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Palestinian children sit next to the site of an Israeli strike on a house, amid the ongoing conflict between Israel and the Palestinian Islamist group Hamas, in Rafah, in the southern Gaza Strip, on April 21.Mohammed Salem/Reuters

Sometimes, in moments when the fighting fell quiet and the howl of hunger grew deafening, Sufyan Thaher brought out his oud to pick out the melody of a familiar song: “‘Cause every night I lie in bed/The brightest colours fill my head.” He sang in Arabic. His daughter, Zainah, learned the lyrics in English.

The music, for a brief spell, soothed the fear and dulled the hunger of the family’s uncertain existence in Jabalia refugee camp, in northern Gaza, not knowing what the next day would bring – whether there would be more bombs, whether there would be anything to eat.

Since war with Israel began last year, Mr. Thaher’s extended family counts 150 people killed.

More recently, it has kept another grim tally: the 15 who have now died of hunger. They are children and infants, some a few years old, some newborns.

Their mothers “were not able to produce milk because of lack of food,” said Mr. Thaher, 43.

Hunger “spared no one.”

The World Food Program has warned that famine is imminent in Gaza, particularly in its northern reaches. In a mid-March report, a partnership of international organizations reported 1.1 million Gazans in “catastrophic” states of hunger. That is half the population of the strip.

“Percentage-wise, this is unprecedented,” Arif Husain, the WFP’s chief economist, said in an interview.

Nine in 10 of the world’s hungriest people – those categorized as being in a catastrophic situation – are in Gaza.

Without urgent efforts to considerably increase the flow of food into Gaza, it is possible there will “be more people who will die from hunger-related causes than from the war itself,” Mr. Husain warned. “Famine is acknowledgment of collective failure. Meaning, we were not able to do our job, so people died.”

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In recent weeks, the worst shortages have eased in northern Gaza, after Israel began to allow the movement of greater supplies of food. It’s a response to U.S. criticism after the killing of seven workers from World Central Kitchen who risked their lives to deliver food. Their deaths helped to bring about some change. In Jabalia, basic commodities have become more available for purchase. No longer does a 25-kilogram bag of flour sell for upward of $1,000.

But a lack of food has been replaced by a lack of affordable food, and interviews with people in northern Gaza suggest the hunger crisis is far from over. Even the international aid that arrives is quickly siphoned away by dealers and merchants to resell at higher prices, Gazans said in interviews with The Globe and Mail.

A bag of flour now fetches $35, several times its prewar price. Tomatoes and cucumbers sell for four to five times their normal price. Late last week, the WFP supported the reopening of a bakery in Gaza City, which for the first time since Oct. 18 is producing bread, selling 30 pitas for $1.85.

It took an entire day for Mr. Thaher to acquire one pack of pitas, the first the family had tasted in six months.

Transportation to and from the bakery cost him four times the price of the bread. He watched two people die in the queue, an older man and woman whom, he believes, had grown so frail they could not survive jostling in the line.

Mr. Thaher, an athletic instructor, estimates he has shed 40 kilograms. His five children have contracted Hepatitis A.

“The situation is disastrous,” he said.

The signs of malnutrition are obvious to Walid Khahlout, a dietitian in Deir el-Balah. For children and adults alike, “their bodies are thin, their hair is falling out, their faces are pale and yellowish, and their bones are protruding.”

Famine, in his view, “is not imminent, it has already occurred.”

At Kamal Adwan Hospital, premature births have become more common. So have the number of babies born with multiple deformities.

Some women are too weak to survive labour. “They gave birth to their children, then died,” said neonatal nurse Ihdaa Jaber Ali. She has counted 10 such deaths on her shifts alone.

With her own two daughters, aged 7 and 11, she resorted to feeding infant formula when other food ran out.

Her two sons died on Oct. 31, when Israel struck the Jabalia camp, an attack that left an enormous crater in a populated area and killed 12 members of her family.

Their grandfather, Khudair Jaber Ali, lives beneath a tin roof on the remains of the family home. He survived the blast – plucked from the rubble by rescuers – but not without injuries to his back and right leg that have left him on crutches.

It has made him especially vulnerable.

“What do you expect from someone who was taken out of the rubble with a fractured leg – how can you expect them to run after food?” he said.

Malnutrition has left him with stomach pains, dim vision and joint pain.

Speaking late last week, he described his last meal: soup with rice and a bit of hibiscus he was able to forage.

Lubna Abu Nada, who has worked in the food security program with Oxfam, the British charity, said the situation has, relatively speaking, improved from a few weeks ago. Nonetheless, the signs of hunger are broadly visible.

“You can see it if you walk in the streets. Even on the young men, you can see the marks,” she said.

Ms. Abu Nada is married to Mr. Thaher. Together they have five children. Zainah is their oldest, and Ms. Abu Nada listens as her daughter sings for a reporter, the 13-year-old’s voice strong over a scratchy phone line: “A million dreams are keeping me awake/I think of what the world could be.”

It’s a song that has offered the family solace. But Ms. Abu Nada wanted her daughter to sing it in English, she said, “so the whole world will listen.”

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