-content/uploads/2025/07/wfp_food_security_final-web-1.pdf Date: 2017 Date accessed: July 25, 2025 Google Scholar 25. 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