Gaza Humanitarian Response Update | 29 April - 5 May 2024

Response

• Between 29 April and 5 May, Health Cluster partners delivered primary and secondary health services to 124,400 people across Gaza. 
• A total of 19 Emergency Medical Teams (EMTs) are currently deployed, including two in northern Gaza. 
• The Indonesian Hospital in North Gaza has been rehabilitated and reopened. It will offer an emergency Intensive Care Unit (ICU) and an in-patient department. WHO will provide medicines and medical supplies to the facility. 
• Efforts are ongoing to restore health services at the Nasser Medical Complex in Khan Younis, Patients’ Friendly Hospital in North Gaza and at primary healthcare centres in Deir al Balah.  
• International Medical Corps (IMC) has established a field hospital in Deir al Balah with a capacity of 45 beds. The hospital, which includes operation theatres and a neonatal ICU, provides a range of emergency services, including trauma stabilization, Comprehensive Emergency Obstetric and Newborn Care (CEMONC), Severe Acute Malnutrition (SAM) stabilization and other nutrition services, as well as outpatient care. 
• Eight primary healthcare centres (2 in Deir Balah, 3 in Khan Younis and 3 in Rafah) are offering a comprehensive Sexual and Reproductive Health (SRH) package, and 104 medical points across Gaza are providing essential SRH and Gender-based Violence (GBV) services and referrals. 
• Two out of five maternity hospitals operated by the Ministry of Health offer CEMONC services; these are the Kamal Adwan Hospital in Gaza city and Al Emirati Hospital in Rafah. 
• UNFPA has deployed 75 midwives to ensure the continuous provision of services in the upcoming months and has trained 53 midwives deployed by UNRWA, Save the Children, Juzoor and the Palestinian Medical Relief Society. 

Challenges

• Fuel shortages continue to hamper health interventions at hospitals and primary healthcare facilities.  
• Continuous hostilities pose significant barriers to accessing healthcare service points. 
• More than 540,000 women and girls of reproductive age are at increased risk due to poor access to life-saving services, clean water, and sanitation. 
• 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 continue to fuel rising cases of acute jaundice syndrome and bloody watery diarrhoea, posing a significant public health challenge. 

Response

• Nutrition interventions are currently being provided at 307 sites across Gaza, including 22 health facilities, 248 formal and informal shelters, and 37 sites in the host communities. These include 104 Outpatient Therapeutic Programme (OTP) sites.
• Since mid-January, 64,976 children aged 6-59 months have undergone Mid-Upper Arm Circumference (MUAC) screenings, of whom 4,299 have been diagnosed with acute malnutrition, including 3,139 with Moderate Acute Malnutrition (MAM) and 1,160 with SAM.  
• In March and April, 55 children suffering from SAM with medical complications were hospitalized, of whom 60 per cent were at the Kamal Edwan Hospital in northern Gaza. To strengthen inpatient treatment of SAM cases with complications, WHO, jointly with MedGlobal, plans to establish a stabilization centre at the hospital operated by the Patient's Friends Benevolent Society in Gaza city. Nurses and doctors at three Ministry of Health facilities and at the Kamal Adwan Hospital have also received capacity building on the inpatient management of SAM cases with complications.  
• UNICEF continued to scale up the outpatient treatment of acutely malnourished children to 104 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 15 nutrition partners. In North Gaza, UNRWA has also trained volunteers to provide OTP services at one primary healthcare centre and four medical points. Meanwhile, outpatient nutrition services are expanding. At Al Helu Hospital in Gaza city, IMC volunteers and Juzoor, with Nutrition Cluster support, received training on simplified protocols for the management of malnutrition.   
• Jointly with WFP and other partners, UNICEF is 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.  
• During the reporting period, the distribution of nutrition supplies significantly improved in northern Gaza. UNICEF delivered 400 cartons of ready-to-use therapeutic food (RUTF) and 250 cartons of high-energy biscuits (HEB) to the Kamal Adwan Hospital. Additionally, WFP, through its partner IHH, provided six metric tons of lipid-based nutrient supplements to five distribution sites across northern Gaza, covering the 15-day needs of approximately 8,000 pregnant and breastfeeding women (PBW) and children under the age of five. UNICEF also provided Al Helu Hospital in Gaza city with 355 cartons of RUTF, 114 cartons of HEBs, and 400 cartons of ready-to-use infant formula (RUIF).  
• In April, a total of 17,334 caregivers of children under the age of two, including 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 (SCI) has set up seven Mother-Baby Areas (MBAs) throughout Gaza, with plans underway to further scale up and provide integrated nutrition services at one of the MBAs in Deir al Balah. Thirty community health workers have been recruited by SCI and trained on IYCF-E practices to help new mothers in these facilities. Four additional MBA sites are also being assessed and are expected to become operational soon. 

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 across all Gaza governorates continue to hamper the early detection of children and women in need and the provision of adequate nutrition support to those who need it. 
• To enhance interventions, both in terms of number of people reached and quality of services provided, Nutrition Cluster partners need to be able to scale up, in a safe way, their operational presence, particularly in the northern and central areas of Gaza, where nutrition services are currently scarce. 

Response

• During the month of April, 19 partners provided food assistance across Gaza, including food parcels, hot meals, bread and flour. On average, around 975,000 people received food parcels on a weekly basis. Unfortunately, due to access constraints, distribution in northern Gaza continued to be low compared to the high needs. 
• The distribution of fodder continued in Rafah, Khan Younis, and Deir al Balah, with people each receiving a 50-kilogramme sack, sufficient to feed five sheep for five days. The second round of distribution is ongoing. 
• Around 16 bakeries supported by WFP are currently operational throughout Gaza, including four in northern Gaza.  
• Since November, 1.9 million people have received flour in southern Gaza, of whom 1.6 million have received a second round and 946,000 are now receiving a third round. 

Challenges

• Humanitarian access throughout Gaza remains limited, particularly in the north, exacerbating the catastrophic levels of food insecurity already faced by the population and hindering the urgent delivery of life-saving food assistance.  
• Distribution efforts continued to face challenges. mainly due to the limited number of trucks allowed access. Analysis carried out by the cluster for response activities during the second week of April, show, for instance, that food distribution only reached 10 per cent of the population in northern Gaza (around 36,000 people), with a limited number of humanitarian partners able to provide assistance.  
• The limited number of entry points into Gaza and sub-optimal operating hours at crossings and checkpoints continue to constrain the ability to expand supply routes.  
• Infrastructural and security hurdles continue to hinder mobility and safe humanitarian access within Gaza, with security escorts necessary to safeguard convoys.  
• Lack of sufficient fuel for essential services and operations.

Response

• Repair works on the damaged Mekerot water connections at Al Muntar in the north and Bani Suhaila in the south of Gaza have been completed. The downstream transmission lines have also been rehabilitated, with both connection points now operational, delivering water at rates of approximately 700 and 500 cubic metres per hour, respectively. In total, all three water pipelines coming from Israel are partially operational, providing about 1650 cubic metres per hour.
• In April, WASH Cluster partners completed the following activities:  
  • Some 21,576 cubic metres of water trucked to IDP sites and communities in Khan Younis, Deir al Balah and Rafah. 
  • Installation and/or rehabilitation of around 1,600 metres of water networks (transmission or distribution) and household connections in Khan Younis. 
  • Some 4,738 household water storage tanks distributed and installed in Rafah. 
  • Around 260 emergency sanitation units installed and/or rehabilitated in Rafah and Khan Younis to support displaced populations in collective centres and make-shift or scattered sites. 
  • Around 4,900 standardized family hygiene kits distributed across the Gaza strip. 
  • Some 17 tons of solid waste collected from communities in Rafah and disposed off at temporary dump sites.

Challenges

• Challenges in providing power generation and energy supply, including the delivery of generators, spare parts, and consumables to critical WASH infrastructure and facilities. These services are crucial to prevent the imminent collapse of water and sewage systems. 
• The inability to access official solid waste landfills in Gaza, particularly Sofa Landfill, hinders the safe transfer of solid waste from contaminated, temporary dumpsites. 

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: 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). In light of a potential Rafah operation, Child Protection partners have intensified efforts to prevent family separations and identify and register unaccompanied and separated children, including through increased community engagement and the distribution of child identity bracelets. 
• Gender-Based Violence (GBV): Between 21 and 29 April, 14,000 multivitamin supplements were distributed to GBV survivors in Rafah; 22 GBV service providers were trained on GBV and referral pathways to enhance the quality of support provided; 2,240 Dignity Kits and 270 menstrual hygiene management (MHM) kits were distributed to displaced women and girls in Rafah, Deir al Balah and Khan Younis; 1,085 women and girls were reached with recreational activities. The GBV Sub-Cluster also continues to provide psycho-social support (PSS), individual and group counselling, and case management. 
• Mine Action: Key activities include: i) continued deployment of additional Explosive Ordnance Disposal (EOD) officers to advise humanitarian actors on safe practices around unexploded ordnance (UXOs) and, where access permits, conduct Explosive Hazard Assessments (EHAs) 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; iii) EORE campaigns via radio and flyers; and iv) ongoing design of a mapping tool to capture suspected UXO threats and high-risk areas. Between October 2023 and the end of April 2024, Mine Action partners conducted over 50 EHAs and supported more than 95 inter-agency convoys. Moreover, partners repeatedly reached around 1.5 million people through digital EORE campaigns, while 206,219 people were reached through in-person EORE activities, and 47,500 informational materials were distributed.  

Challenges

• Denial of entry of critical items, such as mine action supplies, sanitary pads, dignity and MHM kits for women and girls, as well as recreational materials for children. These supplies are absent or extremely limited on the local market and, when available, they have been subjected to soaring prices.    
• 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.  
• Shortages of cash are preventing some recipients from cashing out their Cash and Voucher Assistance (CVA), as well as preventing payments to local service providers and staff salaries. This is also negatively impacting living conditions of women and girls and increasing their risk of exposure to violence or exploitation. 
• Logistic and security constraints continue to hamper the creation of safe spaces for confidential GBV case management activities, such as safe houses/shelters for high-risk cases and the Clinical Management of Rape (CRM), and the implementation of alternative care options for unaccompanied children. 

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). While 26 partners have been involved in the response to-date, most cluster response activities continue to be delivered by local partners, who, despite facing large-scale constraints, are doing everything possible to support students in need.   
• Efforts continue to establish and/or expand Temporary Learning Spaces (TLS) 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. Partners have so far established 11 TLS, benefiting about 6,000 children, mainly in Rafah and Khan Younis. At least four other TLS have been established through community-led initiatives, benefiting at least 2,000 additional children. Efforts are ongoing to map all TLS to identify needed support by Education Cluster partners as well as facilitate referrals of needs covered by other humanitarian stakeholders (e.g. child protection, GBV, WASH).
• Growing demand for education within communities is also resulting in the establishment of community-led education activities. The Education Cluster has started mapping such initiatives and is working towards connecting these spaces with partners so that more children may benefit. In addition, the Cluster is advocating with other Clusters to expand the range of services provided in TLSs, including awareness raising on UXOs, GBV, and child protection, among others.   
• The Cluster continues to prioritise 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. 

Challenges

• The continued use of schools as shelters and the lack of spaces to establish TLS affect the delivery of education-in-emergency response. The large number of tents in overcrowded informal sites means that no extra spaces are available for other activities.  
• Limited resources, particularly funds, and continued restrictions on the entry of recreational and psychosocial support kits, classified as non-humanitarian by Israeli authorities, are hindering the implementation of critically needed response activities. These supplies are also not available on the local market, preventing partners from sourcing these materials locally. 
• The education response remains significantly underfunded, with less than 21 per cent of the required funds received as of 5 May. 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 31,205 cubic metres of humanitarian supplies on behalf of 32 partners at four warehouses in Rafah.  
• The Cluster-operated cargo notification system has so far been utilized by 32 organisations, informing them once their cargo arrives at the Rafah transshipment point and ready for pick up.   
• On 30 April, the fifth direct convoy, comprising 30 trucks, including 25 trucks carrying food assistance provided by WFP, was dispatched from Amman via the Jordan corridor and entered northern Gaza through the Erez Crossing. Also on 30 April, a five-truck convoy transporting key equipment, such as mobile storage and prefabricated units, was dispatched from Jordan through the Amman-Aqaba-Neweiba-Al Arish-Kerem Shalom-Rafah route. 
• As of 28 April, the pipeline forecast for the next three months stood at 319,607 metric tons of humanitarian aid, including 247,868 metric tons through the Egypt corridor, 33,968 metric tons through the Jordan corridor and an additional 37,771 metric tons, exclusively of flour, from the Ashdod port. 

Challenges

• Infrastructural damage, access challenges, lengthy checkpoint clearance procedures, lack of logistical supplies, assets, and spare parts, as well as fuel shortages, continue to limit storage and transport capacity within Gaza.  
• The absence of a regular schedule for convoys travelling directly from Amman to Gaza 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 as humanitarian cargo will now require Israeli customs clearance; the resumption date remains unknown pending clarification on custom clearance requirements. 
• The Logistics Cluster has no presence at crossings or cross-loading points, preventing real-time visibility on cargo approved or rejected by the Israeli authorities. 
• Access to northern Gaza remains extremely limited. 
• Uncertainty about the opening of additional entry points continues to undermine the effective planning of cargo and international procurement.

Response

• The ETC Cluster is assessing with UNDSS and OCHA a plan for internet connectivity at the newly proposed Joint Humanitarian Operations Centre (JHOC) in Deir al Balah, including preparations for addressing data connectivity gaps and carrying out needed ICT assessments.  
• According to information provided by the two national telecommunications service providers, as of 30 April, there were more than 1.35 million active mobile phone users across Gaza, up from 1.3 million during the preceding week. This figure represents the total number of people who were actively using mobile phones at the time of data extraction on 30 April, providing indicative data about the number of people across Gaza with access to charged cellular phones, able to make and receive calls. Repair of network sites has resulted in improved quality of calls. Landline and internet coverage has increased and is stronger as you move from north to southern Gaza.  
• National telecommunications service providers are undertaking two projects aimed at providing IDP sites and humanitarian workers in select locations with WiFi to enable programming and operations. 
• For more information on ETC activities, please visit: Palestine: Conflict | Emergency Telecommunications Cluster (ETC) (etcluster.org). 

Challenges

• The ETC Cluster urgently needs US$1.8 million requested in the revised oPt Flash Appeal launched on 17 April to address urgent and critical life-saving communication efforts in Gaza until 31 December 2024. Due to protracted funding challenges, the Cluster is currently unable to purchase the complete Security Communications System [SCS] kits which were pre-approved by Israeli authorities. Once acquired, the Cluster plans to install a kit at each site in Deir al Balah, Gaza city and Jabaliya to ensure an independent and reliable communications platform for humanitarian responders. 
• 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. Only four Very High Frequency (VHF) repeaters and 50 VHF handheld radios have been approved by the Israeli authorities since 7 October 2023.