Hostilities in the Gaza Strip and Israel | Flash Update #128

Key Highlights

• The UN Secretary-General stated that an Israeli offensive on Rafah would “put the final nail in the coffin” of humanitarian aid programmes in Gaza. 
• Health workers across Gaza continue to face enormous risks and challenges to save lives as the health care system struggles to remain functional. 
• MoH in Gaza reports that two infants died in northern Gaza as a result of dehydration and malnutrition, as a quarter of Gaza’s population faces catastrophic levels of food insecurity. 
• According to UNRWA, more than 2,300 trucks have entered Gaza so far in February, a nearly 50 per cent reduction compared to January 2024. 

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. On 27 February, Palestinian armed groups fired several rockets towards southern Israel, with no reports of injuries or damage. Ground operations and heavy fighting between Israeli forces and Palestinian armed groups also continue to be reported, particularly in Khan Younis, Gaza city and Deir al Balah. On 26 February, the UN Secretary-General told the UN Human Rights Council in Geneva that an Israeli offensive on Rafah, the location of “the core of the humanitarian aid operation,” would be “terrifying for more than a million Palestinian civilians sheltering there…[and] put the final nail in the coffin of our aid programmes.”  
• Between the afternoon of 27 February and 11:00 on 28 February, according to the Ministry of Health (MoH) in Gaza, 76 Palestinians were killed, and 110 Palestinians were injured. Between 7 October 2023 and 11:00 on 28 February 2024, at least 29,954 Palestinians were killed in Gaza and 70,325 Palestinians were injured, according to MoH in Gaza.  
  • The following are among the deadliest incidents reported on 26 February: 
  • On 26 February, at about 13:30, two Palestinians were reportedly killed when a house in eastern Al Bureij, in Deir al Balah, was hit.  
  • On 26 February, at about 17:00, five Palestinians were reportedly killed when a house in Al Qarara area, in northern Khan Younis, was hit.  
  • On 26 February, at about 19:00, eight Palestinians including three children were reportedly killed, and others were injured, when a house in the vicinity of Kuwait Hospital, in central Rafah, was hit.  
  • On 26 February, at about 21:00, three Palestinians were reportedly killed, and others were injured, when a house was hit in Deir al Balah. 
• Between the afternoons of 27 and 28 February, there were two Israeli soldiers reported killed in Gaza. As of 28 February, 240 soldiers have been killed and 1,429 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, the vast majority on 7 October. As of 28 February, the Israeli authorities estimate that 134 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies remain withheld in Gaza.  
• Health workers across Gaza continue to face enormous risks and challenges to save lives, as the health care system struggles to remain functional amid continued hostilities, access constraints, lack of supplies, and an overwhelming patient load per health-care worker. Reflecting on her experience at Nasser Hospital in Khan Younis in January, MedGlobal’s medical director, Dr. Nahreen Ahmed, describes a situation where “death [is[ happening in a fully treatable situation” due to the lack of medications and supplies, and doctors are operating to the sound of gunfire and missile strikes. Dr. Ahmed further states that injured persons’ limbs are amputated without anesthesia, and the delivery of urgent medical supplies “can often take weeks to months.” More than 1,000 children are reported to have suffered a loss of limb  because of the bombing since the onset of hostilities, according to UNICEF.  
• On 27 February, MoH reported that some 120 patients still require medical evacuation from Nasser Hospital, the largest hospital in southern Gaza, which has become non-functional and requires urgent repairs to restore running water and electricity, and to cope wih the disposal of solid waste and sewage overflow. MoH also called for the release of 70 health personnel who were detained by Israeli forces during a raid on the hospital, following weeks of heavy fighting in its vicinity and shelling that caused damage to the orthopaedic department. Between 18 and 23 February, the Palestine Red Crescent Society (PRCS) evacuated 72 critically wounded and sick patients from the hospital, with the support of the World Health Organization (WHO) and OCHA. As of 28 February, 64 per cent of hospitals in Gaza have become non-functional (23 out of 36), with the remainder only partially or minimally functional, according to WHO. The situation is especially critical in Rafah where the influx of internally displaced persons (IDPs) has overwhelmed available hospital bed capacities, and in northern Gaza where access by Emergency Medical Teams (EMTs) remains challenging. Between 7 October and 20 February, WHO documented 378 attacks on health care across Gaza that resulted in the killing of 659 people and the injury of 843 others.   
• The food insecurity and malnutrition crisis in Gaza is intensifying. On 27 February, MoH in Gaza reported that two infants had died in Kamal Adwan Hospital in northern Gaza, as a result of dehydration and malnutrition. Food Security Sector (FSS) partners are reporting a lack of sufficient basic food supplies and  an urgent need to import the agricultural inputs necessary for reactivating domestic production of essential fresh food, such as  eggs, vegetables, meat, fish and milk.  Children, pregnant and breastfeeding women, the elderly, people with underlying health conditions, and tens of thousands of injured persons are at  high risk of malnutrition, as are hundreds of thousands of Palestinians in northern Gaza, which has been largely cut off from assistance despite some relief efforts. In a briefing to the Security Council on food security risks in Gaza on 27 February, Director of OCHA Coordination Division, Mr. Ramesh Rajasingham, highlighted recommendations to ensure, among others, “the lifting of restrictions on fishing activity, access to farmland and the entry of agricultural products,” warning that if no action is taken, “widespread famine in Gaza is almost inevitable.” According to projections by the Integrated Food Security Phase Classification (IPC) for the period between 8 December and 7 February, the entire population of the Gaza Strip faces crisis or worse levels of food insecurity, including more than half a million people, or one in four households, facing catastrophic conditions characterized by lack of food, starvation and exhaustion of coping capacities.  
• According to Médecins Sans Frontières (MSF), the “prolonged and unpredictable administrative procedures” which Israel imposes on aid deliveries to Gaza are impeding access to lifesaving equipment and supply for health care facilities. Because of strict screening procedures, it can take up to one month for supplies to enter Gaza, and if the Israeli authorities deny entry to reject even a single item, the entire cargo is returned to Egypt. With no official list of restricted items, MSF reports that it has consistently been denied the import of power generators, water purifiers, solar panels, and other medical equipment. According to the MSF project coordinator in Gaza: “These supplies mean the difference between life and death for many people,” including thousands who suffer from chronic diseases such as cancer, diabetes or epilepsy.  WHO reports that referring patients outside of Gaza for tertiary care is also a challenge, with 2,293 patients and 1,625 companions permitted to exit through the Rafah Crossing since the onset of hostilities, while more than 8,000 patients are currently on the waiting list. UNRWA is also reporting difficulties in having its trucks enter Gaza due to security constraints and temporary closures at both the Kerem Shalom and Rafah Crossings. According to UNRWA, more than 2,300 trucks have entered Gaza so far in February, a nearly 50 per cent reduction compared to January 2024, and far short of the estimated 500 trucks needed each day to meet people’s basic needs. Security has been severely impacted due to the killing of several Palestinian policemen in Israeli airstrikes near the Kerem Shalom Crossing recently, which has led to the withdrawal of the policemen from the Palestinian side of the crossing, and trucks being stopped and their contents either robbed or taken directly by residents deeply in need of assistance. 

West Bank Updates

• On 27 February, Israeli forces shot and killed a Palestinian man near An Nu'man checkpoint near Al Khas community in Bethlehem. The man was reportedly trying to bypass the checkpoint through an informal opening in the Barrier fence on foot.  
• Since 7 October 2023, 404 Palestinians have been killed, including 102 children, and 4,592 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, 91 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. 
• On 26 February, a group of armed Israeli settlers, believed to be from Telem settlement, raided At Taybe village in Hebron and handcuffed and detained three elderly farmers while they were working on their land, according to eyewitnesses. The farmers were taken to a military base near Tarqumiya checkpoint for several hours before they were released. Landowners report that they have been regularly prevented from reaching their land by Israeli forces and/or settlers since 7 October. In total, OCHA has recorded 595 Israeli settler attacks against Palestinians that resulted in Palestinian casualties (52 incidents), damage to Palestinian-owned property (477 incidents), or both casualties and damage to property (66 incidents), since 7 October 2023. 
• 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. These 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 who have been stranded in the West Bank were assisted with up to three payments to meet their most urgent needs.  
• On 27 February, Israeli forces installed a roadblock at the main entrance to Rantis village, west of Ramallah, impacting the daily movement of more than 3,600 people. Since 7 October, the Israeli army has installed dozens of new obstacles to movement throughout the West Bank, including road gates, earth-mounds and roadblocks, exacerbating the access and movement of Palestinians that had been impeded by some 645 obstacles prior to 7 October. The restrictions disconnect cities, villages and vulnerable communities from one another, and disrupt communities’ access to basic services and the delivery of humanitarian aid. 

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. UNICEF estimates that some 17,000 children are unaccompanied or separated. 
• 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 $907 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.