It's a shocking image of despair and anguish; at the centre is toddler Muhammad Zakariya Ayyoub al-Matouq, a child in Gaza.
The frail toddler has a starkly pronounced spine and shoulder blades, wears a plastic bag nappy, and is being held by his mother.
The photograph was published widely by several media outlets, including SBS News, as a depiction of reports of spreading starvation in Gaza.
In one of his strongest statements yet on the issue, Prime Minister Anthony Albanese said scenes of starvation in Gaza "break your heart", singling out a picture of Matouq on Sunday.
He said civilian casualties and deaths in Gaza were "completely unacceptable" and "completely indefensible".
But a British journalist and antisemitism researcher has said the image is "misleading", prompting the New York Times to issue a clarification about its publication after "new information" surfaced.
Claims of 'misleading' image
Independent investigative journalist David Collier has accused the mainstream media of publishing the image of Matouq without acknowledging the 18-month-old's pre-existing medical conditions.
Getty Images, which hosts several photos of Matouq, described the child as "sick" and "also displaying signs of malnutrition" in its captions.
Collier, who is a critic of Hamas — the political and military group that rules Gaza — and describes himself as a Zionist on his website, said that's not the whole story.
He wrote on X that he has seen medical reports and spoken to Matouq's mother, Hedaya, to uncover that the child has required specialist care in the past.
"Mohammed is medically vulnerable; he needs specialised formula and medication," he wrote.
On his website, he says that in other pictures of the family, his mother and older brother "look healthy and are not suffering from any type of starvation that would be necessary to cause the thinness suffered by Mohammed".
Collier took aim at "most legacy media", which he said "need to own up to using deceitful photos".
"You exploited the image of a child with cerebral palsy to push a lie about famine," he wrote.
"You did this because you are all running campaigns to demonise Israel. You did not care anything about the truth. You saw an image you could use — or abuse — and ran with it."
Collier told The Australian it is the "basic role of a journalist to verify and check the facts" before writing a story.
"I'm not waving an Israeli flag, saying everything is perfect, that's not what I'm doing. What I'm saying is that it's vital that the media maintains its standards, because if it can't, then what is the point?" he said.
The New York Times said it learned about the "pre-existing health problems" after it had published the image.
"We have since learned new information, including from the hospital that treated him [Matouq] and his medical records, and have updated our story to add context about his pre-existing health problems," a spokesperson said on Wednesday.
Lucia Goldsmith, Oxfam Australia's head of humanitarian, told SBS News children with pre-existing conditions may already face difficulties in processing nutrients.
"Many of these children may be experiencing immune deficiencies, so they are often most affected by lack of food," Goldsmith said.
Marko Kerac, who helped draw up the World Health Organization's treatment guidelines for severe acute malnutrition, also said it was typical in the early stages of a hunger crisis that those most impacted suffered from pre-existing illnesses.
"Children with underlying conditions are more vulnerable," Kerac, clinical associate professor at the London School of Hygiene and Tropical Medicine, told the Reuters news agency.
"They get affected earlier."
Reporting from Gaza comes with challenges
The photos originally come from the Turkish news agency Anadolu, whose photographers are some of the few on the ground in Gaza. It was then circulated via Getty Images.
Gathering and verifying information and photographs from the region is complex, and Israel has prevented international media from entering Gaza to report from there, except in cases where media have been embedded with the Israel Defense Forces. CNN reporter Clarissa Ward is one of the few Western journalists who have been able to gain independent access, and only fleetingly.
Like most news organisations around the world, SBS News does not have its own reporters on the ground in Gaza, and sources information, photography and footage from various news agencies such as Reuters, Agence France-Presse and Getty as well as directly from freelance operators.
When SBS News sent an inquiry to Getty Images about the photograph, a statement from the Anadolu Agency was provided in response. It said the agency had reviewed the photograph of Matouq, which was taken by freelance journalist Ahmed Jihad Ibrahim al-Arini.
The response included a statement attributed to the child's mother to clarify the situation.
"At three months old, he suffered from muscle weakness [hypotonia]. Through physiotherapy, he fully recovered and continued normal development. Before we were displaced from Jabalia, he was healthy, smiling, and cheerful," the statement said.
"However, after displacement, due to the food and medicine crisis —particularly the lack of milk — his condition began to deteriorate."
The statement included notes from an interview with nutrition specialist Dr Suzan Mohammed Marouf, who Anadolu Agency said confirmed Matouq is suffering from severe malnutrition as well as a muscle-related illness.
The agency also provided a series of photographs of Matouq throughout his life showing him previously at a higher weight than in the series of viral photos as well as images of other children in similar conditions.
A family member holds up a phone displaying an earlier photo of Muhammad Zakariya Ayyoub al-Matouq, showing his physical health has declined rapidly. Source: Anadolu / via Getty Images
"Our photographs reflect the humanitarian crisis we witness in Gaza in its starkest form."
SBS News has not been able to independently verify the details of pre-existing health conditions supplied by Anadolu or Collier.
'Full-scale famine'
Photos of Matouq and dozens of other emaciated children have made headlines in recent weeks, with Israeli officials denying starvation in Gaza.
"We don't recognise any famine or any starvation in the Gaza Strip," Israel's deputy chief of mission in its Canberra embassy, Amir Meron, told a group of reporters, including SBS News, on Monday.
Israeli officials have instead blamed either the United Nations' inefficiency or Hamas for aid not reaching people in areas it has claimed to control for much of the war.
However, humanitarian groups like UNICEF have described the region as "on the brink of a full-scale famine".
UNICEF, citing data from the Palestinian health ministry, said last week the number of children in Gaza who have died from malnutrition jumped from 52 to 80 — a 54 per cent increase in less than three months.
In a statement made on Wednesday, they said: "Acute malnutrition and reports of starvation-related deaths — the third core famine indicator — are increasingly common but collecting robust data under current circumstances in Gaza remains very difficult as health systems, already decimated by nearly two years of conflict, are collapsing."
Other news agencies, such as Reuters, have published reports from Gaza on malnutrition cases presented at clinics and images of emaciated children.
In a separate interview published on the BBC published late last week, his mother said Matouq used to weigh 9kg but now weighs 6kg. She said: "He used to eat and drink normally but because of lack of food and the situation we're in, he became malnourished."
In the video interview, she mentions her son has hypotonia.
Associate professor Nina Sivertsen, a nursing and family health lecturer at Flinders University, told SBS News children in Gaza are at the most severe risk of the effects of starvation.
"They're more likely to die, especially from common infections like diarrhoea and pneumonia, because starvation already weakens their really fragile immune system," Sivertsen said.
