As crops fail and famine wracks the land, those who turn to the last resort of cannibalism contract kuru, a transmissible spongiform encephalopathy, and their brains become pitted like sponge. As they degenerate the ghouls form into familial packs which whoop and laugh uncontrollably as they pull down the healthy in mob attacks. However they only feast on the bodies after weeks of decomposition, as the notion of consuming fresh meat disgusts them. The ghouls numbers are disproportionately comprised of pregnant or child rearing mothers. They are particularly resistant to the pull of despair and suicide, if only to care for their single child; the greatest number a desperate mother can afford to care for in such conditions.