The Unofficial Hunger Games Companion (7 page)

But “hunger” actually doesn’t come close to defining what happens to Katniss Everdeen and everyone she knows and loves in District 12. It doesn’t describe what happens to emaciated little Rue, who comes from the agricultural district.

The word “starvation” or possibly the phrase “starved to death” is a lot closer to the truth. We know this is true from the beginning of
The Hunger Games
when Gale holds up a loaf of bread, Katniss says she has a goat cheese from Prim, and Gale comments that now, they have “a real feast” (
The Hunger Games
, 7). If a feast consists of bread and cheese, you’re not getting all that much food.

Up front, Katniss tells us that her mother “sat by, blank and unreachable, while her children turned to skin and bones” (
The Hunger Games
, 8). This reference also implies strongly that starvation is a central component of life in The Hunger Games books. In fact, hunger and other horrors are so acute for people in District 12 that Katniss vows never to have any children.

In this fictional world, food is rationed, food is a weapon. Food is withheld from everyone, then granted to the so-called lucky few who are able to kill all the other tributes in the Games. And for those holding the strings, the power, those in the Capitol who create and promote the Games for their own amusement and to dominate and control the masses, well, for them, hunger doesn’t exist. The people in power have more than enough to eat. Their feasts are extravagant orgies of food, reminiscent of the overindulgence in Marie Antoinette’s time. These people eat so much that they purge after meals, only because they want to eat yet more.

Is this fictional world of starvation versus overfeeding all that different from reality? Sure, we don’t have a modern Hunger Games, where children kill each other on television, but we do have a dichotomy of starvation and overfeeding. Within a single country, say the United States, we have rich people attending banquets, eating in fancy restaurants, eating as much as they want of all sorts of foods; we have an obesity epidemic; we have an anorexia and corollary bulimia epidemic; and yet we also have a vast population of starving, homeless, suffering people, including many children.

HUNGER IN THE REAL WORLD

The World Hunger Education Service quotes the United Nations Food and Agriculture Organization that, as of October 2010, 925 million people worldwide are “hungry.” Asia and the Pacific have 578 million malnourished and hungry people, the sub-Sahara portion of Africa has 239 million, Latin America and the Caribbean 53 million, the Near East and North Africa 37 million, and the “developed countries” have 19 million.
¹
These numbers do not pinpoint starvation, but rather, malnourishment and extreme hunger. The same source states that, using stunted growth as a measure, 70 percent of “hungry” children are in Asia and 26 percent are in Africa. When mothers don’t get sufficient nourishment, their babies suffer terribly, not only as infants and toddlers, but if they live to older ages, they are susceptible to mental illness and retardation, blindness, and many other problems.

These numbers are substantiated by the World Food Programme (and UNICEF), which adds that 146 million children are underweight and hungry in the world and that 10.9 million under the age of five die from hunger-related diseases.
²

Children with
kwashiorkor
(see “The Disease of the Displaced Child” in this chapter) suffer from liver malfunctions, decreased immunity, anemia, and if not treated, eventually from shock, comas, and death. One would think that kwashiorkor would be common in young children in The Hunger Games books—that is, if they live that long.

While kwashiorkor primarily afflicts children under the age of five, a similar hunger disease called
marasmus
(see “The Disease of the Baby” in this chapter) primarily afflicts children
under the age of two
. Typically a result of insufficient breast milk or diluted/ unsanitary bottle milk, marasmus causes stunted growth, emaciated bodies, loss of hair, and the type of malnutrition that can lead to mental illness, and other serious problems. Remember, during early childhood, the brain grows a lot, and if stunted by malnutrition, the results typically are disastrous. So in The Hunger Games books, a lot of children could have the bloated stomachs and emaciated bodies of the starving, could be retarded, and could die from malnutrition.

The Disease of the Displaced Child

First defined in the 1930s in Ghana—in the language of Ga—the term
kwashiorkor
means “the disease of the displaced child,” whereby a child is displaced from his mother’s breast, and after early weaning, grows seriously ill. It affects primarily children less than five years old. It is a severe form of protein malnutrition in children and is caused by starvation and diets deplete in meat and animal products.

One would think that a huge percentage of children in the districts would contract kwashiorkor due to their insufficient and inadequate diets, including a lack of meat. By the time most children in The Hunger Games trilogy become tributes, they would be weak, dizzy, and extremely sick. Most of them get grain as food, and few have access to meat.

The symptoms have been displayed countless times in advertisements to help the starving children of the world. The bloated stomachs, the peeling skin with white spots (called,
vitiligo
), the thinning old-man-white hair, the stunted growth, the skeletal body. Other symptoms that we don’t see in photographs include diarrhea, fatigue, an enlarged and fatty liver, decreased immunity, anemia, and renal failure. If not treated, kwashiorkor leads to shock, comas, and death.

The Medical Information Service of the organization, Medicine for Africa, suggests that “close to 50% of an estimated 10 million deaths each year in developing countries, are the result of malnutrition in infants and children under the age of five.”
³

The actual numbers are hard to determine because the causes of death on official certificates may point to poisoning, infection, and other problems rather than the underlying factor of kwashiorkor. For example, children with kwashiorkor may contract and die from malaria, pneumonia, herpes infections, and gastrointestinal diseases caused by parasites, bacteria, and viruses.
⁴
They may die from lethal amounts of mycotoxins called aflatoxins that are in their food. And it doesn’t take much for
aflatoxins
to be lethal: even tiny amounts can cause disease throughout the body and can lead to hepatitis, cirrhosis of the liver, and liver cancer. Even when treated for a year, mortality rates remain high for children diagnosed with kwashiorkor.

The Disease of the Baby

Marasmus
is another manifestation of starvation and inadequate nourishment. As with kwashiorkor, a child with marasmus is incredibly emaciated and stunted, has sparse hair, and a face resembling that of an old man. Marasmus may be caused by a lack of breast milk. It may also be caused by a weak and/or unsanitary formulation of bottled infant milk. In short, it is generally attributed to a lack of overall nutrition, whereas kwashiorkor specifically refers to a lack of protein in the diet.

Generally seen in children less than two years old, marasmus causes dry, loose skin; irritability; extreme appetite; and loss of hair pigment. Kwashiorkor is more severe in that the body is no longer able to absorb nutrients, causing the child to vomit, have diarrhea, and contract infections easily.

Marasmus is the disease of the baby, while kwashiorkor is the disease of the slightly older child.

The prognosis for a child with marasmus may be better than for one with kwashiorkor, but the suffering is no less.

SADLY, HUNGRY CHILDREN
have been among us forever. It’s horrifying when teens and adults starve. When babies and young children starve to death, it’s almost unbearable to think about.

In 1940, the Germans conquered a densely populated area of the Netherlands that imported its food. Under Nazi control, people went hungry, each consuming approximately 1,300 calories per day. In 1944, the allied forces entered the Netherlands, and to help them, the exiled Dutch government in London ordered a railroad strike in the Netherlands. In retaliation, the Nazis blocked the import of any food into the area. Going down in history as the Dutch Hunger Winter, the food embargo from October 1944 through May 1945 killed a lot of people. People were literally dying in the streets.

Because the Dutch kept such good records, baby-starvation researchers in the 1960s were able to examine hundreds of thousands of documented cases of male births during the Dutch Hunger Winter. The researchers also had access to Dutch military records for the men surviving Hunger Winter births.

The Dutch researchers concluded that infertility and newborn deaths soared due to the starvation of the mothers. For example, the period of the Dutch Hunger Winter produced only one-third of normal birth rates expected under more normal circumstances. Also, of the babies who did reach birth, a pronounced number died.

In the first trimester, malnourished mothers carry fetuses who are at great risk of having abnormal central nervous systems, and miscarriages are common. By the third trimester, any surviving fetuses are extremely low in weight, and should the babies be born, they tend to die within the first few months.

These findings are of interest when considering the people in the districts of The Hunger Games books. The same problems could be common throughout the districts, with the death of children in The Hunger Games related to far more than the reapings and the arenas. Even the mothers are at risk in The Hunger Games world because women historically have died from miscarriages, premature births, and complications due to unusual pregnancies, particularly in harsh environments without modern medical help.

Of the male babies who were born during the Dutch Hunger Winter, making it into the military in their late teens, the researchers found higher than normal occurrences of spina bifida, cerebral palsy, and hydrocephalus. However, the surviving babies were mentally competent and had normal intelligence, leading to the conclusion by the 1960s researchers that those born with brain damage had died.
⁵

Later studies of the Dutch Hunger Winter in the 1970s suggested a direct correlation between prenatal/infant starvation and schizophrenia, paranoia, and psychoses. And in 1995, University Hospital Utrecht in the Netherlands and Columbia University joined forces to study why prenatal famine results in an increased risk of schizophrenia. This research found a “spike in schizophrenia” among first trimester babies conceived during the Dutch Hunger Winter.
⁶

More recent conclusions in 2010 from Leiden University working with Columbia University note that “people in their sixties who were
conceived
during the Hunger Winter of 1944–45 in the Netherlands have been found to have a different molecular setting for a gene which influences growth.”
⁷
Hence, prenatal starvation in the first trimester can also
change the genetic material of the fetus
. This particular study points out that the genetic code doesn’t change, but rather, the setting that indicates whether a gene is on or off is what changes. Specifically, the Dutch Hunger Winter survivors have fewer than normal methyl groups on their IGF2 genes. It’s possible that the mutation enables the survivor to adapt rapidly to malnutrition while still in the womb.

But starvation among children hasn’t been confined—not by a long shot—to the Dutch Hunger Winter. Sadly, it’s been all too common throughout time.

In the past two centuries, starvation diseases such as marasmus have been at the root of many childhood deaths. According to Dr. Jacqueline Hansen, who specializes in Early Childhood and Elementary Education at Murray State University, “The rate of infant mortality, or marasmus, among orphans often has reached incredible heights. In 1915, Dr. J. H. M. Knox stated that 90 percent of American orphans died.”
⁸
The extensive destruction of crops during the Vietnam War led to countless childhood deaths.

BBC News wrote in June 2008 that in Ethiopia, “As many as 4.5 million people are judged to need critical, emergency assistance . . . there is not enough food in the country.”
⁹

In Haiti today, starvation is common among infants and children; they were starving before the earthquake. As in The Hunger Games trilogy, there are hunger etiquette rules in Haiti such as: if you steal food, you might be killed, and food stolen or foraged by starving children must be shared with the community.
The New York Times
estimated in January 2010 that “two million Haitians need immediate food assistance.”
¹⁰

And we could continue with the grim statistics, the point being: In the real world, throughout history and continuing to this day, our leaders and our governments are responsible for the starvation and resulting deaths of millions of innocent children. The Hunger Games trilogy brings this problem into full focus, amplifying the real problem by acutely portraying the struggles of children who are starving to death. In our real world, do we hold leaders and governments accountable—
sufficiently accountable?
—for these deaths? Or do we continue to put up with the situation, as long as we’re insulated from the horrifying realities, letting our leaders and governments continue to enact and support policies leading to starvation?