Hostilities in the Gaza Strip and Israel | Flash Update #127

Key Highlights

• On 27 February, the Humanitarian Country Team (HCT) said that humanitarian partners have been unable to reach northern Gaza and increasingly parts of southern Gaza safely, as aid convoys have come under fire and are systematically denied access to people in need.
• Allegations of shooting by Israeli forces at Palestinians waiting for humanitarian aid in Gaza city continue to be reported, raising concerns about the protection of civilians.
• HelpAge reports that the approximately 111,500 older people in Gaza are among those most at risk of hunger, dehydration, illness, injury, and death.
• Three Palestinians are killed in Tubas in the West Bank.

Gaza Strip Updates

• 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, particularly in Khan Younis, Gaza city and east Deir al Balah.
• Between the afternoon of 26 February and 10:30 on 27 February, according to the Ministry of Health (MoH) in Gaza, 96 Palestinians were killed, and 172 Palestinians were injured. Between 7 October 2023 and 10:30 on 27 February 2024, at least 29,878 Palestinians were killed in Gaza and 70,215 Palestinians were injured, according to MoH in Gaza.
• Between the afternoons of 26 and 27 February, there were no Israeli soldiers reported killed in Gaza. As of 27 February, 238 soldiers have been killed and 1,408 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 27 February, the Israeli authorities estimate that 134 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies remain withheld in Gaza.
• Allegations of shooting by Israeli forces at Palestinians waiting for humanitarian aid in Gaza city continue to be reported. On 25 February, at least 10 Palestinians were allegedly killed in two incidents of shelling and shooting at people who were gathering near the An Naboulsi roundabout, in expectation of an aid delivery.
• The following are among the deadliest incidents reported on 25 and 26 February:
  • On 25 February, at about 13:00, seven Palestinians were reportedly killed and 62 others were injured when several houses in Az Zaytoun neighbourhood in Gaza city were hit.
  • On 25 February, at about 16:00, people were reportedly killed and injured when the gate of the Ash Sheikh Redwan Clinic in northern Gaza city was hit.
  • On 25 February, at around 21:00, about 20 Palestinian bodies were reportedly retrieved from different areas in Khan Younis, including five bodies near Nasser Medical Complex.
  • On 25 February, at about 22:30, four Palestinians were reportedly killed, including a woman and a child, and others were injured when a house in An Naser area in Rafah was hit.
  • On 26 February, at about 9:00, four Palestinians were reportedly killed, and three others were injured, when a civilian car and a nearby group of Palestinians were hit in Abu Al Ajin area, in eastern Deir al Balah.
  • On 26 February, at about 10:15, two Palestinian fishers were reportedly killed when the coast off Khan Younis was struck by naval fire.
• On 25 February, the Palestine Red Crescent Society (PRCS) and a United Nations team evacuated 24 patients from Al Amal hospital in Khan Younis. The hospital was subject to a prolonged siege and raids by the Israeli military until 22 February, which resulted in at least 25 fatalities, and rendered it ‘minimally functioning’ according to the World Health Organization (WHO). Despite prior coordination with the Israeli authorities for the staff members and vehicles, Israeli forces blocked the convoy, forced patients and staff from ambulances and stripped the paramedics of their clothes. Three of the PRCS paramedics were subsequently detained, delaying the convoy for over seven hours. Two of the paramedics remain in detention. On 26 February, the PRCS announced the suspension of all humanitarian coordination procedures on medical missions in Gaza for 48 hours, due to “failure to ensure the safety and security of the Society’s Emergency Medical Services teams, the wounded and the sick in PRCS hospitals, centres and ambulances.” On 27 February, regarding the medical evacuation, the Humanitarian Country Team (HCT) in Palestine stated that this was not an isolated case, as aid convoys have come under fire and are systematically denied access to people in need. Furthermore, humanitarian workers have been harassed, intimidated or detained by Israeli forces, and humanitarian infrastructure has been hit, the statement said, indicating that the requirements for the meaningful facilitation of relief efforts have been consistently communicated to the Israeli authorities. As a result of inadequate facilitation of relief operations, humanitarian partners are unable to reach northern Gaza and increasingly parts of southern Gaza safely. The HCT pledged to continue to engage with Israeli forces so that the critically needed humanitarian response is enabled.
• According to a report by HelpAge, the approximately 111,500 older people in Gaza are among those most at risk of hunger, dehydration, illness, injury, and death. Prior to the current hostilities, older people in Gaza were already living with the long-term impact of conflict and displacement, with reduced access to essential health and social services. Older people are also disproportionality affected by non-communicable diseases and are likely to be severely impacted due to damage to health infrastructure and shortages in medication, the report said. Older people who have had to evacuate are said to be mostly accommodated in overcrowded shelters that are inadequate to meet their needs, as many require support to manage chronic health issues and disabilities. Older women often face violence, abuse and neglect because of their age, gender, or other factors such as disability or being a widow, according to the report. These risks are compounded in humanitarian crises for women of all ages on the move and living in emergency shelters. HelpAge is calling for safe, full, and unimpeded humanitarian access to ensure that all affected people, including older people and people with disabilities, can be reached and can access urgently needed basic services and humanitarian assistance.

West Bank Updates

• On 27 February, Israeli forces shot and killed three Palestinians, and another Palestinian was injured, in two separate military operations in Tubas city and the nearby El Far'a Refugee Camp (both in Tubas). The raid in the camp involved an exchange of fire between Palestinians and Israeli forces and the throwing of pipe bombs and stones by Palestinians. Two of the fatalities, including a bystander, were killed in this incident. Initial information indicates that Israeli forces bulldozed multiple sections of streets in the camp, causing damage to infrastructure, including water networks, resulting in continuous water cut-offs. The third fatality occurred when a unit of undercover Israeli forces entered Tubas city and shot him. Reportedly, there was no exchange of fire.
• Since 7 October 2023 and as of 27 February, 403 Palestinians have been killed, including 102 children, and 4,590 Palestinians have been injured, including 708 children, in conflict-related incidents across the West Bank, including East Jerusalem, and Israel. Since the beginning of the year, 90 Palestinians have been killed, including 25 in refugee camps. During the same period, 13 Israelis, including four members of Israeli forces, were killed and 86 injured in conflict-related incidents in the West Bank, including East Jerusalem, and Israel.
• Since 7 October 2023, 576 people, including 276 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.
• According to the latest field assessments, since 7 October 2023, 848 Palestinians, including 397 children, have been displaced, following the destruction of 132 homes during operations carried out by Israeli forces across the West Bank. About 95 per cent of the displacement was reported in the refugee camps of Jenin, Nur Shams and Tulkarm.
• Since 7 October 2023, OCHA has recorded 590 Israeli settler attacks against Palestinians that resulted in Palestinian casualties (52 incidents), damage to Palestinian-owned property (472 incidents), or both casualties and damage to property (66 incidents).
• Since 7 October, the Cash Working Group (CWG) has supported hundreds of conflict-affected Palestinian families in the West Bank through emergency multi-purpose cash assistance. Those include 98 households, comprising 581 individuals, from 15 communities, who were displaced due to settler violence; over 600 households affected by curfews in the H2 area of Hebron; and 131 families, comprising 662 people, affected by military operations in Jenin. In addition, 457 Gazan patients that are stranded in the West Bank were assisted with up to three payments to meet their most urgent needs.
• Between 25 and 26 February, some 50 Palestinians were arrested across the West Bank, including East Jerusalem. Over 5,700 Palestinians have been arrested since 7 October.

Humanitarian Needs and Response Updates | 20–26 February

Health

Needs

• There is a crucial need to expand primary healthcare services within informal shelters; enhance routine immunization coverage; deliver medication for non-communicable diseases; extend sexual and reproductive health services; establish additional field hospitals in various locations across the Gaza Strip; ensure the availability of laboratory equipment, reagents and blood products.
• Following two reported cases of death among children due to Severe Acute Malnutrition (SAM) stemming from inadequate food supplies, there is an urgent need to access northern Gaza to deliver food and establish SAM stabilization centres along with outpatient therapeutic feeding programmes.

Response

• Between 12 and 18 February, 45 health cluster partners delivered primary and secondary healthcare services across Gaza, reaching 124,800 people.
• WHO, in collaboration with OCHA and PRCS, led missions to Nasser Medical Complex, Al-Amal, and European Gaza hospitals to evacuate critical patients to the International Medical Corps (IMC), United Arab Emirates, and Indonesian field hospitals as well as Al Aqsa Hospital. The team also prepositioned medicines, medical supplies, and fuel and provided hot meals and water.
• With the support of WHO, the IMC field hospital increased its bed capacity from 98 to 150.
• UNFPA and WHO have successfully identified and deployed 72 midwives across various shelters and at designated medical points to provide services for spontaneous vaginal deliveries, antenatal care and family planning.
• Medical Global, with WHO’s support, established a SAM stabilization centre in Tell As Sultan primary healthcare centre in Rafah with a capacity of five beds. Additionally, preparation for a training session for 32 healthcare workers on the management of SAM cases with medical complications is underway.

Challenges

• Shortages of fuel, food, medicine, and medical supplies at hospitals in northern Gaza and lack of access to the area.
• Continued hostilities in Khan Younis pose significant barriers to accessing healthcare.
• Following the strike on MSF’s guest house on 20 February, intensified efforts to ensure the safety of humanitarian guest houses throughout Gaza are urgently needed.
• The increase of bloody and watery diarrhea can be directly attributed to the lack of safe drinking water, posing a significant public health challenge.
• The absence of segregated sanitation facilities and electricity within shelters presents a considerable safety risk, depriving women and girls of secure environments and thereby increasing their vulnerability to sexual violence.

Nutrition

Needs

• A new report by the Global Nutrition Cluster highlights a steep rise in malnutrition among children and pregnant and breastfeeding women in the Gaza strip.
• Sustained collaboration with partners is needed to enhance their capacity in various nutrition response areas, including Mid-Upper Arm Circumference (MUAC) screening capacity, identifying cases of Severe Acute Malnutrition (SAM) and Moderate Acute Malnutrition (MAM), and facilitating treatment using simplified protocols.
• There is a crucial need to expand MUAC screening into northern Gaza, where the situation is deteriorating rapidly and there is limited capacity.
• Continued distributions of supplementary nutrition food and blanket supplementary food to those in need to prevent malnutrition.

Response

• Five implementing partners continue conducting screenings for malnutrition among children aged 6 to 59 months, using MUAC measurements in shelters and health facilities. In total, 10,963 children aged 6-59 months underwent MUAC screening. Children with SAM and MAM are receiving treatment through the simplified treatment protocol.

Challenges

• Restricted access to northern Gaza significantly contributes to insufficient humanitarian aid delivery, leading to concerns about food insecurity and the possibility of widespread starvation and fatalities due to hunger.

Food Security

Needs

• The food security situation continues to be extremely critical across Gaza, particularly in northern Gaza, with people reportedly feeding their children animal fodder. Vulnerable segments of the population, including children, the elderly and people with underlying health conditions, are particularly exposed to the risk of malnutrition and famine.
• The food security situation in the Middle Area and southern governorates is also critical, with most of the population queuing for hours to receive food when trucks manage to enter. In Rafah, the situation is increasingly concerning, with growing reports of people stopping aid trucks to take food and eat it immediately.
• There is an urgent need to increase the fleet of delivery trucks.
• There is an urgent need to import the agricultural inputs necessary for reactivating domestic production of essential fresh foods like eggs, vegetables, meat, fish and milk to ensure the availability of a balanced nutrition.
• There is a need to establish secure and uninterrupted humanitarian corridors, with the support of the private sector and a focus on critical resources like fuel and cooking gas.

Response

• Between 19 and 25 February, a total of 18 partners engaged in providing food assistance across the Gaza Strip, reaching around 1.7 million people with food assistance at least once. Rafah Governorate received about 45 per cent of the total food assistance, followed by Deir al Balah (24 per cent), Khan Younis (15 per cent), and northern Gaza Strip (15 per cent).

Challenges

• Operating partners are reporting a lack of food to distribute, and some are reporting that existing stocks will last for only two days.
• The large number of people reached with hot meals is still insufficient to meet daily nutritional requirements.
• Ongoing airstrikes and heavy fighting in Gaza continue to affect the flow of food, posing challenges for the conduct of safe and efficient humanitarian operations. Frequent border closures, restrictions, and security concerns hinder the delivery of a consistent and dependable food supply.
• Rafah crossing is now working at a reduced rate and Karem Shalom is encountering closure due to Israeli demonstrators preventing trucks from entering. The humanitarian community is engaging with all relevant stakeholders to address this issue.

Protection

Needs

• Identification, tracing and reunification as well as interim and alternative care arrangements are critically needed for unaccompanied, previously detained and separated children.
• Provision of MHPSS, including psychological first aid (PFA) and specialized counselling, and winter clothing and blankets are urgently needed for children and newborn babies.
• Re-establishment of emergency Gender-Based Violence (GBV) services and referral pathways, including health services for GBV survivors, Clinical Management of Rape (CMR), MHPSS, as well as safe spaces and shelters are needed.
• There is a need for a continuous pipeline to distribute dignity kits and Menstrual Hygiene Management (MHM) supplies for over 690,000 menstruating women and girls.
• A comprehensive Humanitarian Mine Action (HMA) response is needed given the likely scale of Explosive Ordnance (EO) contamination despite the absence of formal large-scale assessments of contamination levels.
• There is a need for deployment of Explosive Ordnance Disposal (EOD) operators to conduct explosive hazard assessments of safe sites for humanitarian response, in addition to training for humanitarian workers and messaging tailored to different groups on Explosive Ordnance Risk Education (EORE) and Conflict Preparedness and Protection (CPP).
• Victim Assistance (VA) services for survivors of shelling and explosive ordnance-related accidents are also needed.

Response

• Child Protection partners have reached 267,511 boys and girls and 27,307 women and men through awareness-raising interventions, MHPSS, identification and registration of unaccompanied and separated children, and distribution of clothing kits.
• GBV sub-cluster partners have provided 26,800* women and girls with 104,320 packs of sanitary napkins, which is sufficient to cover needs for the next 3 months, as well as a total of 3,500 Dignity Kits and 8,926 MHM kits.
• GBV responders are conducting procurement and distribution of CMR kits, and identification of health service points to provide CMR.
• Partners are exploring ways to establish emergency safe spaces, to provide PFA and recreational activities for vulnerable women and girls. Partners continue to expand PFA services for vulnerable groups, including GBV survivors, through frontline responders.
• Mine Action (MA) partners are actively engaged in carrying out Explosive Threat Assessments to the prioritized humanitarian sectors, delivering EORE and CPP sessions, producing educational materials, conducting digital campaigns, Radio and SMS campaigns, tailoring them to people with disability needs, and exploring partnerships with local organizations to enhance their reach and impact.
• To ensure a well-coordinated effort, the MA sub-cluster has now established active bi-weekly technical working groups on EORE-CPP, GIS, and will soon initiate an explosive ordnance disposal forum for Gaza.*

Challenges

• Difficulties in providing sufficient urgent and safe alternative temporary care arrangements for unaccompanied children, especially adolescents, due to physically and resource-exhausted families and communities, extreme overcrowding and continuous insecurity.
• Limited access prevents the provision of critical protection services to thousands of affected people.
• Obtaining authorization to deploy MA personnel, especially EOD operators for EO contamination assessments; restrictions on importing essential humanitarian mine action supplies; and unreliable communication systems that interfere with EORE, messaging, and coordination activities.

Logistics*

Response

• Storage and transport capacity inside Gaza remains challenging with ongoing assessments for identification of additional storage options. The Cluster continues to facilitate access to temporary storage, transport, and cargo notification transshipment services.   
• The Logistics Cluster delivered an online training on the Service Request Forms (SRF), for storage and transport bringing together 79 participants.  
• IMPACCT Working Group and the Logistics Cluster organized an information session with UN agencies on customs clearance challenges in Jordan. A second session with International NGOs is already planned for the following week.   
• The Logistics Cluster common service provision in Port Said, Egypt will be discontinued at the end of February as storage is not identified as current gap. Assessment of logistics gaps and needs remains ongoing.  
• As of 25 February 2024, the Logistics Cluster received for storage 6,251 m3 of cargo on behalf of 17 organisations in Gaza in total, and so far supported 21 organisations with cargo notification services in Rafah.   
• The last convoy of 23 trucks from Amman – King Hussein Bridge - Gaza departed on 14 February, and it took nine days to reach Rafah due to protests in Nitzana—upcoming convoy date to be shared. So far, through Jordan corridor, the Logistics Cluster facilitated partners` access to the inter-agency convoy, transporting a total of 3,596 mt of relief items on 267 trucks on behalf of six partners, taking the King Hussein Bridge route. 

Challenges and Gaps

• The storage and transport capacity inside Gaza remains challenging with ongoing assessments for identification of additional storage options. The Logistics Cluster continues facilitating access to temporary storage, transport, and cargo notification transshipment services.  
• The Logistics Cluster is collecting the pipeline for incoming cargo through the Egypt and Jordan corridors for the coming three months. This is a vital exercise for operational planning, understanding the resources available and allocating based on the prioritization list. Partners have received a dedicated form for their organisation via email and are requested to update it every Sunday. Partners who have not received the form can reach out to [email protected].

Emergency Telecommunications

Needs

• There is an urgent need for independent communication platforms for responders in Gaza to coordinate emergency response and deliver aid, amid ongoing communication blackouts and unreliable/intermittent access to telecommunication services.
• There is a crucial need to import all essential satellite-based communications equipment (sat phones, data solutions), Security Communications Systems (VHF Radios and networks), and power solutions (solar power solutions, generators).

Response

• Since its establishment, the ETC has been engaging with the Israeli authorities to obtain authorization to import all essential telecommunications equipment into Gaza and provide independent access to communications for humanitarian responders.
• The ETC has been supporting humanitarian agencies in Gaza with Information and Communication Technology (ICT) assessments, technical advice and information, repairs, and guidance on the use of ICT equipment. Since 9 January, the ETC has conducted 16 ICT assessments in 13 locations in Rafah, and supported 17 humanitarian agencies with ICT repairs, technical advice, and guidance on the use of ICT equipment to maximize the available telecommunications resources on the ground.
• 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 impede the humanitarian response in Gaza.
• The process of importing telecommunications equipment into Gaza remains lengthy and extremely challenging.

Multi-Purpose Cash Assistance (MPCA)

Response

• Between 19 and 25 February, 27,028 households received one round of emergency MPCA. Cash out operations are concentrated in the governorates south of Wadi Gaza, with the majority being reported in Rafah. As of 25 January, one round of emergency MPCA was delivered to some 160,000 households, a top-up was delivered to 35,000 people (including people with disabilities and nursing mothers), and over 16,000 households have received a second round.
• Since 7 October, some 116,000 households have cashed out their assistance, and about 5,400 payments have been cancelled after not being cashed out for months mainly due to the lack of connectivity and available agents (especially north of Wadi Gaza). Provided assistance falls well short of need given market collapse and price volatility.
• Based on the last post-distribution monitoring data (PDM) collected between mid-January and mid-February, food remains the most purchased item with humanitarian cash (80 per cent), followed by medicines (39 per cent), water (23 per cent), hygiene bedding (10 per cent), and transportation. PDM data show that cash remains a relevant modality of assistance which can be used by recipients to access goods and services that remain available.

Challenges

• Poor electricity supply and connectivity is affecting the ability of financial service providers to make cash accessible, compromising the encashment of the MPCA package.
• Since late December, commercial trucks have sporadically entered Gaza, with 830 trucks recorded as of 26 February. Informal markets are the primary source of accessible goods, which complicates efforts to track distributions and gather market data.

Funding

• The Flash Appeal for the occupied Palestinian territory (oPt), which 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), was extended through the end of March 2024. As of 26 February, member states disbursed nearly $906 million against the updated Flash Appeal (74 per cent); this includes about $616 million out of $629 million (98 per cent) requested for October-December 2023 and $291 million out of $600 million (48 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 Central Emergency Relief Fund (CERF) are currently funding more than 94 ongoing projects in the Gaza Strip to meet urgent humanitarian needs, notwithstanding constraints on the entry and delivery of aid into and within the Gaza Strip. These interventions, totalling about $88 million, address needs in the areas of food security, shelter, water, sanitation and hygiene (WASH), health and protection. Since October 7, the oPt HF has received a total of $88 million in contributions from member states and private donors. Private donations are collected directly through the Humanitarian Fund.

Protection against sexual abuse and exploitation (PSEA) remains a cross-cutting priority for all clusters. Aid distribution must be delivered with dignity and respect. Any wrongdoing can be reported through SAWA toll-free number 164. SAWA will assist and provide services free of charge and with the utmost confidentiality. 

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