To document food acquisition experiences during Iraqi military occupation in Kuwait. Retrospective cross-sectional study. Urban areas in Kuwait during occupation. Those living in Kuwait during the period of occupation, and aged between 15 to 50 years at the time of occupation, recruited by snowball sampling. A total of 390 completed questionnaires (response rate 78%, 202 female and 188 male) were returned. During the occupation, food became increasingly difficult to acquire. Two food systems emerged: (i) an underground Kuwaiti network linked to foods recovered from local food cooperatives and (ii) a black market supplied by food imported through Iraq or stolen locally. Food shortages led to reductions in meal size and frequency. Some respondents (47·7%) reported not having sufficient income to purchase food and 22·1% had to sell capital items to purchase food. There was a significant increase (P<0·01) in home production, with 23·1% of people growing vegetables and 39·0% raising animals to supplement food needs. Reduction in food wastage also emerged as a significant self-reported behaviour change. Respondents reported deterioration in the quality and availability of fish, milk, and fruit in particular. Despite a decrease in opportunities for physical activity, most respondents reported that they lost weight during the occupation. Although the Kuwaiti population fell by about 90 % and domestic food production increased during the 7-month occupation, the local population continued to rely heavily on imported food to meet population needs. The high prevalence of self-reported weight loss indicates the inadequacies of this food supply. High apparent food security in systems which significantly exceed the ecological carrying capacity of the local environment and rely on mass food importation remains vulnerable.

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