And those who are in the mountains and highlands shall perish of hunger: Those who are in the mountains may refer to people who will flee the cities and towns to escape the danger of war (compare Isa 2.10, 19, 21; Rev 6.15-16). There is no need to add the phrase and highlands (see the Revised Standard Version footnote); it contributes nothing to the meaning here.

And they shall eat their own flesh in hunger for bread and drink their own blood in thirst for water: This clause surely refers to cannibalism, not to people literally eating themselves, but the bodies of their relatives (their own flesh and their own blood). Compare Jer 19.9.

An alternative model for this verse is:

• Anyone who flees to the mountains will starve to death; they will get so hungry and thirsty that they will eat their own relatives.

Quoted with permission from Bullard, Roger A. and Hatton, Howard A. A Handbook on 1-2 Esdras. (UBS Helps for Translators). Miami: UBS, 2019. For this and other handbooks for translators see here.