Gaza Humanitarian Response Update | 22–28 April 2024

Response

• Medical Aid for Palestinians-UK (MAP UK) has commenced Rapid Response Team (RRT) implementation at 15 medical points and is reporting to WHO’s Early Warning, Alert and Response System [EWARS].
• There are currently 19 Emergency Medical Teams (EMTs) operational at 12 hospitals across Gaza. 
• Between 13 and 28 April, WHO and CADUS conducted 425 referrals of patients from northern Gaza to healthcare facilities across the southern governorates. Moreover, with support from other health partners, 18 patients in need of advanced medical care were referred for treatment outside of Gaza. 
• Between 13 and 28 April, 16 partner surgical teams carried out a total of 1,816 emergency surgeries for trauma patients. These include 12 teams at Ministry of Health hospitals and four at field hospitals.   
• UNFPA has established two Sexual and Reproductive Health (SRH) clinics to enhance Comprehensive Emergency Obstetric and Newborn Care (CEMONC) services at the International Medical Corps (IMC) field hospital in Rafah and UK-Med field hospital in Khan Younis. A refresher CEMONC training for 16 midwives was also conducted at the UK-Med facility.  
• UNFPA distributed community midwifery kits and 1,200 postpartum kits for mothers and newborns.  
• Joint efforts are ongoing by WHO, UNICEF, UNFPA, UK-Med, MSF-France and MAP-UK to restore health services at the Nasser Medical Complex, including rehabilitation of some parts of the hospital. 
• One Cluster partner has delivered nine oxygen concentrators with a capacity of up to 10 litres per minute. This marks the first entry of such vital supplies into Gaza since October 2023.  Two other health partners have also received pre-approval for importing additional oxygen concentrators.

Challenges

• Repeated attacks on healthcare facilities have decimated the health sector, resulting in additional loss of hospital bed capacity.  
• Restrictions on the entry into Gaza of vital medical supplies, including mobile laboratories and related equipment, hemodialysis machines and infection prevention and control resources, continue to degrade the already limited health services available. 
• The lack of safe drinking water and poor sanitation conditions are fueling a rise in cases of acute jaundice syndrome and bloody watery diarrhoea. 
• Fifteen per cent of the estimated 5,500 women giving birth every month in Gaza face potentially life-threatening complications due to inadequate healthcare provision. 
• The ongoing crisis continues to expose women and girls to heightened risks of sexual and gender-based violence, infections, early marriages, early and unintended pregnancies and miscarriages. The absence of separate sanitation facilities, compounded by the lack of reliable electricity within shelters, deprives women and girls of safe spaces, rendering them more vulnerable to sexual violence. 
• Access and security concerns for newly deployed EMTs involved in trauma response efforts.

Response

• Cluster partners continue to conduct Mid-Upper Arm Circumference (MUAC) screenings. During the reporting period, UNRWA expanded its screenings to four shelters in Khan Younis and efforts are underway to further expand the screening to an additional four shelters. To date, 55,384 children aged 6-59 months have been screened, of whom 4,063 have been diagnosed with acute malnutrition, including 2,945 with Moderate Acute Malnutrition (MAM), and 1,118 with Severe Acute Malnutrition (SAM). These children are currently receiving treatment, including 47 suffering from SAM with medical complications requiring inpatient care.  
• UNICEF has expanded the outpatient treatment of acutely malnourished children to 104 Outpatient Therapeutic Programme (OTP) sites across Gaza, providing services in North Gaza (36 sites), Deir al Balah (12 sites), Khan Younis (two sites) and Rafah (53 sites) through 13 nutrition partners. Jointly with WFP and other partners, UNICEF is also exploring ways to expand MUAC screenings and OTP services to some of the 169 Blanket Supplementary Feeding Program (BSFP) sites. Moreover, services have resumed at the IMC field hospital in Rafah, which has a six-bed capacity.  
• Between 19 and 26 April, WFP and seven partner organizations distributed 15-day allocations of lipid-based nutrient supplements to 13,952 children under the age of five and 5,512 pregnant or breastfeeding women (PBW) in Deir al Balah, Khan Younis, and Rafah.  
• Since 1 April, 11,286 caregivers of children under the age of two, including pregnant and breastfeeding women (PBW), received sensitization sessions on Infant and Young Child Feeding Practices in Emergencies (IYCF-E).  
• To support efforts to foster IYCF-E practices, Save the Children has set up seven Mother-Baby Areas throughout Gaza, with an additional four sites expected to be operational soon. Thirty community health workers have been recruited and trained on IYCF-E practices to help new mothers in these facilities. Plans are ongoing to expand the range of nutrition services provided.  
• Nutrition interventions are being provided at 296 sites, including 21 health facilities, 238 formal and informal shelters, and 37 sites in the host communities. 

Challenges

• Cases of acute malnourishment among children continue to rise due to the unprecedented food crisis, deteriorating health, water and sanitation services, and widespread fear and stress undermining the ability of mothers to breastfeed their babies.  
• Access constraints continue to hamper the early detection of children and women in need and the provision of adequate nutrition support to targeted beneficiaries despite sustained efforts by the Nutrition Cluster to strengthen partners’ capacities.  
• Unreliable communications and internet connectivity are hindering the scaling up of services and the reporting and tracking of conducted activities.

Response

• Efforts continue to enhance protection monitoring, assessments, coordination, and mainstreaming, including the integration of GBV prevention and risk mitigation and mine action in the activities and plans of other clusters and working groups.
• Child Protection: i) Since October 2023, a range of services have been provided to more than 370,000 children and 70,000 caregivers. These include mental health and psycho-social support (MHPSS), distribution of clothes and shoes, and awareness raising on explosive ordnance risks and child rights (see here data on the response); ii) Advocacy on programmatic priorities also continues (see for instance the UASC advocacy note), including the dissemination of guidance on ethical reporting among all media actors to ensure children’s best interest and adherence to “do no harm” principles.
• Gender-Based Violence (GBV): i) Provision of dignity kits, psycho-social support (PSS), individual and group counselling, recreational activities, and Cash and Voucher Assistance (CVA); ii) Two safe spaces for GBV survivors have become operational in Al Mawasi/Rafah and Deir al Balah.
• Mine Action: i) Continued deployment of Explosive Ordnance Disposal (EOD) officers to advise humanitarian actors on safe practices around unexploded ordnance (UXOs) and, where access permits, conduct Explosive Threat Assessments (ETA) in priority sites; ii) Delivery of Explosive Ordnance Risk Education (EORE) and Conflict Preparedness and Protection (CPP) sessions in Rafah and Deir al Balah, including for humanitarian workers, local partners and children; ii) EORE campaigns via radio, social media and SMS, and ongoing design of a mapping tool to capture suspected UXO threats and high-risk areas.

Challenges

• Denial of entry of critical supplies with limited or no availability on the local market, such as mine action supplies and recreational materials for children, and soaring market prices of available items.  
• Prohibited entry of some items, such as satellite phones, VHF radios, and armored vehicles.  
• Administrative hurdles, such as registration of organizational entities and delayed provision of visas.  
• Denials of fuel requests, frequent interruptions of internet and communications services as well as damage to key infrastructure continue to curtail mobility and operations. 
• Migration of qualified frontline workers outside Gaza. 
• Logistic and security constraints hamper the creation of safe spaces for confidential GBV case management activities, including safe houses/shelters for high-risk cases (including the Clinical Management of Rape (CMR), and the implementation of alternative care options for unaccompanied children.   
• Inability of some beneficiaries to cash out their CVA.

Response

• Since October 2023, Education Cluster partners have reached more than 238,000 students and teachers, providing them with psychosocial support, emergency learning, recreational supplies and activities, and awareness-raising sessions (please see Education Cluster 5W dashboard). Most cluster response activities continue to be delivered by local partners. 
• Based on information provided by the Ministry of Education (MoE), 1,000 students from the Gaza Strip have registered to undertake their high school exams in Egypt (800) and other countries (200) through special arrangements organized by the MoE. In addition, 11,000 Gaza students have so far registered to benefit from a distance learning programme organized by the MoE and offered at 19 schools in the West Bank.  
• The Cluster continues to prioritize the provision of Education in Emergencies (EiE), recreational activities, and psychological support, including Social Emotional Learning (SEL) activities, to children in shelters and designated emergency shelters (DESs) to help them cope with trauma and build resilience so they can thrive in the long term.   
• Efforts are ongoing to establish and/or expand Temporary Learning Spaces (TLSs) in and around IDP shelters in order to provide non-formal learning to school-aged children in light of the large-scale damage to education infrastructure. 

Challenges

• Restrictions on the entry of recreational and psychosocial support kits, which are unavailable on the local market, are hindering the implementation of critically needed response activities, especially at TLSs in informal shelters.  
• The continued absence of schooling in the Gaza Strip, where about 86 per cent of schools have been destroyed, damaged or likely damaged, is depriving children of opportunities for their social, emotional and cognitive development. With limited humanitarian aid and education supplies, over 625,000 children are also at risk of dropping out of school, rendering them vulnerable to exploitation, child labour, early marriage, and other forms of abuse.  
• The education response remains significantly underfunded, with less than 21 per cent of the required funds received as of 29 April. Unless funding is received, partners’ capacity to respond is constrained.   
• The continued lack of approvals of fuel requests submitted by cluster partners is undermining their capacity to implement planned activities. 

Response

• To date, the Logistics Cluster has facilitated storage services (with pick-up at the Rafah transshipment point) for 28,422 cubic meters of humanitarian supplies on behalf of 29 partners at four warehouses in Rafah. 
• The Cluster-operated cargo notification system has so far been utilized by 27 organizations, informing them once their cargo arrives at the Rafah transshipment point and is ready for pick up.  
• On 25 April, the fourth direct convoy, comprising 50 trucks of food assistance, was dispatched from Amman to the Kerem Shalom Crossing via the Jordan Corridor, without any cross-loading of the trucks along the route. 
• Four Temperature Controlled Units (TCUs) have arrived in El Arish, through the EU Humanitarian Air Bridge. Two TCUs have been dispatched to Gaza, while the other two will remain in El Arish in support to the Egyptian Red Crescent Society (ERCS).  
• As of 21 April, the pipeline forecast for the next three months stood at 349,192 metric tons of humanitarian aid, including 287,650 metric tons through the Egypt corridor, 35,385 metric tons through the Jordan corridor and an additional 26,157 metric tons, exclusively of flour, from the Ashdod port.

Challenges

• Infrastructural damage, access challenges, lengthy checkpoint clearance procedures and the lack of logistical supplies, assets, and spare parts continue to limit storage and transport capacity within Gaza. 
• The absence of a regular schedule for convoys travelling directly from Amman to the Kerem Shalom Crossing prevents effective planning and a timely and reliable flow of aid via the Jordan Corridor. Other convoys carrying assistance via the King Hussein/Allenby Bridge have been paused and the resumption date remains to be determined.  
• The Logistics Cluster has no presence on the Israeli side of the Kerem Shalom Crossing, preventing real-time visibility on cargo approved by the Israeli authorities.  
• Access to northern Gaza remains extremely limited. 
• Uncertainty about the opening of additional entry points in the north, such as Erez Crossing, continues to undermine the effective planning of cargo and international procurement. 

Response

• On 21 April, Israeli authorities approved the ETC’s request to activate the data internet connectivity service on 20 Iridium satellite phones; these were purchased by the ETC and donated to the UN Department for Safety and Security (UNDSS) in December 2023 and are currently being used by UN humanitarian responders in Gaza. 
• The ETC field coordinator was deployed to Gaza on 22 April to strengthen face-to-face engagements and support partners with technical advice and guidance on telecommunications services. 
• On 24 April, Israeli authorities approved the import of four Very High Frequency (VHF) repeaters, 50 handheld radios and cabling; this will enable the ETC to set up a reliable and secure communication platform for humanitarian responders across Gaza.   
• For more information on ETC activities, please visit: Palestine: Conflict | Emergency Telecommunications Cluster (ETC) (etcluster.org). 

Challenges

• Limited access to electricity, fuel, and telecommunications services continues to hamper effective coordination of the emergency response and delivery of life-saving aid.  
• The import of telecommunications equipment into Gaza. 

Response

• Between 22 and 28 April, the SAWA helpline answered 1,260 calls, delivered 392 psychosocial counselling sessions, and referred 195 cases to formal protection mechanisms. 
• The PSEA network, jointly with the Child Protection Area of Responsibility (CP AoR) and partners, has developed a children’s story titled “Zaatar on the Sea Shore”, which highlights children’s ability to protect themselves from risks of sexual exploitation and abuse (SEA) during emergencies.  
• Between 22 and 29 April, six new awareness materials and posts on PSEA were published through Sanad’s social media accounts. To date, Sanad’s Facebook, Instagram and Telegram accounts have a total of 7,172 followers and are reaching a monthly average of about 1.4 million Meta users.  
• In-person awareness sessions on PSEA continue to be regularly conducted for humanitarian responders and service providers. On 18 April, 11 aid workers participated in such sessions in Gaza.

Challenges

• Internet and telecommunication blackouts continue to hinder awareness raising on SEA at community level as well as effective reporting on potential SEA cases. 
• As access to Meta platforms is highly restricted in Gaza, the only way to ensure that awareness materials on PSEA reach the target audience is through paid promotions.