Five times in the course of the past year, the world’s leading hunger monitor warned that Gaza could be teetering on the precipice of famine. Each time, the watchdog stopped short of concluding one was under way, Reuters reports.

Gregory Shay, a retired pediatric pulmonologist from California, spent October treating children in Gaza, and to him, it looked like famine was gripping the territory.

Shay worked at Nasser Hospital in the southern Gaza city of Khan Younis. Most of the children he treated subsisted on bread and rice, recalled Shay, a volunteer with the US-based non-profit organization MedGlobal. Without vegetables, fruit or meat, he said, the children lacked the vitamins or minerals needed to stave off disease.

Most days, Shay said he treated on average 40 new patients who were admitted to the hospital. Many had severe cases of pneumonia, and several others suffered from meningitis, an illness that can kill in hours. Newborns were often small for their age, he said. Some had birth defects or suffered from neonatal sepsis, a blood infection that’s a leading cause of infant mortality.

“I’ve never seen the kind and number of infections that I saw in Gaza,” said Shay, who has made 35 medical aid trips during the past decade, “You just look at these kids and you know that it’s a famine.”

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