RAMALLAH, West Bank - A typical breakfast in Fatima Khodour's three-room apartment consists of tea and boiled tomatoes seasoned with thyme and olive oil. For the late afternoon lunch, the main and final meal of the day, the menu is the same, plus fried potatoes.
It feeds 11 people from three generations.
"I know this isn't enough," said Khodour, 39, whose family has been without a source of income for nearly two years, ever since clashes between Palestinians and Israelis cost many Palestinians their jobs. "But what can I do?"
Khodour's sisters, nieces, nephews and mother crowd in their living room, the smallest ones forced to sit on laps for lack of couches or chairs. "Kids need all different kinds of food," she said. "But everything that they want or need doesn't exist in their lives, or ours. We simply cannot provide it because of the harsh situation. We have no money."
Her family is not starving. But it is trapped by Israeli curfews and roadblocks that have brought poverty and now the threat of malnutrition, a problem affecting a growing number of Palestinians in the West Bank and Gaza Strip, according to a study conducted by the Johns Hopkins Medical Institutions for the United States Agency for International Development.
The study's findings, researchers from Hopkins and Al-Quds University said last week in interviews, show that restrictions imposed on Palestinians by Israel are affecting individuals' health.
For the past seven weeks, Israeli soldiers have occupied the major Palestinian cities and restricted their 700,000 residents to their homes. In Ramallah, the army curfew has been lifted for about eight hours every few days; residents of Nablus have been allowed outside for only five days since the end of June.
USAID officials are scheduled to release the formal findings of the nutritional study tomorrow, a report prepared as part of a larger two-year study of ways to improve Palestinian health care and emergency services.
Researchers have found troubling ironies. Though many households are suffering from malnutrition, fruit and vegetable markets overflow with food whenever Israeli soldiers lift their curfews. And food prices have plummeted.
Two pounds of tomatoes cost about 20 cents, compared with a dollar in Jerusalem. But many Palestinians cannot afford to buy more than the barest necessities, even at those lower prices.
As a result, produce piles up at markets in city centers, unsold or unable to reach rural areas because of curfews and army checkpoints. Farmers see their fruit and vegetables going to waste; for lack of buyers, farmers are also slaughtering their flocks of chickens, the most readily available protein source. Even vendors who find customers aren't able to break even.
"Food is available," said Dr. P. Gregg Greenough, a field researcher at Hopkins' Center for International Emergency, Disaster and Relief Studies, who oversaw the study from Jerusalem. "It's just that people can't afford it."
Established in 2000, the center has also worked with the new government of Afghanistan to create an ambulance service.
Though the formal findings have not been released, the study has already prompted officials from the United States, the European Union, Russia and the United Nations to urge Israel to ease its restrictions on Palestinians.
U.S. Ambassador Daniel C. Kurtzer told a meeting of officials promoting reform of the Palestinian Authority that immediate steps were needed to "avert a humanitarian disaster."
Greenough hired students from Al-Quds University, who interviewed people in 1,000 households in East Jerusalem, the West Bank and Gaza.
Researchers with medical backgrounds recorded families' eating habits, documented the contents of their refrigerators, tested their water and drew blood. Greenough said field workers were sometimes delayed at checkpoints or turned away. He often had to drive to checkpoints to retrieve data from workers who were not allowed to return to Jerusalem or pass from one Palestinian village to another.
The doctors were alarmed by what they discovered.
Preliminary findings, based on one-third of the total sample, show that 30 percent of the children surveyed suffer from chronic malnutrition, a condition that did not pose an immediate health threat. About 20 percent suffered from acute malnutrition, justifying prompt medical attention. Two years ago, a similar study found a chronic malnutrition rate of 7 percent, and an acute malnutrition rate of 2.5 percent.
"An alarming number of people are borrowing money to buy food," Greenough said. "And they tell us they are buying less food than they used to."
USAID declined to release complete findings before a news conference scheduled for tomorrow, but a Palestinian group posted preliminary numbers on its Web site:
Half of the people living in 320 households surveyed reported borrowing money to buy food, and 16 percent said they had to sell furniture, jewelry and other assets.
More than 30 percent of the Palestinians living in the West Bank and Gaza Strip are now dependent on food handouts from groups such as the Red Cross and the World Food Program.
Nearly 30 percent reported buying smaller amounts of grain and flour, considered staples, which researchers said could indicate that the food problem is growing more severe.
In the West Bank city of Nablus, researchers found that, because of fecal contamination, none of 300 households surveyed had drinking water meeting international health standards.
Greenough said that one-third of the people surveyed attributed their problems to the curfews and closures, and the rest to lack of jobs. Before the violence erupted, 125,000 Palestinians crossed into Israel to work; now only a few thousand are allowed in.
The problems are greater in the impoverished Gaza Strip, where 1.2 million Palestinians are packed into 230 square miles.
The findings that many Palestinians can no longer afford to buy food appear to be supported by a recent survey by the World Bank. It reported that 70 percent of Palestinians now live below the poverty line, earning less than $2 a day.
A study by Bir Zeit University reported that before the start of the uprising in September 2000, 22 percent of families in the West Bank and Gaza Strip lived in poverty, which the study defined as less than $11 a day for a family of four.
This year, that number had risen to 50 percent.
In recent weeks, Israel has announced that it plans to ease restrictions on the West Bank and Gaza Strip by scaling back curfews, allowing up to 12,000 Palestinians into Israel to work and making it easier to pass through checkpoints that isolate villages and cities.
"We know that the Palestinian population is suffering," said Daniel Beaudoin, an Israeli Defense Ministry liaison to the Palestinian Authority. "There is no doubt about that. We want to help them, but we can't compromise our own security."
At the request of the American Embassy, Hopkins researchers briefed Israeli officials on their study's conclusions. Those officials responded by acknowledging that the military occupation is causing hardships, but officials also blame the Palestinian Authority.
"They cynically use the Palestinian population to promote the fighting and launch terror attacks," Beaudoin said. If suicide bombings and other attacks against Israel stop, he said, then the army will pull out and life in the West Bank will improve.
"There is a conflict between what the Palestinians need and what Arafat is delivering," Beaudoin said. "Every time we ease curfew or open up checkpoints, we run the risk of our citizens getting killed. The suffering of the Palestinian people is not good, but we think the Palestinian Authority could do much more."
The Khodour family's problems are typical. Fatima is single but takes care of her ill sister and her four children. Another sister, with her two children, 2 years and 9 months, moved in last month after their house was destroyed by the Israeli army and her husband arrested. Also living in the small apartment are Fatima's 70-year-old mother and an out-of-work brother.
The brother used to work for a Jerusalem construction company, earning about $25 a day in wages. That job ended when the uprising began in 2000. Since then, Khodour and her family have been living off donations from aid agencies and neighbors.
The family's rent is $34 a month, and the family is now more than a year behind. Fatima said the building's owner, a Palestinian who lives in the United States, recently warned, "If I don't pay, I'll have to leave the house."
For now, the Khodour family plans on staying put, because the family has nowhere else to go. Most days are spent inside, taking shelter from the heat and the Israeli army. When the curfew is lifted, Fatima ventures out to a produce market.
"I buy just what I need," she said. "I can't really shop."
She uses powdered milk, never fresh milk. She serves chicken once a week or every 10 days. She often runs out of flour to make bread. And the eggs in her refrigerator are in danger of spoiling. Before the violence, the family ate lamb or chicken almost every night.
Razan Hamed, 2, is fed three bottles of warmed powdered milk a day; the rest of the time he drinks water from a bottle. The family cannot afford formula, so Fatima crumbles bread in the milk to give him sustenance.