When children are deprived of sufficient food, a cascade of health failures can quickly follow. Critical illness and death threaten, and even those who survive may face a lifetime of health challenges.

Young Palestinians, particularly those under age 5, are especially vulnerable in the Gaza Strip, where Israel has imposed restrictions on the entry of aid throughout the war, at times shutting crossings entirely. The highest levels of malnutrition since the war began were reported this summer, and its largest city has been officially declared under famine by a panel of food-security experts.

Food and other critically needed supplies began trickling back into Gaza in May after an 11-week blockade imposed by Israel. It wasn’t enough. In July, food consumption hit its lowest point since the war began, according to the Integrated Food Security Phase Classification, a U.N.-backed group of experts who monitor world hunger.

More aid has gone into Gaza since then. But food shortages remain widespread, and for some of the most vulnerable Gazans, the damage may already have been done.

When children are severely malnourished, their bodies draw on reserves to wage a last-ditch battle for survival. Eventually, their organs begin to break down.

Sometimes they become skeletally thin. Other times they swell up. They can be lethargic to the point of motionlessness, and stop eating even if there is food, because eating takes energy they don’t have. As their defense systems begin to fail, they may die suddenly from common diseases that a healthier child might withstand.

This is what happens to a malnourished body.

When children are experiencing acute malnutrition, most regular foods won’t reverse the process.

The World Health Organization recommends that acutely malnourished children be fed energy-dense foods, such as nut butters and sweet potatoes, and sometimes these can be found locally.

But they are not always readily available in Gaza, where markets and farms have been destroyed. Children there need a specially formulated therapeutic food: an enriched milk, for very young children, or a peanut-based product packed with calories, vitamins and nutrients. The W.H.O. also recommends a broad-spectrum antibiotic to treat infections.

The most seriously malnourished children need to be treated in a hospital, in part because they have no appetite and their bodies are trying to conserve energy. These children are fed specially formulated milk, often through a nasal-gastric tube.

Sharif Matar, a pediatrician at al-Rantisi Children’s Hospital in northern Gaza, said doctors were struggling to cope with a shortage of that enriched milk. While more is available now than even a month ago, health workers still find themselves rationing it to make sure the most severe cases have enough, he said in an interview in late August.

“We are trying to do our best with what we can,” Dr. Matar said. “But in terms of the quality or quantity of what’s available, it’s not enough.”

Throughout the war, Israeli officials have consistently played down the severity of hunger in Gaza. Prime Minister Benjamin Netanyahu’s office called the recent Gaza City famine declaration “an outright lie,” and said the experts behind the famine report had overlooked Israeli efforts since late July to bring more food into the territory.

Aid officials, however, say those measures fall short of what is needed. During the first two weeks of August, the U.N. said nearly 6,000 children out of more than 58,000 screened were found to be acutely malnourished.

Gaza’s doctors are not used to handling such acute malnutrition, said Dr. Matar, as the enclave has never faced a crisis this severe. Some clinicians at his hospital have been taking emergency classes organized by the W.H.O., while others were trying to read whatever they could on how to treat it, he said.

Health officials in Gaza say dozens of children have died of malnutrition since June, but it is not clear how many of them were suffering from both malnutrition and other illnesses or preexisting conditions. Children suffering from malnutrition can be more susceptible to contracting other illnesses, and children with preexisting conditions can be more vulnerable to becoming malnourished, experts say.

Some of the children who get treatment have recovered, including one critically ill 5-year-old girl who was saved with therapeutic milk, Dr. Matar said.

For a child, food is not just energy for the day at hand. It’s the essential building block for a life ahead, needed for the development of muscle, bone and brain.

Even if children experiencing severe malnutrition receive effective treatment and survive, they may suffer from stunted growth, soft bones, liver and kidney problems and cognitive issues. Over the longer term, there may be increased risk of stroke, diabetes and heart disease.

Given the widespread lack of food in Gaza, treating even a single child can at times feel Sisyphean, said Jamil Suleiman, the director of al-Rantisi Children’s Hospital. Some have been released from care to tent encampments where their parents are still struggling to find enough food, Dr. Suleiman said.

“Some of the children we release come back with the same problems a week later,” he said.

Marquez’s latest victory means he can clinch a seventh MotoGP world title at the next race in Japan in a fortnight.

Ducati’s Marc Marquez resisted a spirited challenge from Aprilia’s Marco Bezzecchi to win the San Marino Grand Prix on Sunday, taking his revenge after crashing out of the lead in Saturday’s sprint, and inching closer to the MotoGP title.

Bezzecchi had inherited victory in the sprint when Marquez crashed out. This time, however, the determined Spaniard overtook the Aprilia rider on lap 12, having started on the second row of the grid, and never looked back.

Marquez’s 11th race victory of the season takes him to 512 points – a record tally for a MotoGP rider in a single season – and he celebrated his victory by unzipping his leathers and holding his red suit up on the podium like a matador.

Gresini Racing’s Alex Marquez finished a distant third, and brother Marc, with a 182-point lead, can clinch his seventh title at the Japanese Grand Prix this month.

“Today I gave everything I had. It’s true that the mistake from yesterday gave me extra concentration, extra power, extra energy,” an exhausted Marc Marquez said.

“I was just there following him [Bezzecchi], trying to push him always super close, because it’s impossible to do 27 laps without any mistake. And in the end, he did a small mistake on turn eight, and then I led the race.

“Super important for Ducati; I felt the pressure this weekend.”

Six more rounds remain, but Marc Marquez can now win his first title since 2019 if he outscores brother Alex by just three points in Japan.

Superb launch

At the start, Marc had a superb launch off the line and he veered to the outside to quickly move up to second behind polesitter Bezzecchi while Alex was pushed down to third.

As the top three streaked away, Yamaha’s Fabio Quartararo found it difficult to maintain that pace, and he was soon battling with KTM’s Pedro Acosta, who eventually found his way past the former champion to chase the leading pack.

But Acosta’s hopes of fighting for the podium went up in smoke when he retired with a broken chain, with the young Spaniard furiously wagging his finger at the bike after he stopped on the side of the track.

Ducati’s Francesco Bagnaia had another race to forget in a nightmare season for the twice champion, who crashed out of seventh place, his third place in the championship now seriously under threat from Bezzecchi.

Up front, Marc continued piling the pressure on Bezzecchi, and the Aprilia rider finally buckled on lap 12 when he was a breath late on the brakes and went wide, opening the door for the red Ducati to ease past him and into the lead.

Unrelenting Bezzecchi

Bezzecchi gave chase, unrelenting and eager to reclaim the lead. But Marc remained calm and the Spaniard was in no mood to crash out of the lead twice in one weekend.

Bezzecchi shook his head in frustration with six laps left as Marc set the fastest lap of the race.

Marc tried his best to shake off the younger Italian, who found an extraordinary late race pace to challenge for the lead. But the Ducati rider responded once again as they traded fastest laps and left third-placed Alex more than six seconds behind.

“Besides [missing out on] the victory, this is maybe the best race of my life, because I was super competitive all weekend – pole position, sprint win, second place,” Bezzecchi said.

“I was close to Marc, who is at the moment the strongest on the grid. I’m very happy, I gave my all, I’m destroyed!”

VR46 Racing riders Franco Morbidelli and Fabio Di Giannantonio finished fourth and fifth, respectively, while Gresini’s Fermin Aldeguer was sixth.

Romania says a Russian drone has breached its airspace – the second Nato country to report such an incursion.

Romanian fighter jets were in the air monitoring a Russian attack in Ukraine on Saturday and were able to track the drone near Ukraine’s southern border, the defence ministry said in a statement.

Ukrainian President Volodymyr Zelensky said the incursion could not be a mistake – it was “an obvious expansion of the war by Russia”. Moscow has not commented on the Romanian claims.

On Wednesday, Poland said it had shot down at least three Russian drones which had entered its airspace.

In its statement, Romania’s defence ministry said it detected the Russian drone when two F-16 jets were monitoring they country’s border with Ukraine, after “Russian air attacks on Ukrainian infrastructure on the Danube”.

The drone was detected 20km (12.4 miles) south-west of the village of Chilia Veche, before disappearing from the radar.

But it did not fly over populated areas or pose imminent danger, the ministry said.

Poland also responded to concerns over Russian drones on Saturday.

“Preventative operations of aviation – Polish and allied – have begun in our airspace,” Prime Minister Donald Tusk said in a post on X.

“Ground-based air defence systems have reached the highest state of readiness.”

Earlier this week Russia’s defence ministry said there had been “no plans” to target facilities on Polish soil.

Belarus, a close Russian ally, said the drones which entered Polish airspace on Wednesday were an accident, after their navigation systems were jammed.

On Sunday, the Czech Republic announced it had sent a special operations helicopter unit to Poland.

The unit consists of three Mi-171S helicopters, each one capable of transporting up to 24 personnel and featuring full combat equipment.

The move is in response to Russian’s incursion into Nato’s eastern flank, the Czech Defence Minister Jana Cernochova said.

In response to the latest drone incursion, President Zelensky said the Russian military “knows exactly where their drones are headed and how long they can operate in the air”.

He has consistently asked Western countries to tighten sanctions on Moscow.

US President Donald Trump also weighed in on airspace breach earlier this week, saying he was “ready” to impose tougher sanctions on Russia, but only if Nato countries met certain conditions, such as stopping buying Russian oil.

Russia launched a full-scale invasion of Ukraine in February 2022 and has been making slow progress in the battlefield.

Trump has been leading efforts to end the war, but Russia has intensified attacks on Ukraine since President Vladimir Putin returned from a summit with Trump in Alaska last month.