It isn’t true that starvation is just like being hungry, only worse. ‘Victims of starvation die of nutritional dystrophy,’ Lizzie Collingham writes in The Taste of War,

a process whereby, once the body has used up all its fat reserves, the muscles are broken down in order to obtain energy. The small intestine atrophies and it becomes increasingly difficult for the victim to absorb nutrients from what little food he or she is able to obtain. As a defence mechanism the body reduces the activity of the vital organs such as the heart and liver and the victim suffers not only from muscular debility but from a more general and overpowering fatigue … The water content of the body reduces at a slower rate than the wasting of the muscles and tissues and the flaccidity of the body increases. Some victims of starvation develop hunger oedema and swell up with excess water … The skin becomes stretched, shiny and hypersensitive. Blood pressure drops and the victim is plagued by keratitis (redness and soreness of the cornea), sore gums, headaches, pains in the legs, neuralgic pains, tremors and ataxia (a loss of control over the limbs). Just before death the victim veers wildly from depression to irritation and then a profound torpor … Most importantly, the heart atrophies … Organ failure is the final cause of death.

This was the fate of an estimated 20 million people in the Second World War – about the same number as were killed in combat.

LRB 14 July 2011 | PDF Download