Famine - the look and feel

Famine, it has been argued, is one of the most devastating of the preventable disasters in human culture and history. Despite the tireless work of relief agencies, individuals, and governments to end world hunger, many regions continue to face famine regularly. Military instability, political unrest, climate changes, natural disaster, and other factors can lead to food shortages, failure of distribution systems, and hunger.

A question recently hit my in-box regarding the effects of famine. What does it look like? What health effects occur?

Those are very difficult questions because famine doesn't come in one shape. The faces of famine are many, as are the causes.


There are victims of famine who would not look substantially different from Nicole Richie (pictured on the left) -- a little bony, head a little too big for the body, but otherwise without outward signs of dysfunction. Now, I'm not saying how Nicole got her body to look like that, because I don't know, but during famine, this shape will often appear after months of mild calorie deficiency. The amount of food taken in is reasonably close to what is needed, but misses the mark. Energy levels tend to fall off, as the body attempts to conserve calories, which in many pre-industrial countries means less food is produced and thus less food is available, making the situation increasingly worse. That said, there are certainly people whose natural body type fits this profile, and that doesn't mean they are starving. Those people may have just as much energy as anybody else and eat diets comparable or even higher in calories than the average, but their bodies naturally do not store the same amount of fat or muscle as someone with a different build.

A familysuffering from malnutrition in India.

More prolonged or more drastic starvation results in an even bonier appearance. Health problems of extreme starvation include hair loss, loss of or decay of teeth, brittle bones, thin skin, mouth and skin sores, bleeding gums, lack of energy, weakness, lethargy (extreme drowsiness or inability to engage in normal activities due to weakness or tiredness), increased susceptibility to infections of all sorts, and death.

A Sudanese boy suffering from extreme malnutrition.

Children who experience famine are many times more likely to die before reaching adulthood, are shorter of statue, and can have learning disabilities, developmental delays, and reduced IQ because normal brain development requires a good deal of fat and nutrients. See also my post on infants during famine.

There are also photographs that show up on impassioned TV infomercials attempting to solicit aid for regions of the world under famine that depict bony children with large bellies. There are two reasons for this distinctive appearance. First, in many cases, the large bellies are a result of parasites. Worms contracted from dirty drinking water, undercooked meats, or unclean or partially spoiled food breed and multiply in the abdomen, feeding off what food the person is able to take in. The worms grow while the person starves for lack of calories. The second reason is ascites (pronounce ass-site-ees), which is caused by severe malnutrition that leads to low protein levels in the blood. Protein is what holds fluid in your bloodstream, so without it, the fluid tends to leak into the abdominal cavity (belly) and make it appear swollen.

Famine can occur in populations where average intake of calories exceeds the American Dietetic Association's recommendations of an average of 2,000 calories per day if the people must expend significantly more calories than the average American on whom those recommendations are based, such as in farming communities without modern farming equipment or technology, in areas where the environment temperature is extremely cold or hot, etc..

There could also be adequate calories in a person's diet, but insufficient vitamins and minerals to support life. Diseases associated with malnutrition (the condition of not being properly nourished) are many and are specific to the nutrients being missed. Examples of nutrients include vitamin B, iron, protein, calcium, vitamin C, etc.. Any component that humans must get via diet which is missing or deficient in the diet can cause disease associated with malnutrition. Malnutrition can be a "silent" disorder - occurring in people who "look" average weight or even extremely obese. Symptoms vary by the nutritional component(s) the body is missing.

*****This blog is written for fiction writers, for the purpose of writing fiction. Information herein is not intended for use by real people, pets, trees, or imaginary friends. Arizela is not responsible for information used for purposes other than those expressly intended*****

Cuts on the inner forearm

A question recently hit my in-box from an author who has a character being tortured for information. In the scenario, the author intended to have the protagonist "stabbed on the inside of his forearm and the knife gets dragged through the flesh towards the wrist a couple of inches." The protagonist needs to be worried, but able to walk a good distance and not pass out or die from shock.

The trouble with using a knife as a torture device is that unless the torturer is very skilled at what he does and knows anatomy very well, he's as likely to kill as extract information. In this particular case, there are two decent sized arteries running along the inside of the forearm, the radial and ulnar arteries (see photo). Stabbing down into the flesh and dragging the blade toward the wrist is almost sure to hit at least one of them.

Slashed wrists is a common method of attempted suicide which is widely known to not be terribly effective because by the time the artery gets to the wrist, it's pretty small. It can take hours to bleed to death from a slashed wrist, but cut the artery higher up the arm and you've got bigger problems. Shock can set in pretty quickly - my best guess being within ten minutes. And after that, you've got some time to stabilize the victim, but he's not going to be doing much to help you as he will likely be unconscious or too confused to function.

If your victim gets away within minutes of the cut and applies pressure directly to the wound and then gets help, chances are good with surgery and perhaps blood transfusions that the victim will live.

If you want a lot of pain, an alarming amount of blood but not truly immediately dangerous, you could go with any major muscle group that isn't near a major artery. Muscle bleeds a lot. Some locations that are pretty choice, the calf muscle, the muscles of the outer forearm, the top of the thigh or outer thigh area, the shoulder. Think meaty parts that aren't near pulse-points. The muscle will likely stop working for a while, but with some stitches will generally heal up pretty well.

Alternately, cuts that bleed an alarming amount, hurt a lot, and are generally unlikely to cause death are cuts to the ears, scalp or forehead. Try not freaking out when someone slashes you across the forehead and there's blood running into your eyes.

*****This blog is written for fiction writers, for the purpose of writing fiction. Information herein is not intended for use by real people, pets, trees, or imaginary friends. Arizela is not responsible for information used for purposes other than those expressly intended*****