Hostilities in the Gaza Strip and Israel | Flash Update #119

Key points

• Intense Israeli bombardment from air, land and sea continues to be reported across much of the Gaza Strip, resulting in further civilian casualties, displacement, and destruction of civilian infrastructure. Ground operations and heavy fighting between Israeli forces and Palestinian armed groups also continue to be reported, especially in Khan Younis and Deir al Balah. On 14 February, Palestinian armed groups in Gaza reportedly launched several rockets and missiles into Israel, with no casualties reported.  
• Between the afternoon of 14 February and 13:30 on 15 February, according to the Ministry of Health (MoH) in Gaza, 87 Palestinians were killed, and 104 Palestinians were injured. Between 7 October 2023 and 13:30 on 15 February 2024, at least 28,663 Palestinians were killed in Gaza and 68,395 Palestinians were injured, according to MoH in Gaza. 
• Between the afternoons of 14 and 15 February, there were no Israeli soldiers reported killed in Gaza. As of 15 February, 230 soldiers have been killed and 1,361 soldiers injured in Gaza since the beginning of the ground operation, according to the Israeli military. In addition, over 1,200 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities, the vast majority on 7 October. As of 15 February, the Israeli authorities estimate that about 134 Israelis and foreign nationals remain captive in Gaza and reportedly include fatalities whose bodies are being withheld. 
• Intensified airstrikes on Rafah, where more than half of Gaza’s population are crammed into less than 20 per cent of the Gaza Strip, and statements by Israeli officials have reportedly led to the movement of people out of Gaza’s southernmost governorate toward Deir al Balah. On 13 February, the Palestine Red Crescent Society (PRCS) reported that it has established a field hospital west of Rafah to provide medical services to the wounded and sick despite the shortage of medical supplies. On 14 February, the International Committee of the Red Cross (ICRC) emphasized that international humanitarian law “protects all civilians from the effects of hostilities, including those who may not be able to depart Rafah,” and added: “Israel, as the occupying power, must ensure that the basic needs of the civilian population are met. In addition, it is necessary … that the trickle of aid being let into Gaza becomes a steady, robust stream: food, drinkable water, hygiene items, medicines, and materials to do basic sanitation and allow for adequate shelter.” 
• As of the time of writing of this update, on 15 February, Israeli forces reportedly entered Nasser Hospital in Khan Younis, including the maternity department, according to MoH in Gaza. The Israeli military has alleged that Hamas was holding hostages or withholding the bodies of Israelis within the compound. These events are unfolding following the besiegement of the hospital, allegations of continued sniper fire in the vicinity, and sewage continuing to flood the emergency department. According to MoH in Gaza, following the forceful evacuation of thousands of people from the hospital under the orders of the Israeli military, and as of the evening of 14 February, more than 2,500 people remained in the hospital, including about 1,500 internally displaced persons (IDPs), about 490 health workers and their families, and 600 patients and their companions, including people in the intensive care unit and three babies in incubators. On 14 February, MoH in Gaza reported that a doctor was injured when the third floor of the hospital was hit. The orthopaedic department was also hit, killing one patient and injuring many others. On 14 February, the World Health Organization (WHO) Director-General, Tedros Adhanom Ghebreyesus, reported that two planned missions to reach the hospital over the past four days had been denied access and his staff have lost contact with the hospital personnel. “Nasser is the backbone of the health system in southern Gaza. It must be protected. Humanitarian access must be allowed,” he added.  
• Humanitarian and health workers continue to face enormous challenges and risks to serve people in need of urgent assistance and save lives, particularly given continued attacks on health facilities, the lack of supplies, and overcrowding. On 14 and 15 February, PRCS reported that Al Amal hospital building sustained damage due to intense shelling in the vicinity of the hospital. On 13 February, WHO reported that patients and health workers had evacuated the Patients Friends Association Hospital, in northern Gaza, in early February, and the hospital has been rendered out of service after sustaining severe damage. Between 7 October and 12 February, there were 378 attacks on health care across Gaza, affecting 98 health facilities and 98 ambulances, according to WHO. Some 65 per cent of these attacks were reported in Gaza and North Gaza governorates. Reporting from the European Gaza Hospital on 8 February, the Humanitarian Coordinator ad interim, Jamie McGoldrick, highlighted the need to bring in more supplies to ease the pressure on hospitals, noting that “the systems here are breaking down. We are not getting enough supply in here to support the doctors.” 
• Between 1 January and 12 February, 51 per cent of missions planned by humanitarian partners to deliver aid and undertake assessments to areas to the north of Wadi Gaza were denied access by the Israeli authorities. During the same period, 25 per cent of missions planned to areas assessed as necessitating coordination to the south of Wadi Gaza were denied by the Israeli authorities. Missions to areas not requiring coordination south of Wadi Gaza are not included in these statistics. 

Hostilities and casualties (Gaza Strip)

• On 13 February, at about 9:30, three Palestinians including a girl were reportedly injured when the boundary wall of the external hall of Rafah Crossing was shelled. 
• On 13 February, at about 13:00, two Palestinian journalists were reportedly injured when a group of journalists in the Mirage area in northern Rafah, were hit.  
• On 13 February, at about 14:00, six Palestinians including an unknown number of women and children were reportedly killed when a civilian car was reportedly hit in Ash Sheikh Radwan area in northern Gaza city. 
• On 14 February, at about 19:00, a handcuffed Palestinian detainee who was allegedly sent by Israeli forces to deliver a message to IDPs at Nasser hospital to evacuate, was reportedly shot and killed afterwards.  

West Bank Updates

• On 14 February, Israeli forces shot and killed a 16-year-old Palestinian boy and injured 18 others (including 10 children), all by live ammunition, during an Israeli army raid in the village of Beit Ummar in Hebron at the time of dismissal of students from schools. During the raid, clashes took place between Palestinian stone throwers and Israeli soldiers. 
• Since 7 October 2023, 389 Palestinians have been killed, including 100 children, and 4,499 Palestinians, including 697 children, have been injured in conflict-related incidents across the West Bank, including East Jerusalem, and Israel. During the same period, 10 Israelis, including four members of security forces, were killed and 75 injured in conflict-related incidents in the West Bank, including East Jerusalem, and Israel.  
• On 13 February, Israeli settlers, accompanied by Israeli forces, raided the village of Yasuf, in Salfit governorate, as well as threw stones and shot live ammunition at houses. As a result, one Palestinian was injured, and two houses sustained damage. In addition, settlers forced out some families picnicking near a water spring in the village. Since 7 October 2023, OCHA has recorded 537 Israeli settler attacks against Palestinians that resulted in Palestinian casualties (50 incidents), damage to Palestinian-owned property (427 incidents), or both casualties and damage to property (60 incidents).  
• On 14 February, the Israeli authorities demolished a residential structure comprising three housing units in Silwan, in East Jerusalem, due to the lack of building permits. As a result, three households comprising 11 people, including five children, were displaced. The residence belonged to the family of a community leader who has been outspoken against the demolition of Palestinian homes in East Jerusalem, particularly in Silwan. Since 7 October 2023, 524 people, including 256 children, have been displaced in Area C and East Jerusalem after their homes were demolished due to the lack of Israeli-issued building permits, which are almost impossible to obtain.  
• Since 7 October 2023, 814 Palestinians, including 332 children, have been displaced, following the destruction of 127 homes during operations carried out by Israeli forces across the West Bank. About 94 per cent of the displacement was reported in the refugee camps of Jenin, Nur Shams and Tulkarm.  

Funding

• The Flash Appeal for the occupied Palestinian territory (oPt) was extended through the end of March 2024 on a “no cost” basis given that enabling operational conditions for the implementation of planned activities did not materialize, and requirements were split between the last quarter of 2023 and the first quarter of 2024. The Flash Appeal, which was launched in October 2023 and updated in November 2023, requests US$1.2 billion to meet critical needs of 2.7 million people across the oPt (2.2 million in the Gaza Strip and 500,000 in the West Bank, including East Jerusalem). As of 13 February, member states disbursed a total of $900.7 million against the updated Flash Appeal (72.2 per cent); this includes $608.7 million out of $629.1 million (96.8 per cent) requested for October-December 2023 and $278.4 million out of $600 million (46.4 per cent) requested for January-March 2024. For funding analysis, please see the Flash Appeal Financial Tracking dashboard.
• The occupied Palestinian territory Humanitarian Fund (oPt HF) and the CERF are currently funding more than 94 ongoing projects in the Gaza Strip to address urgent humanitarian needs. These interventions, totalling approximately $77 million, cover needs in the areas of food security, shelter, water, sanitation and hygiene (WASH), health and protection. Since October 7, the oPt the HF has received a total of $86 million in contributions from member states and private donors. Private donations are collected directly through the Humanitarian Fund. Recently approved projects include $3.5 million for the Emergency Fleet Augmentation project that aims to enhance aid delivery to Gaza under the oPt HF, and $700,000 for “Strengthening Collective Gender Responsive and Inclusive Accountability to Affected People in OPT” under the CERF.

HUMANITARIAN NEEDS AND RESPONSE UPDATES | 5–12 February

Health

Needs

• High need for primary health services in informal shelters hosting IDPs.
• The high number of surgeries and procedures has led to increased demand for anaesthetic and analgesic medications which are in short supply.
• There is a need to increase routine immunization coverage and conduct a catch-up campaign.
• Provision of medication for non-communicable diseases and psychotropics is needed.
• There is a need to reduce overcrowding in maternity hospitals.
• The continued siege around some hospitals is significantly affecting their case management capacity.
• Laboratory equipment and reagents are needed to support diagnostics.
• Blood and blood products in hospitals are needed for emergencies and medical procedures to ensure that patients receive timely transfusions.

Response

• Cluster partners are reaching a weekly average of about 450,000 people in need of various health services and supplies.
• Ongoing disease surveillance at all health facilities is underway to ensure early diagnosis and treatment of cases as well as early detection of potential outbreaks.
• Planning to open stabilization centres for acute malnutrition cases with medical complications. One will be at Tal as Sultan and another in one of the field hospitals.
• 12 Emergency Medical Teams (EMTs) were deployed, assisting more than 16,000 patients.
• A weekly average of nearly 300,000 primary health care consultations was reported by partners.

Challenges and Gaps

• There is a need to strengthen referral mechanisms between hospitals.
• The influx of IDPs migrating to Rafah has overwhelmed the available bed availability in hospitals, leading to insufficient capacity to meet the healthcare needs of the population. Heigtened insecurity in Rafah is also greatly affecting response activities.
• Heightened insecurity and limited access to health facilities in the northern and middle governorates continue to present major challenges for partners to respond.
• Persisting siege of hospitals remains a major challenge.
• Referring patients outside of Gaza remains a challenge, as the waiting list continues to grow.
• Partner operations continue to be negatively affected by the displacement of staff, social stresses and telecommunication challenges.
• Limited access to proper WASH facilities is hindering prevention of diseases.

Nutrition

Needs

• There is a need for continued prepositioning of essential nutrition supplies to ensure timely access to life-saving supplies in areas facing significant challenges.
• Ongoing collaboration with partners is still needed to enhance capacity in Mid-Upper Arm Circumference (MUAC) screening, identify cases of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM), and the delivery of effective treatment.
• There is an urgent need to establish a stabilization centre in Rafah for treating children suffering from severe malnutrition and suffering from complications.

Response

• Thirty-six staff members (17 Female, 19 male) received training on MUAC screening to enhance early case identification and treatment. The training is crucial for enhancing the capacity of our partners and expanding MUAC screening across affected areas.
• Five implementing partners continue conducting screenings for malnutrition in 4,466 children aged 6 to 59 months, using MUAC measurements in shelters and health facilities. Children who are detected with MAM and SAM are referred for treatment using simplified treatment protocol.
• The Nutrition Cluster continues to conduct MUAC training sessions every week.
• UNICEF and WFP continue to collaboratively stock up nutritional supplies in the Gaza Strip and the West Bank.
• The Nutrition Cluster is partnering with WHO to set up a stabilization centre in Rafah with five beds to treat children with SAM and suffering from medical complications.

Challenges and Gaps

• Ongoing hostilities in Gaza have caused significant food shortages, poor access to clean water and sanitation facilities, and disruptions to healthcare services. This situation is putting children under five and pregnant or lactating women (PLW) at a relatively higher risk of malnutrition.
• Without private areas for breastfeeding women, it is challenging to encourage and sustain breastfeeding practices. This lack of privacy could have lasting negative effects, particularly on children under two years of age and new-born babies.

Shelter and Non-Food Items (NFI)

Needs

• Some 1.7 million people are need of shelter and NFI assistance, including 900,000 people reached with partial shelter and NFI assistance. Partial assistance means that although a household has received some shelter and NFI items, not all their needs have been met.
• Urgent needs are tents, sealing-off kits (SOKs) and NFIs, including bedding, kitchen sets, and winter clothing. SOKs can be used to consolidate makeshift shelters or to protect damaged housing to facilitate return where possible.
• Technical assistance is required to improve self-built shelters and spontaneous/informal sites. Also see Shelter Cluster snapshot, as of 7 February.

Response

• A total of 26 partners are providing assistance. Some 28,000 tents, 7,600 SOKs, and 35,000 NFI kits are currently in the pipeline.
• The vast majority of assistance is currently provided in-kind; cash will be pursued further when market conditions allow.
• Further details in the Cluster response strategy and website dashboard.

Challenges and Gaps

• Slow entry of items into Gaza due to limited aid trucks and bureaucratic processes are complicating procurement.
• Rising prices of shelter materials in neighbouring markets, including high freight rates and shipping costs.
• Need to restore commercial imports and re-establish local markets to relieve pressure on in-kind provision.
• Restrictions on or denial of the entry of key shelter items including timber, hand tools, and cooking stoves.
• Lack of security and access to IDP locations, including logistical challenges such as lack of fuel and rising social tensions because of the limited quantity of aid available in comparison to outstanding needs.
• Unplanned sites and lack of adequate tools is leading to water damage to makeshift shelters and tents, and recurrent displacement resulting in loss and need for re-distribution of assistance.

Water, Sanitation and Hygiene (WASH)

Needs

• Some 2.25 million people need WASH Assistance. Two-thirds of IDPs are concentrated in the Rafah area and urgently need WASH support.
• Access to safe drinking water for the entire population of Gaza is needed, especially for IDPs and in the northern areas of Gaza.
• Currently only 5.7 per cent of water is being produced from all the water sources in Gaza, compared to pre-war production levels. Safe drinking water and water for domestic use, including personal hygiene, remains very limited.
• Only 17 per cent of the 284 groundwater wells are operating with limited hours; some 39 wells were destroyed and 93 were moderately to severely damaged.
• None of the wastewater treatment systems are working due to damage, lack of fuel/power supply, and maintenance. Municipalities have limited water treatment, no water quality testing capacity, and no fuel for solid waste management, and operations have been suspended since 19 November 2023.
• Mekorot Connections: Two of the three water pipelines are not functioning (the Mentar pipeline since the beginning of the conflict, and the Bani Suhaila pipeline since 18 December. The Bani Saeed pipeline is functioning, but is currently producing 6,000 cubic metres per day, which is only 42 per cent of its full capacity. Plans are in place to repair the Bani Suheila pipeline, but there are challenges for safe access, communication, and coordination of repair activities.
• Two out of out of three desalination plans are partially operating: the Middle Area plant produces an average of 750 cubic metres per day and is distributed via water trucking and the South Gaza desalination plant produces 1,700 cubic metres per day; around 600 cubic metres are distributed via water trucking and 1,100 cubic metres via the water network.
• The UAE's small desalination plant located on the Egyptian side of Rafah, operates at full capacity, providing 2,400 cubic metres per day, following the construction of a 3-kilometre transmission line.

Challenges and Gaps

• The risk to public health is intensified due to an acute scarcity of hygiene materials and adequate sanitation infrastructure. Persistent anecdotal reports of Hepatitis A cases in Gaza, as recorded by UNRWA and the Health Cluster, highlight ongoing concerns.
• The constraints of the clearance and transport of items considered to be dual-use into Gaza remain a limiting factor of the overall WASH response.
• Sanitation remains a major issue and the situation continues to deteriorate. Despite significant efforts by UNICEF through its partners to construct 80 family latrines this week, the sanitation coverage remains very low. WASH partners continue to construct family latrines, but the lack of cement, wood and other construction materials slows down the progress.
• The crisis is exacerbated by a fuel shortage, hindering sewage station operation and leading to environmental and public health concerns. The situation is worsened by continuous restricted access to essential sanitation supplies and services in Gaza.

Education

Needs

• More than 625,000 students and nearly 23,000 teachers in the Gaza Strip have been affected by school closures and attacks on education, leaving them with no access to education or a safe place.
• According to the Ministry of Education, as of 6 February, more than 4,851 students and 239 educational staff have been killed and more than 8,227 students and 836 teachers have been injured in the Gaza Strip since 7 October.
• Some 92 per cent of all school buildings in Gaza are being used as shelters for IDPs and/or have sustained varying levels of damage. Some 392 schools (79 per cent of the total school buildings in Gaza) have sustained damage, including 141 schools that sustained major damage or were destroyed. Combined, these schools previously served some 457,019 children and more than 17,043 teachers. The North, Gaza, and Khan Younis governorates have been especially impacted, accounting for 76 per cent of all damaged schools (source: Education Cluster Damaged School Dashboard.)
• The Education Cluster conducted a Satellite-derived Damage Assessment of all Gaza schools to verify damage to schools based on proximity to damaged sites. Key findings include:
  • Satellite-derived Damage verification exercise confirmed the large level of damage to schools previously reported by the cluster in Gaza.
  • Actual damages to school infrastructure might be 15 to 20 per cent higher than what has been previously reported by the Education Cluster.
  • At least 55 per cent of schools in Gaza will either need full reconstruction or major rehabilitation work to be functional again.
  • One quarter of directly hit and damaged schools are UNRWA-run schools
  • Forty-five per cent of school buildings that have been used by IDPs as shelters, have been either directly hit or damaged.
  • The satellite-derived images provide evidence for military use of schools.
• Education partners are concerned about reports, videos and pictures depicting schools being used for military operations by Israeli forces, including their use as detention and interrogation centres, or as military bases.
• Key priorities include 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); establishing Temporary Learning Spaces (TLS) in shelters/DESs to start non-formal learning for children; and provision of emergency supplies and learning kits. In addition, a key need is to identify and support of children with disabilities and other needs, with assistive devices for learning.

Response

• Since October 2023, eleven partners have reached more than 135,126 students and teachers with psychosocial support, emergency learning, recreational supplies and activities, and awareness sessions in the Deir al Balah, Khan Younis, and Rafah governorates. Most of the cluster responses are delivered by local partners (source: Education Cluster 5W dashboard).
• UNICEF, with three of its partners and Teacher Creativity Centre, is working on establishing TLS to start non-formal education activities with displaced children in shelters/DESs.
• The Education and the Shelter Clusters are jointly carrying out advocacy activities to highlight the devastating impacts of the current situation in Gaza on children and the inextricable links between shelter and schooling.

Challenges and Gaps

• No activities have been undertaken in the North Gaza and Gaza governorates due to ongoing hostilities and access challenges.
• As of 11 February, the education response remains significantly underfunded, receiving less than 10 per cent of its requirements. Urgent funding is required to meet immediate response requirements.

Logistics

Response

• The Logistics Cluster has conducted the Gaps and Needs Analysis Survey to identify needs and gaps, and to adapt the Cluster`s strategy and services accordingly. Findings will be made available by mid-February.
• The Logistics Cluster has made available to partners an additional common warehouse in the North Camp of Rafah, bringing up the total storage capacity to 2,470 m2. The Logistics Cluster has secured storage space at the WFP warehouse in Amman with a capacity of 1,300 m2 for consolidation and pre-positioning of cargo.
• As of 11 February, the Logistics Cluster in Rafah has stored 6,696 cubic metres of cargo for of 16 organisations and supported 21 organizations with cargo notification service.
• On 6 February, the Logistics Cluster facilitated access for an inter-agency convoy (five partners), which transported a total of 335 metric tons of relief items on 24 WFP trucks from Jordan to Gaza, via the King Hussein Bridge.

Challenges and Gaps

• The storage and transport capacity inside Gaza remains limited. The Logistics Cluster continues to facilitate access to temporary storage, transport from handover points to common warehouses, and cargo notification trans-shipment services.
• The Logistics Cluster is coordinating the pipeline for incoming cargo through the Egyptian and Jordanian corridors for the coming three months. This is a vital exercise for operational planning, in terms of understanding the resources available and making allocations based on the prioritization list. Partners have received a dedicated form and are requested to update it weekly. Partners who have not received the form can reach out to [email protected].

Emergency Telecommunications  

Needs  

• Recurrent telecommunications shutdown in the Gaza Strip continues to restrict people from accessing life-saving information and is impeding other forms of humanitarian response.  

Response  

• On 8 February, the Emergency Telecommunications Cluster (ETC) presented a one-month telecommunications planning and implementation document to the Humanitarian Coordinator, Deputy Humanitarian Coordinator and other agencies in Rafah. The plan should inform humanitarian responders, clusters, and agencies about achievable telecommunication goals with or without the anticipated humanitarian pause, provided the successful importation of the required telecommunications equipment. 
• Since 9 January, the ETC has supported humanitarian agencies with Information and Communication Technology (ICT) assessments, technical advice and information, repairs, and guidance on the use of ICT equipment in Gaza.  
• Since its establishment on 3 November 2023, the ETC has been engaging with the Israeli authorities to obtain authorizations to import all essential telecommunications equipment into Gaza and provide independent access to communications for humanitarian responders. 

Challenges and Gaps  

• Limited access to electricity, fuel, and telecommunications services continues to hamper the humanitarian response in Gaza.  
• The import of telecommunications equipment into Gaza is fraught, lengthy, and extremely challenging. 

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 counselling and referrals for affected communities to access life-saving services. The PSEA Network monitors calls daily and will increase the number of counsellors if necessary.

* Asterisks indicate that a figure, sentence, or section has been rectified, added, or retracted after the initial publication of this update.