In several regions, including Gaza and Sudan, post-famine conditions could potentially lead to the development of refeeding syndrome.

In regions of catastrophic hunger, such as Gaza and Sudan, the safe resumption of aid is crucial to prevent a humanitarian crisis. Unfortunately, the ongoing blockade and military offensive in Gaza have led to the tragic deaths of 197 people, including 96 children, due to famine.

Food crisis experts have warned of "widespread death" if action is not taken to alleviate hunger in these regions. In Sudan, international agencies predict that 3.2 million children under the age of 5 will suffer from acute malnutrition in the next year.

The situation in El Fasher, North Dafur, Sudan, is particularly dire, with people under siege and starving for over a year. In Gaza, a third of the population of 2.1 million haven't eaten in days.

Preventing refeeding syndrome, a potentially fatal condition that can occur when malnourished people resume normal eating too quickly, is essential in these circumstances. The safe and effective reintroduction of nutrition requires a systematic, medically supervised approach.

This approach includes gradually reintroducing nutrition, with caloric intake starting at about 60% to 80% of the recommended daily calorie requirement and increasing slowly. Feeding should be gentle and spread out, often through frequent small meals or continuous nasogastric feeding to reduce risks like hypoglycemia.

For children and severely malnourished individuals, fortified milks and ready-to-use therapeutic foods (RUTF) that are nutrient-dense and easy to digest are preferred over basic, unbalanced food aid like flour or high-carb rations. RUTFs are specially formulated with low sodium, higher potassium, and higher phosphate.

Micronutrient supplementation, such as administering thiamine, phosphate, and other essential vitamins and minerals, also helps prevent key complications like hypophosphatemia commonly seen in refeeding syndrome.

Close clinical monitoring is vital, with patients needing continuous medical oversight and electrolyte and fluid balance monitoring. This ideally should be by trained healthcare providers to promptly identify and manage any complications during the critical initial weeks of refeeding.

Relief efforts must ensure sufficient medical resources and qualified personnel to manage the clinical complexities of refeeding malnourished populations safely. Adhering to protocols recommended by bodies like the World Health Organization (WHO) and the European Society of Clinical Nutrition and Metabolism has been shown to reduce morbidity and mortality from refeeding syndrome in vulnerable groups.

Governments in famine-hit regions need to prioritize safe conditions for aid agencies to resume their work. International pressure is needed to ensure governments in regions like Gaza and Sudan grant aid agencies access to malnourished children and pregnant women.

Researchers are also looking to other RUTF products prepared closer to African and Asian sites, such as ones made from chickpeas, mung beans, maize, and lentils. This could help address the unique nutritional needs of these regions and improve the accessibility of lifesaving treatments.

In Nigeria, malnutrition has led to the deaths of 625 children in the first six months of 2025, where funding from international donors has been cut. Aid organizations supply special milk formulations and RUTFs like Plumpy'Nut to help prevent refeeding syndrome in famine regions.

In Gaza, UN-backed health monitors report that 100,000 Palestinian women and children are facing severe malnutrition. The sudden arrival of vitamins and electrolytes like potassium, phosphorus, and magnesium can disrupt critical organ processes and lead to arrhythmia - an irregular heartbeat.

Starvation begins when people don't get enough calories to keep up with the body's energy demands, causing the body to slow down metabolic processes and organ activity. Introducing food or nutrition slowly, known as "stabilization feeds," is the first step for malnourished individuals. RUTFs are designed to deliver essential nutrition specifically for severely malnourished children without overloading their bodies and risking refeeding syndrome.

In conclusion, the prevention of refeeding syndrome in famine-affected regions requires a systematic, medically supervised approach that combines slow-calorie reintroduction, micronutrient support, specialized therapeutic foods, and rigorous clinical monitoring to mitigate potentially fatal metabolic disturbances. International cooperation and pressure are essential to ensure aid agencies can reach those in need and prevent a humanitarian crisis.