The survival of all living creatures is entirely dependent on God's constant, active care. When God withdraws His divine grace and goodness, the very foundation of reality is shaken [מצודת דוד, ביאור שטיינזלץ]. The commentators agree that this withdrawal is practically understood as the withholding of food and sustenance, creating a harsh reality where it appears as though God has forgotten His creations and no longer sees them [רד״ק, אבן עזרא, מאירי]. This severe disconnect causes overwhelming fear and panic among all living things. Lacking any alternative source of help, the creatures are faced with the stark reality that their survival relies strictly on Him [רד״ק, ביאור שטיינזלץ].
As this withdrawal continues, the primary approach among commentators is that God gathers their life force, taking their souls back to a hidden place [רד״ק, מצודת ציון, מלבי״ם, אבן עזרא, מצודת דוד, מאירי, ביאור שטיינזלץ]. The removal of the spirit causes them to die [מצודת ציון], bringing about a process of finality and complete destruction [רש״י]. Once the soul departs, the physical body returns to the earth from which it was originally formed, leaving nothing behind [רד״ק, אבן עזרא, מצודת דוד, מאירי].
In contrast to this physical interpretation of famine and natural death, an alternative perspective views these events as a profound spiritual awakening. In this light, God withdrawing His presence—such as by holding back the rain—is a deliberate action meant to push humanity to recognize their guilt and repent. Rather than taking life away, God actually grants people additional spirit and understanding so they can grasp the severity of their situation. Recognizing that they are on the edge of perishing, they return to the dust not through physical death, but by throwing themselves to the ground in deep repentance and sincere prayer [אלשיך].