Hostilities in the Gaza Strip and Israel | Flash Update #11

KEY POINTS

• Hundreds of fatalities in Al Ahli Arab hospital in Gaza were reported as this Flash Update was being finalized (22:00). The compound hosted patients and internally displaced persons (IDPs) seeking safe shelter.

• As hostilities entered the eleventh day, heavy Israeli bombardments on Gaza, from the air, sea and land, have continued almost uninterrupted. In the last 20 hours (as of 17:30), 192 Palestinians have been killed, bringing the cumulative fatality toll in the Gaza Strip to 3,000, including at least 853 children, according to the Ministry of Health in Gaza (excluding Al Ahli hospital casualties). Hundreds of additional fatalities are believed to be trapped under the rubble.

• The number of IDPs in Gaza is estimated at about one million, including about 352,000 IDPs staying in UNRWA schools in central and southern Gaza alone, in increasingly dire conditions. This afternoon (17 October), an UNRWA school in Al Maghazi refugee camp in central Gaza, sheltering some 4,000 IDPs, was hit during an Israeli airstrike, killing at least six people.
• The Spokesperson for the UN Human Rights Office stated on Tuesday that there are “appalling reports that civilians attempting to relocate to southern Gaza were struck and killed by an explosive weapon,” and urged Israel “to avoid targeting civilians and civilian objects or conducting area bombardments, indiscriminate or disproportionate attacks.”
• The complete siege of Gaza continues. The Rafah Crossing has remained closed, preventing the entry of desperately needed humanitarian aid, including food, water and medicines awaiting on the Egyptian side.
• The UN Assistant Secretary-General for Humanitarian Affairs stressed today (17 October) the need for a humanitarian suspension of hostilities enabling the delivery of aid, along with some respite from the bloodshed.
• Gaza has been under full electricity blackout for the seventh consecutive day. Today, the World Health Organization (WHO) managed to deliver locally stored fuel to Gaza’s largest hospital (Shifa), enabling the operation of generators for a few more days. Other hospitals are operating at a bare minimum capacity.
• The average water consumption for all needs (drinking, cooking and hygiene) is currently estimated at three litres per day per person in Gaza. There is increasing water consumption from unsafe sources, placing the population at risk of death or infectious disease outbreak.
• The Palestinian armed groups’ indiscriminate rocket firing towards Israeli population centres continued, with no new Israeli fatalities reported (as of 21:00 17 October). Overall, more than 1,300 Israelis and foreign nationals have been killed in Israel, according to Israeli authorities, the vast majority on 7 October.
• At least 199 people are held captive in Gaza, including Israelis and foreign nationals. On 16 October, UN’s emergency relief chief Martin Griffiths expressed deep concern about the deepening humanitarian crisis in Gaza and about the fate of Israeli hostages, stressing that “they have to be let out straight away.”
• In the West Bank, since the afternoon of 15 October, Israeli forces have killed three Palestinians, bringing the fatality toll by Israeli forces and settlers since 7 October to 61, including 16 children.

GAZA HUMANITARIAN OVERVIEW

Hostilities and casualties

Israeli airstrikes and shelling continued. Among the deadliest attacks recorded today (17 October) were airstrikes on residential buildings in Rafah city (at least 28 fatalities); in Khan Yunis (40 fatalities) and in the Emirati neighbourhood of Khan Yunis (21 fatalities). The fatalities included people moving southward in compliance with the Israeli military order to evacuate the northern Gaza Strip.

This afternoon (17 October), an UNRWA school in Al Maghazi refugee camp in central Gaza, sheltering some 4,000 IDPs, was hit during an Israeli airstrike, with at least six people killed and dozens injured, including UNRWA staff. UNRWA has been providing the coordinates of its facilities to relevant parties on a daily basis.

Since the start of hostilities, 3,000 Palestinians have been killed and 12,500 have been injured (excluding Al Ahli hospital casualties). The fatality toll in Gaza during the 11 days of hostilities has already surpassed the total number of fatalities during the 2014 escalation, which lasted for over 50 days (2,251 Palestinian fatalities). According to the Ministry of Health in Gaza, as of 16 October at 18:00, 47 entire families have been killed, amounting to about 500 people.

Additionally, it is estimated that hundreds of people are still trapped beneath the rubble awaiting rescue, or recovery. The decomposition of bodies under collapsed buildings is an increasing humanitarian and environmental concern.

Rescue teams, primarily from the Palestinian Civil Defense, are struggling to carry out their mission, amid continuous airstrikes, severe shortage of fuel to run vehicles and equipment, and with limited or no connection to mobile networks.

As of 21:00, 17 October, no new Israeli fatalities have been reported. According to official Israeli sources, at least 1,300 Israelis and foreign nationals have been killed in Israel, and at least 4,229 have been injured, the vast majority on 7 October. The fatality toll is over three-fold the cumulative number of Israelis killed since OCHA began recording casualties in 2005 (nearly 400).

According to the Gaza Ministry of Public Works, as of 14 October, 8,840 housing units had been destroyed and 5,434 housing units had been damaged and rendered uninhabitable.

Prior to today's attack on Al Ahli hospital, WHO had documented 57 attacks on health care, resulting in 16 fatalities of health care workers and 28 injuries, damage to 26 hospitals and other healthcare facilities, including 17 hospitals and 23 ambulances. Four of the latter, all in northern Gaza (Beit Hanoun, Hamad Rehabilitation, Al Karama, and Ad Dura) had to be evacuated and are no longer operational.

The scope of damage sustained by education and other civilian infrastructure as a result of bombardments is also of increasing concern. As of 16 October, 167 educational facilities have been hit by airstrikes, including at least 20 UNRWA schools, two of which were used as emergency shelters for IDPs, and 140 Palestinian Authority (PA) schools, one of which was destroyed. One university building and seven churches were damaged, and at least eleven mosques were destroyed.

Water and sanitation facilities have also been severely damaged. As of 12 October, at least six water wells, three water pumping stations, one water reservoir, and one desalination plant serving over 1,100,000 people were damaged.

Displacement

The cumulative number of internally displaced people (IDPs) since the start of hostilities is estimated at about one million, including over 352,000 IDPs staying in UNRWA designated emergency shelters (DES) in central and southern Gaza alone. The number of IDPs in UNRWA’s DES in Gaza city and North Gaza is currently unavailable. In addition, about 55,000 IDPs are staying in 51 non-UNRWA shelters, most of which are in Gaza city and northern Gaza.

The hosting capacity at UNRWA’s 104 DES, in the southern areas, is overstretched. In Rafah, IDPs constituted over 80 per cent of the population prior to the hostilities. This includes children, the elderly, those in need of medical care, people with disabilities, and pregnant women. Essential resources like water, food, and medicine are in critically short supply, leading to rising frustration and tensions among IDPs.

Anecdotal reports indicate that many displaced families have been returning to Gaza city and the north of Gaza (west of Wadi Gaza) due to ongoing airstrikes targeting the southern areas, compounded by the difficult living conditions in the South, with cramped temporary shelters, lack of water, electricity, sanitation.

In Israel, an almost full evacuation of Sderot city (population about 34,000), in southern Israel, was completed on 15 October. Smaller Israeli communities around Gaza had been fully vacated in previous days, while most residents of Ashqelon (population about 155,000) have also reportedly left. The Israeli authorities are providing for the needs of these IDPs (this report focuses on the humanitarian situation in Gaza).

Basic services and livelihoods

Electricity

For the seventh consecutive day (since 11 October), Gaza has been under a full electricity blackout, following Israel’s halt of its electricity and fuel supply to Gaza, which in turn triggered the shutdown of Gaza’s sole power plant. Forcing essential service infrastructure to rely on backup generators, which are limited by the scarcity of fuel in the Strip.

According to officials at the Gaza Power Plant, the Israeli authorities have warned that the plant would be targeted if it attempted to resume operations. The Israeli Defense Minister indicated that electricity, fuel and full water supply to Gaza would not be restored until the Israeli hostages are released.

Health care

Today (17 October), WHO, together with UNRWA, managed to deliver 10,600 litres of fuel to Shifa, Gaza’s largest hospital located in Gaza city. This will enable the hospital’s generators to operate for a few more days. On the other hand, Al Yemen As Saeed hospital in norther Gaza ran out of fuel, was forced to shut down generators and consider the transfer of a number of patients.

The rest of the hospitals across Gaza (except the four that have been evacuated), have been operating at a bare minimum capacity. Measures adopted to maintain emergency rooms operational include the suspension of certain surgeries, working in darkness and limiting elevator usage. Vital procedures such as sterilization and dialysis may soon be halted.

The Ministry of Health in Gaza has been reallocating to hospitals limited amounts of fuel still available in other public facilities to prevent their complete shutdown, while calling on people who have fuel for domestic consumption to donate it to the hospitals.

Of particular concern is the situation of an estimated 20,000 people with mental health illnesses; their access to mental health services and drugs has been interrupted, while being exposed to violence and abuse, and going missing during evacuation. An estimated 50,000 pregnant women face extreme challenges to accessing prenatal and maternity care due to risks related to movement, the halt of health facilities, and shortage of lifesaving supplies.

Water and sanitation

Water production from municipal groundwater sources is at less than five per cent the pre-hostilities level. The three seawater desalination plants, which, prior to the hostilities produced seven per cent of Gaza’s water supply, are currently not operational. Water trucking operations came to halt in most areas due to the lack of fuel, insecurity and roads blocked by debris. Bottled water is largely unavailable, and its price has made it unaffordable for most families. Private vendors, who operate small water desalination and purification plants, which are mostly run by solar energy, became the main suppliers of clean drinking water.

Consequently, the average water consumption from all sources and for all needs (including cooking and hygiene) dipped to just three litres per day per person, according to estimates by partners of the Water, Sanitation and Hygiene (WASH) Cluster. People have resorted to consuming brackish water extracted from agricultural wells, increasing exposure to pesticides and other chemicals, placing the population at risk of death or infectious disease outbreak.

Eastern Khan Younis (Bani Suheila area) is currently one of the few areas where piped water is supplied to households for a few hours a day. This followed the Israeli authorities’ reactivation of one out of three water lines servicing this area. This line supplies about 14,400 cubic metres of water per day, which is less than four percent of the water consumed in the Gaza Strip prior to the hostilities. The distribution of this water to the rest of Khan Younis city is impaired by the lack of pumping capacity.

Most of the 65 sewage pumping stations are not operational, increasing the risk of sewage flooding. In some areas, sewage and solid waste have been accumulating in the streets, posing health and environmental hazards. All five wastewater treatment plants in Gaza have been forced to shut down due to lack of power.

Food security

A spokesperson of the World Food Program (WFP) indicated on Monday that stocks of essential food commodities are sufficient for only two weeks, while there are only four or five days of stocks left in shops.

Bread supply is running low, and people are lining up for hours to get bread. Bakeries are unable to operate due to the shortage of essential ingredients, particularly wheat flour, which is expected to be depleted in less than a week. Only one of the five mills in Gaza is functioning. Moreover, five bakeries out of 23 in Gaza contracted by WFP are still operational.

The blackout has disrupted food security by affecting refrigeration, crop irrigation, and crop incubation devices, consequently harming various livelihoods, including poultry, cattle, fish, and other commodities.

The lack of access to fodder and damage from the airstrikes have taken a toll on farmers, with many breeders, primarily small-scale ones, reporting substantial losses among their animals, particularly in the poultry sector. Farmers are losing their crops in agricultural lands situated in the east of Khan Yunis and other locations.

Movement and access

The Rafah crossing with Egypt remains closed, preventing the entry of desperately needed humanitarian aid, including food, water, and medicines; it is estimated that about 3,000 tons of goods are awaiting entry in trucks on the Egyptian side of the crossing.

The Erez and Kerem Shalom crossings with Israel also remained closed. Referrals for patients and their companions to exit the Gaza Strip to reach their medical appointments in the West Bank and Israel have ceased since 7 October. People from Gaza working in Israel were not able to return home. Hundreds have been detained by Israeli authorities, while over 1,000 were transferred to the West Bank.

Access to the sea has been prohibited by the Israeli military, and all fishing activity stopped since the hostilities began. Access within 1,000 metres from Israel’s perimeter fence remains prohibited, preventing access to large areas of farming lands and, alongside safety concerns, has decreased produce yield, directly affecting hundreds of thousands of farmers.

Humanitarian operations

All humanitarian agencies and personnel have faced major constraints in providing humanitarian assistance, due to airstrikes, movement restrictions and shortages of electricity, fuel, water, medicines and other essential items. The prevailing insecurity is preventing safe access to people in need and essential facilities, such as warehouses.

Despite these challenging conditions, humanitarian actors are working around the clock to support the most vulnerable. The major operation entails the hosting of IDPs in UNRWA schools, where basic food, medicine and support is provided to retain dignity and a glimmer of hope. Other interventions include the distribution of food and cash assistance to IDPs and emergency fuel to WASH facilities, psychosocial support helplines, and a mass media campaign to raise awareness about the risks of unexploded ordnance (for further detail, see Humanitarian Needs and Responses).

The reach of operations will remain limited without a humanitarian suspension of hostilities, the opening of the crossings with Israel and Egypt and significant funding for humanitarian response.

Following the outbreak of hostilities, the oPt Humanitarian Fund (HF) redirected a total of US$9 million towards the priority needs identified, while the global Central Emergency Response Fund (CERF) allocated another $9 million, supplementing a pre-existing $6 million allocation.

On 12 October, the OPT Humanitarian Country Team (HCT) launched a Flash Appeal calling for US$294 million for 77 humanitarian partners to address the most urgent needs of 1,260,000 people in Gaza and the West Bank. This Flash Appeal is set to be revised given the significant increase in humanitarian needs. So far, France has pledged $1.1 million, and Germany $631,000.

WEST BANK HUMANITARIAN OVERVIEW

Casualties

In the West Bank, including East Jerusalem, confrontations between Palestinians and Israeli forces have continued. Since the start of the hostilities, until 16:00 on 17 October, Israeli forces have killed 56 Palestinians, including 15 children. An additional five Palestinians, including one child, were killed by Israeli settlers during two consecutive settler attacks in Qusra (Nablus).

Over the past 24 hours (until 17 October, 16:00), Israeli forces shot and killed two Palestinians and injured nine others with live ammunition during search-and-arrest operations in Aqbat Jaber Refugee Camp in Jericho and Halhul town (Hebron); these incidents were followed by confrontations. An elderly man succumbed to his wounds sustained on 13 October.

Additionally, since 7 October, Israeli forces injured 1,202 Palestinians, including at least 117 children; an additional 28 Palestinians were injured by settlers. Over 1,100 Palestinians were injured, mostly by Israeli forces, in the context of demonstrations. Some 27 per cent of injuries were caused by live ammunition.

Settler-related violence

Settler violence across the West Bank, especially in Palestinian communities near Israeli settlements, has been on the rise. Since 7 October, OCHA has recorded 82 settler attacks against Palestinians resulting in casualties or property damage, including some where Israeli forces were involved. This represents an average of almost seven incidents per day, compared with a daily average of three incidents per day since the beginning of this year.

In the past eleven days, at least seven Palestinian communities in Area C of the West Bank have been fully or partially displaced amid settler attacks and threats. At least 43 Palestinian households comprising 283 people, including 146 children, were displaced from the herding Bedouin communities in the Ramallah, Hebron, Bethlehem, and Nablus governorates.

Attacks on health care

Since 7 October, WHO has documented 77 attacks on health care in the West Bank, affecting 61 ambulances and including: 42 attacks involving obstruction to delivery of health care; 43 involving physical violence towards health teams; 15 involving detention of health staff and ambulances; and nine involving militarized search of health assets.

HUMANITARIAN NEEDS & RESPONSES

Multi-Purpose Cash Assistance (MPCA)

Priority Needs

• Access to basic needs and services is severely halted by the lack of resources and the security situation. IDPs outside formal shelters (DES) have extremely limited access to assistance. Those are prioritized for Emergency MPCA.
• · Banks are temporarily closed, limiting access to cash. The capacities of financial service providers are severely limited and changes by the hour (partners currently using PalPay).
• · Depletion of stocked items to be purchased is worsening.

Response to Date

• · 4,461 households started receiving Emergency MPCA (NIS754 or US$187 per household) since the evening of 13 October.
• · An increase of Emergency MPCA to 1,650 households in the coming days is planned.

Protection

Priority Needs

• An estimated 20,000 people in need of specialized mental health services, including mental health drugs, who are in precarious situations with the disruption to mental health services.
• Documentation of violations of International Human Rights Law and Humanitarian Law.
• Opening roads, safe access to basic needs, medicines, mental health support, and ambulance services in the West Bank.

Response to Date

• Ten child protection and Mental Health Psychosocial Support (MHPSS) partners are operating in, and for, Gaza (six in the Gaza Strip and four partners in the West Bank) providing remote psychosocial support.
• The United Nations Mine Action Service (UNMAS) has initiated an emergency mass media campaign through various platforms, including social media and radio stations, to send Explosive Ordnance Risk Education (EORE) and Conflict Preparedness and Protection (CPP) messages to as wide a population as possible.
• In the West Bank, the assigned MHPSS Focal Points are responding to settler violence triggers. The MHPSS Coordination Lead Focal Points at governorate levels are intervening as needed.

Shelter

Priority Needs

• Urgent need to provide services and basic Shelter and Non-Food Items (NFI) to IDPs.
• Provision of Non-Food Items and house maintenance for people displaced in urban centers and with host families.
• Provision of shelter cash assistance for IDPs (reintegration package and belongings loss compensation) for at least 3,000 families.

Response to Date

• 270,000 IDPs are hosted at 102 UNRWA schools across the Gaza Strip.
• Distribution of 3,900 non-food items in Rafah and Khan Younis, including bedding sets and dignity kits.
• Distribution of 820 hygiene kits to displaced families.
• ICRC/PRCS distributed 120 non-food items for displaced families.

Health

Priority Needs

• Addressing shortages of medical supplies impacting case management.
• Fuel for hospitals and ambulances is running out.
• Urgent need to restock medical supplies given depletion of stocks in the local market.
• UNRWA has medical points in 53 out of the 108 shelters. The Health Cluster is identifying other partners to support the remaining shelters. Health Cluster partners are mobilizing and prepositioning supplies in Egypt.
• WHO was able to deliver 10,600 litres of fuel to Shifa Hospital.

Response to Date

• Partners continue to procure supplies from the local market to support hospital operations.
• Surge staff remain present in the hospitals supporting case management.
• Ambulances and emergency medical teams continue to operate despite the risk and difficult environment.

Food Security

Priority Needs

• Electricity, fuel, and water sources to maintain agriculture.
• Many shops have food supplies to last less than a week.
• Safe access to farms, livestock, fisheries, and other livelihoodz.
• Urgent import of fodder.

Response to Date

• The World Food Program (WFP) reached 220,000 displaced people residing in UNRWA shelters, providing canned food and bread.
• 243,291 IDPs received cash-based transfer (CBT) for food. Of those, 139,312 have been redeemed.
• 15,000 people redeemed their food e-vouchers in shops on 16 October. In addition, five trucks carrying 100 metric tonnes of food parcels and 15 metric tonnes of fortified biscuits from Dubai are expected to arrive in Al Arish, Egypt.
• WFP reached about 170,474 IDPs residing in UNRWA shelters on 16 October with 6,229 parcels of bread.
• 15,000 people redeemed their food e-vouchers in shops yesterday. Some 58 per cent in the northern and 42 per cent in the southern governorates.

Education

Priority Needs

• Safe access to schools and communities.

Planned Responses

• Provision of school-based psychosocial support and recreational activities for at least 70,000 children and school staff as soon as the situation allows.
• Emergency rehabilitation for at least 20 damaged schools, following a cluster rapid needs assessment.
• Provision of emergency supplies and learning kits to 10,000 children in DES and 50,000 children in schools once they reopen.
• Provision of catch-up classes, especially to displaced children (at least 20,000 children).

WASH (Water, Sanitation and Hygiene)

Priority Needs

• Provision of clean drinking water to the population.
• Provision of alternative power supply and 20,000 litres/day of emergency fuel to sustain the operation of WASH facilities, along with replenishing the chlorine supply for water treatment plants.
• Support to restore disrupted municipal services, including solid waste management, water, and sanitation operations, as appealed by the Gaza Strip municipalities.
• Delivery of essential WASH services and provisions to IDPs in collective centers, including drinking water and hygiene kits.

Planned Response to Date

• Providing 3 litres of bottled water per person per day in IDP shelters.
• Some 1,500 hygiene kits were distributed to the families in the UNRWA IDP centres
• Service hub planning in Rafah, Egypt with supply chain from local markets and/or agency stocks (including fuel and bottled water for quick recovery, hygiene kits, water storage bladder tanks, jerrycans, materials for treatment plans) and planning IDP kits for 300,000 people.
• Reviewing and checking feasibility of water trucking operations.

Protection against sexual abuse and exploitation (PSEA) remains a cross-cutting priority for all clusters. The SAWA helpline, reachable at 121 and through WhatsApp at +972 59-4040121 (East Jerusalem at 1-800-500-121), operates 24/7. This toll-free number is widely disseminated across all areas of intervention to report cases of SEA and to facilitate emergency counseling and referrals for affected communities to access life-saving services. The PSEA Network monitors calls daily and will increase the number of counselors if necessary.