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On the morning of 7 October, Amal Alabadla was heavily pregnant and snuggled up in bed with 18-month-old Noah when they were woken by a wall of sound.
Hamas had launched its attack on Israel, firing thousands of rockets over the border. Israeli jet fighters launched retaliatory attacks soon after.
In Khan Younis, Amal had no idea what was going on. She was anxious and terrified and, eight months pregnant, she started bleeding heavily. She had to get to hospital but her husband was working outside Gaza, in the occupied West Bank, and she was alone.
After a three-hour wait, the first taxi driver could only take her part of the way. The streets were full of people who didn’t know what to do or where to go.
All the time, she was bleeding.
When Amal, an architect, got to the hospital she was sent for a caesarean section immediately. Mohamed was born into a world irrevocably changed.
Since then his mother has been in a daily battle to keep him and his two-year-old brother alive.
As with 90% of people in Gaza, Amal and her family haven’t had a healthy, balanced diet in months. The problem is particularly acute in the north, where 90% of children and 95% of pregnant and breastfeeding women face severe food shortages.
Earlier this month the World Health Organization said children were dying of starvation in northern Gaza after visiting hospitals there.
But even in the south finding baby formula is a struggle.
The fight for formula
In many of the emergencies the UN responds to, the rate of breastfeeding is high. But in Gaza, as in the UK, only about half of women breastfeed beyond six weeks.
“As soon as the conflict started we knew this was going to be a challenge,” says Anu Nayaran, Unicef’s senior adviser on child nutrition in emergencies.
“If you are not breastfeeding your child, you’re in the middle of a conflict, you are not going to suddenly be able to start feeding your infant,” she says. “You are wholly reliant on baby formula.”
Amal managed to breastfeed Mohamed for a month but then found she wasn’t producing enough milk.
“I was afraid and nervous all the time. I wasn’t focusing on good food for me. So I didn’t have milk for him,” she says. “But I tried.”
As the war progressed it got harder. Gaza’s water system is barely functioning. Most new mothers are dehydrated, which hampers their ability to produce milk.
“People are getting less than two litres of water a day and that’s barely enough to drink, let alone wash,” says Ms Nayaran.
Not enough baby formula is getting into Gaza. There is little left on the market. Although the UN has responded by sending it in as aid, the number of trucks entering Gaza is much lower than before the outbreak of war. Meanwhile the fighting and the breakdown of social order mean convoys inside Gaza have been attacked and looted.
Israel denies impeding the entry of aid to Gaza and blames aid agencies on the ground for failing to distribute what does get in. But on Friday Australian Foreign Minister Penny Wong said there were large stocks of food waiting to go in to Gaza, “but there is no way to move it across the border into Gaza and deliver it at scale without Israel’s co-operation, and we implore Israel to allow more aid into Gaza now”.
Because of the lack of clean water, Unicef is sending pre-mixed baby formula to Gaza. It is safer to use but harder to transport in large quantities.
Three days into recovery from her c-section, Amal was displaced for the first time, forced to evacuate her mother’s home.
The fourth time they were displaced they left in the night, two hours before the place was bombed. “I couldn’t take the milk and diapers with me because they destroyed the whole building to the ground,” she said.
Amal initially took her children to Rafah, thinking it would be safer, but returned to the Khan Younis area. She couldn’t find the things she needed in Rafah. Mohamed has a dairy allergy; ordinary formula makes him sick. She found one tub of non-dairy formula but it was $40 (£31), ten times the price before the war.
By mid-January the family were living on a patch of scrubland outside Khan Younis and Amal had only two days of baby formula left. At three months old, Mohamed could eat nothing else.
“I’ll dig the mountains to provide it,” she texted. “My baby needs it.” She sent her brothers to search in the rubble of buildings but they came back empty-handed.
She decided to go to Rafah to search the shops and markets again. That journey would usually take just 20 minutes by car, but Israeli forces were now active on the route.
On the way they encountered three tanks; one fired in their direction with the shot landing near the car. The driver reversed and they escaped. Panicked and desperate to get back to her children, she didn’t manage to find any formula.
Little food, less water
Fighting in Khan Younis intensified in February and the noise from the explosions was especially difficult for Noah. He has epilepsy and the bombing makes his seizures worse. His epilepsy medication has run out and Amal can’t find it anywhere.
The family have little food and less water. Amal has been boiling it over the fire to try to get it clean. “It’s still dirty but I’m doing my best,” she said.
About 24,000 children have been born since the beginning of this war, according to estimates by the WHO. Gaza’s entire population is facing crisis levels of hunger but the risk is especially acute for young children.
“Children can get sick very fast,” says Anu Nayaran at Unicef. They have fewer stores of fat and muscle and can slip quickly into acute malnutrition.”
Even when they are treated there are long-term consequences. Malnutrition can lead to higher rates of diabetes, heart disease and even obesity in later life.
A study of adults in the Democratic Republic of Congo, who were treated for severe acute malnutrition as children, found it had a long-term effect on their cognitive development, negatively affecting educational achievement and self-esteem.
Amal has given up on finding formula for now. But Mohamed would not go hungry, yet. She found a mother in the same area who is breastfeeding him alongside her own baby. Amal was paying her with some baby clothes and a little money.
They were camping on a patch of sand in the coastal area of al-Mawasi in tents made from planks and rubber sheets, eating canned food and bread from donated flour if they could get it and cooking with foraged wood. Al-Mawasi had been designated as a “humanitarian area” by the Israeli military earlier on in the war.
Even that set-up would not last long. Last Sunday they were displaced yet again when their camp came under attack. The tent next to Amal’s was shelled and four people were killed.
“It’s a miracle we are alive,” she texted.
Like many other Gazans she has now resorted to online crowdfunding to try to raise the thousands of dollars her family will need to pay brokers to get on a list of people approved to leave Gaza for Egypt and safety.
One evening Amal sent the last picture she took of her life before the war, dated the night of 6 October.
Noah was lying on the soft carpet, propped up on a big cushion, watching cartoons on TV and swigging milk from his bottle. He’s kicking his legs in the air under the soft glow of fairy lights on the living room wall.
He fell asleep tucked up with his mother that night in a world far away from the dust, dirt and brutality that mark their life now.
“I’m trying to do what is possible,” said Amal. “I just need to rescue my kids from this horrific war.”