SHAMM QUDEIH ARRIVED EMACIATED IN ITALY FROM GAZA LAST MONTH. SHE'S SINCE CELEBRATED HER SECOND BIRTHDAY AND GAINED A LITTLE MORE THAN A KILOGRAM.

HER PROGRESS IS WELCOMED BY DOCTORS TREATING HER FOR SEVERE MALNUTRITION WORSENED BY A GENETIC METABOLIC DISEASE.

JUST WEEKS AGO, SHAMM WAS ALL SKIN AND BONES AS SHE CLUNG TO HER MOTHER IN A HOSPITAL IN SOUTHERN GAZA. SHE WAS EVACUATED TO ITALY FOR MEDICAL TREATMENT, ALONG WITH SIX OTHER PALESTINIAN CHILDREN.

SHAMM’S MOTHER STRUGGLED TO GET HER PROPER MEDICAL CARE IN GAZA, VISITING MULTIPLE HOSPITALS AND CLINICS. DOCTORS SUSPECTED THE RARE CONDITION, BUT COULD NOT TEST FOR IT, MUCH LESS TREAT IT PROPERLY.

SOUNDBITE (Arabic) Islam Qudeih, mother of Shamm Qudeih:

“We went to more than one hospital and they told me that she has malnutrition, since the beginning, they told me malnutrition. Then it became worse as a result of the lack of food, treatment and possibilities. And the environment where Shamm had to live affected her so much."

FOR A WHILE, DOCTORS ADMINISTERED A SPECIAL FORMULA, BUT SHAMM WOULDN'T TAKE IT, HAVING LOST THE HABIT OF DRINKING MILK AFTER THE SUPPLY IN GAZA RAN OUT.

SOUNDBITE (Italian) Doctor Daniele De Brasi, Head of Departmental Simple Operational Unit (UOSD) of Medical Genetics, Santobono Pausilipon Children’s Hospital:

“Slowly slowly, without pushing too much for a gain (of weight), since in such conditions the rapid increase (of weight) could not play in our favor, we managed to make her gain weight steadily, in the right timeframe, and she has gained about a kilogram since she was admitted (to the hospital)."

SHAMM IS AMONG 181 PALESTINIAN CHILDREN BEING TREATED IN ITALY, ACCORDING TO THE ITALIAN FOREIGN MINISTRY.

ABOUT ONE-THIRD OF THOSE HAVE ARRIVED SINCE MARCH, WHEN ISRAEL ENDED A CEASEFIRE WITH HAMAS AND IMPOSED A TOTAL BLOCKADE FOR 2 1/2 MONTHS WHEN NO FOOD OR MEDICINES ENTERED THE STRIP.

ISRAEL DENIES THERE IS STARVATION IN GAZA, DESPITE ACCOUNTS TO THE CONTRARY FROM WITNESSES, U.N. AGENCIES AND EXPERTS. IT SAYS IT ALLOWED ENOUGH AID TO ENTER BEFORE AND AFTER THE TIGHTENED BLOCKADE, WHICH IT SAYS WAS AIMED AT PRESSURING HAMAS.

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Since arriving emaciated in Italy from Gaza, little Shamm Qudeih has celebrated her second birthday and gained weight on a new diet that includes a special porridge.

Her remarkable progress has been welcomed by the doctors treating her for severe malnutrition, worsened by a genetic metabolic disease.

Just weeks ago, the toddler was all skin and bones as she clung to her mother in a hospital in southern Gaza, after months of being unable to get the food and treatment she needed because of an Israeli blockade aimed at pressuring the Hamas militant group to release hostages.

Video showing her wincing in her mother’s arms, with her hair matted and ribs protruding from her chest, was taken by Associated Press freelance journalist Mariam Dagga on 9 August, just days before the child was evacuated to Italy for medical treatment, along with six other Palestinian children.

It was one of Dagga’s last images - she was among 22 people killed in the 25 August Israeli strike on the same hospital in southern Gaza.

Almost a month later after Dagga filmed her, and Shamm is sitting up, alert in a hospital bed in Naples, her fine blonde hair pulled into a ponytail and wearing a t-shirt emblazoned with the word “cute.”

Her wide eyes gleam and she breaks into a smile as her older sister and mother call her name from across the room.

Dr. Daniele de Brasi is the pediatric genetics disease specialist who is treating the little girl at Santobono Pausilipon Children’s Hospital in Naples.

He says Shamm was “in a serious and challenging clinical state" when she arrived, weighing around four kilograms (9 pounds).

She now weighs 5.5 kilograms (just over 12 pounds), which is still no more than half of the median weight for a child of her age, according to de Brasi.

The doctor says “a big part” of her undernourishment was due to a genetic metabolic disease called glycogen storage disease, which preliminary tests have confirmed.

Lab tests are still out to determine the specific variant, which will help decide future treatment and her prognosis.

But so far, the medical team was "very satisfied" with Shamm's progress.

Shamm suffered from malnutrition from her birth, just weeks before the October 7, 2023, attack by Hamas-led militants.

Her mother, Islam, struggled to get her proper medical care, visiting many hospitals and clinics.

Doctors suspected the rare condition but could not test for it, much less treat it properly.

They sometimes offered antibiotics.

“It became worse as a result of the lack of food, treatment and possibilities," Islam says while her daughter rests on her shoulder.

The mother wished for her face not to be shown on camera for religious reasons.

She explained the family were displaced "maybe about 15 times, from tent to tent".

For a while, doctors administered a special formula, but Shamm would not take it, having lost the habit of drinking milk after the supply in Gaza ran out.

Last month, the United Nations warned that starvation and malnutrition in Gaza were at the highest levels since the war began.

Nearly 12,000 children under age five were found to have acute malnutrition in July - including more than 2,500 with severe malnutrition, the most dangerous level.

The World Health Organization says the numbers are likely an undercount.

Shamm is among 181 Palestinian children being treated in Italy, according to the the country's Foreign Ministry.

About one-third of those have arrived since March, when Israel ended a ceasefire with Hamas and imposed a two and a half month blockade on all imports, including food and medicine.

Israel denies there is starvation in Gaza, despite accounts to the contrary from witnesses, U.N. agencies and experts.

It says it allowed enough aid to enter before and after the tightened blockade, which it says was aimed at pressuring Hamas.

In Naples, Shamm now has a feeding tube in her nose to ensure she gets the right mix of nutrients overnight.

During the day, she is free to eat solid food, which the doctor said also includes meat and fish.

A cornerstone of her diet is the carbohydrate-rich porridge.

Her current intake is around 500 calories a day, which doctors are gradually increasing.

Shamm's 10-year-old sister, Judi, traveled with her to Italy as an accompanying family member.

Doctors also began treating her after noting that she was at least three or four kilograms underweight, de Brasi said.

She has gained two kilograms (nearly 5 pounds) and is in good condition.

With both daughters improving, the girls' mother is allowing herself to experience relief.

But it is too soon to think about going back to Gaza.

AP video shot by Andrea Rosa & Mariam Dagga