NAPLES: Since arriving emaciated in Italy from Gaza, little Shamm Qudeih has celebrated her second birthday and gained weight on a new diet that includes a special porridge — progress welcomed by doctors treating her for severe malnutrition worsened by a genetic metabolic disease.
Just weeks ago, the toddler was all skin and bones as she clung to her mother in a hospital in southern Gaza, after months of being unable to get the food and treatment she needed because of an Israeli blockade aimed at pressuring the Hamas militant group to release hostages. Then she was evacuated to Italy for medical treatment, along with six other Palestinian children.
A striking photo of Shamm wincing in her mother’s arms, with her hair matted and ribs protruding from her chest, was taken by Associated Press freelance journalist Mariam Dagga just days before the child left Gaza on Aug. 13. It was one of Dagga’s last images. She was among 22 people killed in an Aug. 25 Israeli strike on the same hospital in southern Gaza.
More than half a million people in Gaza, a quarter of the population, are experiencing catastrophic levels of hunger because of the blockade and ongoing military operations, the world’s leading authority on hunger crises said last month. Gaza City, in the north, is experiencing famine, it said.
Toddler perks up
By this week, Shamm was sitting up, alert in a hospital crib in Naples, her fine blonde hair pulled into a high ponytail. She wore a T-shirt emblazoned with the word “cute.” Her wide eyes gleamed as her older sister and mother called her name from across the room, and she broke into a smile.
Weighing around 4 kilograms (9 pounds) when she arrived in Italy, Shamm was “in a serious and challenging clinical state,” said Dr. Daniele de Brasi, a pediatric genetic disease specialist who is treating her at Santobono Pausilipon Children’s Hospital in Naples.
She now weighs 5.5 kilograms (just over 12 pounds), which is still no more than half of the median weight for a child of her age, de Brasi said.
The doctor said “a big part” of her undernourishment was due to a genetic metabolic disease called glycogen storage disease, which interferes with the absorption of nutrients, particularly carbohydrates, and can cause muscle weakness and impede growth. The condition is primarily managed through a high-carbohydrate diet.
So far, “We are very satisfied with her progress,’’ de Brasi said.
A mother’s struggle.
Israel military offensive on Gaza has killed more than 64,000 Palestinians in nearly two years of fighting. The Gaza Health Ministry, which is part of the Hamas-run government and run by medical professionals, does not say how many were civilians or combatants but that around half of those killed were women and children.
The family was forced to move more than a dozen times, and Shamm’s mother, Islam, struggled to get her proper medical care, visiting many hospitals and clinics. Doctors suspected the rare condition but could not test for it, much less treat it properly. They sometimes offered antibiotics.
“It became worse as a result of the lack of food, treatment and possibilities,” Islam said in an interview with Shamm resting on her shoulder. “We have been displaced maybe about 15 times, from tent to tent. We walked long distances and, along the way, it was hot, and the sun was hitting us.”
For a while, doctors administered a special formula, but Shamm would not take it, having lost the habit of drinking milk after supplies in Gaza became scarce.
The UN warned last month that starvation and malnutrition in Gaza are at the highest levels since the war began. Nearly 12,000 children under 5 were found to have acute malnutrition in July — including more than 2,500 with severe malnutrition, the most dangerous level. The World Health Organization says the numbers are likely an undercount.
A final photograph in Gaza
It was at Nasser Hospital in the southern Gaza city of Khan Younis that Dagga photographed Shamm for the last time on Aug. 9. During the visit, Shamm cried in pain in her hospital bed. Her arms, legs and ribs were skeletal, her belly swollen.
Islam had gone to school with Dagga, who visited the hospital, and remembered her fondly.
“She was always coming to the hospital to check on me and Shamm,” right up to the day of their departure for Italy, Islam said. “She stayed until the last step of the stairs to say goodbye to me.”
After arriving in Italy, Islam learned that Dagga had died in an attack that killed four other journalists.
“I was upset when I heard and knew that she had died,” Islam said.
Ongoing treatment
Shamm is among 181 Palestinian children being treated in Italy, according to the Italian Foreign Ministry. About one-third of those have arrived since March, when Israel ended a ceasefire with Hamas and imposed the 2 1/2 month blockade on all imports, including food and medicine.
Israel denies there is starvation in Gaza, despite accounts to the contrary from witnesses, UN agencies and experts. It says it allowed enough aid to enter before and after the tightened blockade and has allowed increased supplies in recent weeks.
In Naples, Shamm now has a feeding tube in her nose to ensure she gets the right mix of nutrients overnight. Doctors aim to remove the tube in about a month. During the day, she is free to eat solid food, including meat and fish. A cornerstone of her diet is the carbohydrate-rich porridge.
Her current intake is around 500 calories a day, which doctors are gradually increasing.
“In these cases, growing too fast can cause problems,” de Brasi said.
Her 10-year-old sister, Judi, was brought to Italy as an accompanying family member, and doctors began treating her after noting that she was at least three or four kilograms underweight, de Brasi said. She has gained two kilograms (nearly 5 pounds) and is in good condition.
With both daughters improving, Shamm’s mother is allowing herself to experience relief. But it is too soon to think about going back to Gaza, where Shamm’s father is.
“Now there is no way to go back, as long as the war is going on. There are no possibilities for my daughters,’’ she said.
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Toddler evacuated from Gaza with rare disease recovers from malnutrition in Italian hospital
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Toddler evacuated from Gaza with rare disease recovers from malnutrition in Italian hospital
- Little Shamm Qudeih was emaciated when she arrived last month
Morocco aims to boost legal cannabis farming and tap a global boom
BAB BERRED: Since he started growing cannabis at 14, Mohamed Makhlouf has lived in the shadows, losing sleep while bracing for a knock on his door from authorities that could mean prison or his entire harvest confiscated.
But after decades of operating in secret, Makhlouf finally has gained peace of mind as Morocco expands legal cultivation and works to integrate veteran growers like him into the formal economy.
On his farmland deep in the Rif Mountains, stalks of a government-approved cannabis strain rise from the earth in dense clusters. He notices when police pass on a nearby road. But where the crop’s aroma once meant danger, today there is no cause for concern. They know he sells to a local cooperative.
“Legalization is freedom,” Makhlouf said. “If you want your work to be clean, you work with the companies and within the law.”
The 70-year-old Makhlouf’s story mirrors the experience of a small but growing number of farmers who started in Morocco’s vast black market but now sell legally to cooperatives producing cannabis for medicinal and industrial use.
New market begins to sprout
Morocco is the world’s biggest producer of cannabis and top supplier of the resin used to make hashish. For years, authorities have oscillated between looking the other way and cracking down, even as the economy directly or indirectly supports hundreds of thousands of people in the Rif Mountains, according to United Nations reports and government data.
Abdelsalam Amraji, another cannabis farmer who joined the legal industry, said the crop is crucial to keeping the community afloat.
“Local farmers have tried cultivating wheat, nuts, apples, and other crops, but none have yielded viable results,” he said.
The region is known as an epicenter of anti-government sentiment and growers have lived for years with arrest warrants hanging over them. They avoided cities and towns. Many saw their fields burned in government campaigns targeting cultivation.
Though cannabis can fetch higher prices on the black market, the decreased risk is worth it, Amraji said.
“Making money in the illegal field brings fear and problems,” he said. “When everything is legal, none of that happens.”
Market remains under tight regulation
The change began in 2021 when Morocco became the first major illegal cannabis producer, and the first Muslim-majority country, to pass a law legalizing certain forms of cultivation.
Officials heralded the move as a way to lift small-scale farmers like Makhlouf and Amraji out of poverty and integrate cannabis-growing regions into the economy after decades of marginalization.
In 2024, King Mohammed VI pardoned more than 4,800 farmers serving prison sentences to allow longtime growers “to integrate into the new strategy,” the justice ministry said at the time.
Since legalization was enacted in 2022, Morocco has tightly regulated every step of production and sale from seeds and pesticides to farming licenses and distribution. Though certain cultivation is authorized, officials have shown no sign of moving toward legalization or reforms targeting recreational consumers.
“We have two contradictory missions that are really to allow the same project to succeed in the same environment,” said Mohammed El Guerrouj, director-general of Morocco’s cannabis regulatory agency. “Our mission as policemen is to enforce regulations. But our mission is also to support farmers and operators so they succeed in their projects.”
Licensing and cooperatives are part of new ecosystem
The agency issued licenses last year to more than 3,371 growers across the Rif and recorded nearly 4,200 tons of legal cannabis produced.
Near the town of Bab Berred, the Biocannat cooperative buys cannabis from roughly 200 small farmers during harvest season. The raw plant is transformed into neat vials of CBD oil, jars of lotion and chocolates that have spread across Morocco’s pharmacy shelves.
Some batches are milled into industrial hemp for textiles. For medicinal use and export, some of the product is refined into products with less than 1 percent THC, the psychoactive compound that gives cannabis its high.
Aziz Makhlouf, the cooperative’s director, said legalization created a whole ecosystem that employed more than just farmers.
“There are those who handle packaging, those who handle transport, those who handle irrigation — all of it made possible through legalization,” said Makhlouf, a Bab Berred native whose family has long been involved in cannabis farming.
Legalization has brought licenses, formal cooperatives and the hope of steady income without fear of arrest. But the shift also has exposed the limits of reform. The legal market remains too small to absorb the hundreds of thousands who depend on the illicit trade and the new rules have introduced more pressures, farmers and experts say.
Protests erupted in parts of nearby Taounate in August after cooperatives there failed to pay growers for their crop. Farmers waved banners reading “No legalization without rights” and “Enough procrastination,” furious that payments they were promised for working legally at the government’s urging never came, local media reported.
Illegal cultivation persists
The government insists the transformation is only beginning and challenges can be overcome.
But black market demand remains high. Today, cannabis is grown legally on 14,300 acres (5,800 hectares) in the Rif, while more than 67,000 acres (27,100 hectares) are used for illegal growing, according to government data. The number of farmers entering the legal system remains tiny compared with the number thought to be tied to the illicit market.
An April report from the Global Institute Against Transnational Organized Crime characterized the industry as “more one of coexistence of both markets than a decisive transition from one to the other.”
“A substantial proportion of the population continue to rely on illicit cannabis networks for income generation, perpetuating the dynamics that the state is trying to reform,” the report said.
For now, Morocco’s two cannabis economies exist side by side — one regulated and one outlawed — as the country tries to coax a centuries-old trade out of the shadows without leaving its farmers behind.
“Cannabis is legal now, just like mint,” Amraji said. “I never imagined I’d one day be authorized to grow it. I’m shocked.”
But after decades of operating in secret, Makhlouf finally has gained peace of mind as Morocco expands legal cultivation and works to integrate veteran growers like him into the formal economy.
On his farmland deep in the Rif Mountains, stalks of a government-approved cannabis strain rise from the earth in dense clusters. He notices when police pass on a nearby road. But where the crop’s aroma once meant danger, today there is no cause for concern. They know he sells to a local cooperative.
“Legalization is freedom,” Makhlouf said. “If you want your work to be clean, you work with the companies and within the law.”
The 70-year-old Makhlouf’s story mirrors the experience of a small but growing number of farmers who started in Morocco’s vast black market but now sell legally to cooperatives producing cannabis for medicinal and industrial use.
New market begins to sprout
Morocco is the world’s biggest producer of cannabis and top supplier of the resin used to make hashish. For years, authorities have oscillated between looking the other way and cracking down, even as the economy directly or indirectly supports hundreds of thousands of people in the Rif Mountains, according to United Nations reports and government data.
Abdelsalam Amraji, another cannabis farmer who joined the legal industry, said the crop is crucial to keeping the community afloat.
“Local farmers have tried cultivating wheat, nuts, apples, and other crops, but none have yielded viable results,” he said.
The region is known as an epicenter of anti-government sentiment and growers have lived for years with arrest warrants hanging over them. They avoided cities and towns. Many saw their fields burned in government campaigns targeting cultivation.
Though cannabis can fetch higher prices on the black market, the decreased risk is worth it, Amraji said.
“Making money in the illegal field brings fear and problems,” he said. “When everything is legal, none of that happens.”
Market remains under tight regulation
The change began in 2021 when Morocco became the first major illegal cannabis producer, and the first Muslim-majority country, to pass a law legalizing certain forms of cultivation.
Officials heralded the move as a way to lift small-scale farmers like Makhlouf and Amraji out of poverty and integrate cannabis-growing regions into the economy after decades of marginalization.
In 2024, King Mohammed VI pardoned more than 4,800 farmers serving prison sentences to allow longtime growers “to integrate into the new strategy,” the justice ministry said at the time.
Since legalization was enacted in 2022, Morocco has tightly regulated every step of production and sale from seeds and pesticides to farming licenses and distribution. Though certain cultivation is authorized, officials have shown no sign of moving toward legalization or reforms targeting recreational consumers.
“We have two contradictory missions that are really to allow the same project to succeed in the same environment,” said Mohammed El Guerrouj, director-general of Morocco’s cannabis regulatory agency. “Our mission as policemen is to enforce regulations. But our mission is also to support farmers and operators so they succeed in their projects.”
Licensing and cooperatives are part of new ecosystem
The agency issued licenses last year to more than 3,371 growers across the Rif and recorded nearly 4,200 tons of legal cannabis produced.
Near the town of Bab Berred, the Biocannat cooperative buys cannabis from roughly 200 small farmers during harvest season. The raw plant is transformed into neat vials of CBD oil, jars of lotion and chocolates that have spread across Morocco’s pharmacy shelves.
Some batches are milled into industrial hemp for textiles. For medicinal use and export, some of the product is refined into products with less than 1 percent THC, the psychoactive compound that gives cannabis its high.
Aziz Makhlouf, the cooperative’s director, said legalization created a whole ecosystem that employed more than just farmers.
“There are those who handle packaging, those who handle transport, those who handle irrigation — all of it made possible through legalization,” said Makhlouf, a Bab Berred native whose family has long been involved in cannabis farming.
Legalization has brought licenses, formal cooperatives and the hope of steady income without fear of arrest. But the shift also has exposed the limits of reform. The legal market remains too small to absorb the hundreds of thousands who depend on the illicit trade and the new rules have introduced more pressures, farmers and experts say.
Protests erupted in parts of nearby Taounate in August after cooperatives there failed to pay growers for their crop. Farmers waved banners reading “No legalization without rights” and “Enough procrastination,” furious that payments they were promised for working legally at the government’s urging never came, local media reported.
Illegal cultivation persists
The government insists the transformation is only beginning and challenges can be overcome.
But black market demand remains high. Today, cannabis is grown legally on 14,300 acres (5,800 hectares) in the Rif, while more than 67,000 acres (27,100 hectares) are used for illegal growing, according to government data. The number of farmers entering the legal system remains tiny compared with the number thought to be tied to the illicit market.
An April report from the Global Institute Against Transnational Organized Crime characterized the industry as “more one of coexistence of both markets than a decisive transition from one to the other.”
“A substantial proportion of the population continue to rely on illicit cannabis networks for income generation, perpetuating the dynamics that the state is trying to reform,” the report said.
For now, Morocco’s two cannabis economies exist side by side — one regulated and one outlawed — as the country tries to coax a centuries-old trade out of the shadows without leaving its farmers behind.
“Cannabis is legal now, just like mint,” Amraji said. “I never imagined I’d one day be authorized to grow it. I’m shocked.”
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