GAZA CITY: In some tents and shelters in northern Gaza, emaciated children are held in their parents’ arms. Their tiny arms and legs dangle limp. Their shoulder blades and ribs stick out from skeletal bodies, slowly consuming themselves for lack of food.
Starvation always stalks the most vulnerable first. Kids with preexisting conditions, like cerebral palsy, waste away quickly because the high-calorie foods they need have run out, along with nutritional supplements.
But after months of Israeli blockade and turmoil in the distribution of supplies, children in Gaza with no previous conditions are also starting to die from malnutrition, aid workers and doctors say.
Over the past month, 28 children have died of malnutrition-related causes, according to the Gaza Health Ministry, though it’s not known how many had other conditions. 
Medical professionals staff the ministry, and the UN and other experts see its figures on war deaths as the most reliable estimate of casualties.
Salem Awad was born in January with no medical problems. He is the youngest of six children, his mother, Hiyam Awad, said. But she was too weak from lack of food to breastfeed him.
For the first two months of Salem’s life, a ceasefire was in place in Gaza, and more aid was available, but even then, it was still hard to find milk for him, his mother said. In March, Israel cut off all food from entering the territory for more than 2 ½ months.
Since then, Salem has been wasting away. Now he weighs 4 kg, his mother said. 
“He just keeps losing weight. At the hospital, they say if he doesn’t get milk, he could die,” she said, speaking in the family’s tent in Gaza City.
Israel has been allowing a trickle of aid into Gaza since late May. 
Following an international outcry over increasing starvation, it has introduced new measures, which it claims are intended to increase the amount of food reaching the population, including airdrops and pauses in military operations in some areas. 
But so far, they have not had a significant effect, aid groups say.
Food experts warned this week that the “worst-case scenario of famine is playing out in Gaza.” 
The UN says the impact of hunger building for months is quickly worsening, especially in Gaza City and other parts of northern Gaza, where it estimates nearly one in five children is now acutely malnourished.
Across Gaza, more than 5,000 children were diagnosed with malnutrition this month, though that is likely an undercount, the UN says. Malnutrition was virtually nonexistent before the war. 
Doctors struggle to treat the children because many supplies have run out, the UN says.
Israel denies that a famine is taking place or that children are starving. It says it has supplied enough food throughout the war and accuses Hamas of causing shortages by stealing aid and trying to control food distribution.
Humanitarian groups deny that a significant diversion of food takes place. 
Throughout nearly 22 months of war, the number of aid trucks has been far short of the roughly 500 a day the UN says is needed.
The impact is seen most strongly in children with special needs — and those who have been grievously wounded in Israeli bombardment.
Mosab Al-Dibs, 14, suffered a heavy head wound on May 7 when an airstrike hit next to his family’s tent. For about two months, he has been at Shifa Hospital, largely paralyzed, only partly conscious, and severely malnourished because the facility no longer has the supplies to feed him, said Dr. Jamal Salha.
Mosab’s mother, Shahinaz Al-Dibs, said the boy was healthy before the war, but that since he was wounded, his weight has fallen from 40 kilograms to less than 10 (88 to 22 pounds)
At his bedside, she moves his spindly arms to exercise them. The networks of tiny blue veins are visible through the nearly transparent skin over his protruding ribs. The boy’s eyes dart around, but he doesn’t respond.
His mother puts some bread soaked in water — the only food she can afford — into a large syringe and squirts it into his mouth in a vain attempt to feed him. Most of it dribbles out from his lips. What he needs is a nutrient formula suitable for tube feeding that the hospital doesn’t have, Salha said.
At a school-turned-shelter for displaced people in Gaza City, Samah Matar cradles her son Yousef as his little brother Amir lies on a cushion beside her — both of them emaciated. The two boys have cerebral palsy and also need a special diet.
“Before the war, their health situation was good,” said Matar. They could get the foods they needed, but now “all those things have disappeared, and their health has declined continually.”
Yousef, 6 years old, has lost 5 kg since the war, dropping from 14 kg to 9 kg. His 4-year-old brother, Amir, has lost weight, shrinking from 9kg to under 6, she said.