Stroking the hair of her emaciated daughter on a hospital bed in Gaza City, Nasma Ayad fears time is running out for a medical evacuation of the malnourished eight-year-old to avoid the fate of her sister, who died last month.

"I feel I'm slowly losing my daughter, day after day - everything she's suffering from is multiplying," Ayad said.

With few medical supplies and limited food, treating malnourished Palestinian children with complicated conditions in war-shattered Gaza has become increasingly difficult, according to medical staff and humanitarian agencies.

Jana received treatment for malnutrition last year at an International Medical Corps clinic in the central town of Deir al-Balah after showing signs of weakness and delayed growth.

Though she improved, the frequent interruption of healthcare services and increasing scarcity of food - as Israeli forces who control all access to Gaza have kept up their offensive against Hamas militants - led to a relapse, Ayad said.

She weighs just 11 kilograms (24 pounds) and has trouble seeing, speaking or standing up.

"She started having an edema, which is fluid retention that makes the limbs and the body swell and store water because of the lack of protein and food," said Suzan Marouf, a therapeutic nutritionist at Patient Friend's Benevolent Society Hospital.

Jana's sister, Joury, died on July 20. The child had kidney problems exacerbated by malnutrition, her mother said.

Gaza's spiraling humanitarian crisis prompted the main world hunger monitoring body on Tuesday to assess that a worst-case scenario of famine is unfolding, and that immediate action is needed to avoid widespread death. Images of emaciated Palestinian children have shocked many around the world.

Gazan health authorities have reported more and more people dying from hunger-related causes. The total now stands at 156, among them 90 children, most of whom died in the past few weeks.

Ayad had hoped both her girls could be evacuated to safety to receive treatment outside the Gaza Strip. Health officials had added them to a list of patients who were in need of evacuation last September.

But the evacuations never transpired. Though it was too late for Joury, her mother still holds out some hope for Jana.

"I am calling for the urgent referral of Jana as soon as possible to be treated outside the country," she said.

With the international furore over Gaza's ordeal growing, Israel announced steps over the weekend to ease aid access. But the U.N. World Food Programme said on Tuesday it was still not getting the permissions needed to deliver sufficient aid.

Israel and the U.S. accuse Hamas of stealing aid - which the Islamist group denies - and the U.N. of failing to prevent this. The United Nations says it has seen no evidence of Hamas diverting much aid. Hamas accuses Israel of causing starvation and using aid as a weapon, which the Israeli government denies.

DESCRIPCIÓN DE IMÁGENES

GAZA CITY, GAZA (JULY 29, 2025) (REUTERS – Access all)

1. NASMA AYAD, MOTHER OF MALNOURISHED CHILD, JANA, SITTING NEXT TO HER DAUGHTER WHO IS LYING ON HOSPITAL BED / OTHERS IN WARD

2. VARIOUS OF JANA LYING ON HOSPITAL BED

3. MEDICAL SOLUTIONS / JANA LYING ON HOSPITAL BED

4. (SOUNDBITE) (Arabic) MOTHER OF MALNOURISHED CHILD JANA, NASMA AYAD, 32, SAYING:

“From one place to another, and from hospital to hospital, she stayed in the IMC (Hospital of the International Medical Corps) for eight months for treatment and she was improving. After the girl improved and when we went to Gaza City, to the north, bit by bit, her health condition worsened. She started having severe complications, and her weight started decreasing, her blood is currently six.”

5. NASMA MASSAGING HER DAUGHTER’S LEG

6. JANA LYING ON HOSPITAL BED

7. (SOUNDBITE) (Arabic) MOTHER OF MALNOURISHED CHILD JANA, NASMA AYAD, 32, SAYING (WHILE SITTING NEXT TO HER DAUGHTER):

“My daughter bit by bit will have vision complications. Even her legs, she can’t even move her legs to go to the toilet. Bit by bit, I feel I'm slowly losing my daughter, day after day - everything she's suffering from is multiplying. She’s eight and half years old, her weight is around 11 kilograms and blood is six. Bit by bit, she will have complications in (her) vision, in walking and even in speaking, now she’s having great difficulty in speaking.”

8. NASMA TOUCHING HER DAUGHTER’S HEAD, HOLDING HER HAND

9. NASMA HOLDING HER DAUGHTER’S HAND / ANOTHER WOMAN NEXT TO GIRL ON HOSPITAL BED

10. CANNULA IN JANA’S HAND

11. (SOUNDBITE) (Arabic) MOTHER OF MALNOURISHED CHILD JANA, NASMA AYAD, 32, SAYING:

“My daughter had a (medical) referral since September 14, 2024. Until now, my daughter’s referral has been on hold because of the siege, the (closure) of the borders and the circumstances we are living in. I am calling for the urgent referral of Jana as soon as possible for treatment outside the country.”

12. CANNULA IN JANA’S HAND

13. VARIOUS OF THERAPEUTIC NUTRITIONIST AT PATIENT FRIEND'S BENEVOLENT SOCIETY HOSPITAL, SUZAN MAAROUF, CHECKING ON JANA

14. (SOUNDBITE) (Arabic) THERAPEUTIC NUTRITIONIST AT PATIENT FRIEND'S BENEVOLENT SOCIETY HOSPITAL, SUZAN MAAROUF, SAYING:

“She started having an edema, which is fluid retention that makes the limbs and the body swell and store water because of the lack of protein and food."

DEIR AL-BALAH, GAZA (FILE – JUNE 22, 2024) (REUTERS – Access all)

15. DOCTOR EXAMINING JANA

16. JANA’S THIN LEGS

17. DOCTOR EXAMINING JANA

18. JANA’S BACK

19. VARIOUS OF NASMA SHOWING JANA’S PICTURE ON PHONE BEFORE HER ILLNESS