Hostilities in the Gaza Strip and Israel | Flash Update #129

Key Highlights

• The Ministry of Health (MoH) in Gaza reports that more than 100 Palestinians were killed on 29 February; according to media sources, the incident occurred when thousands of Palestinians reportedly gathered around trucks carrying supplies.
• The reported death toll among Palestinians in the Gaza Strip since the onset of hostilities has surpassed 30,000.
• UN officials are warning of an impending famine in Gaza; MoH in Gaza reports that six infants have died as a result of malnutrition and dehydration.
• A Palestine Red Crescent Society (PRCS) medical point in Jabalya, in northern Gaza, is receiving a daily average of 100-150 cases of Hepatitis A.
• A Palestinian child is killed in Beit Furik village in Nablus, bringing the death toll in the West Bank, including East Jerusalem, to 406 Palestinians, including 103 children, since 7 October.

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 northern Gaza, Deir al Balah, and Khan Younis.
• Between the afternoon of 28 February and 11:30 on 29 February, according to the Ministry of Health (MoH) in Gaza, 81 Palestinians were killed, and 132 Palestinians were injured. Between 7 October 2023 and 11:30 on 29 February 2024, at least 30,035 Palestinians were killed in Gaza and 70,457 Palestinians were injured, according to MoH in Gaza. Separately, MoH reported that 104 Palestinians have been killed and 760 were injured in the early morning hours of 29 February on Al Rashid Road south of Gaza city, warning that the actual death toll is likely to be higher as medical teams are struggling to handle the situation with limited critical care resources. The incident occurred as thousands of Palestinians reportedly gathered around trucks carrying supplies when they were allegedly hit by artillery shells and gunfire, according to initial media reports. The Israeli military, cited by the media, has reportedly acknowledged shooting by its troops, and has also said that most casualties occurred as a result of congestion and incidents of people being run over by trucks.
• Between the afternoons of 28 and 29 February, there were no Israeli soldiers reported killed in Gaza. As of 29 February, 240 soldiers have been killed and 1,431 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 29 February, the Israeli authorities estimate that 134 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies remain withheld in Gaza.
• In two separate incidents on 26 February, UNRWA reports that internally displaced persons (IDPs), including UNRWA staff, sheltering at two schools in Khan Younis were forced to evacuate and some were arrested by Israeli forces. One of the schools reportedly had the main gate, guard room, and generator damaged by Israeli tanks and bulldozers. One female IDP was reportedly killed during this incident – the circumstances are unclear at time of this writing. As of 28 February, according to UNRWA, at least 404 IDPs have been killed, and 1,385 others have been injured, in more than 330 incidents affecting UNRWA premises and shelters hosting IDPs since the escalation of hostilities in October.
• The risk of death from starvation in Gaza is reportedly growing, disproportionately affecting children and pregnant women, and is exacerbated by inadequate water, sanitation and health services, the severing of power and fuel supplies, and the decimation of food production and agriculture. MoH in Gaza reported that six infants have died as a result of malnutrition and dehydration, including two at Shifa Hospital on 28 February. A rise in anemia among pregnant women was also reported at Project HOPE’s clinic in Deir al Balah, where some 21 per cent of 416 pregnant women who visited the clinic between 5 and 24 February showed signs of malnutrition “caused by the lack of protein, iron, and other micronutrients, which can increase the risk of a life-threatening postpartum hemorrhage, premature births, and low birth weight.” According to the Food and Agriculture Organization (FAO), the entire food supply chain in Gaza has been severely disrupted with 97 per cent of ground water reportedly unfit for human consumption, about 27 per cent of greenhouses destroyed, more than 40 per cent of croplands and dozens of home barns, broiler farms and sheep farms damaged, more than 600 agricultural wells damaged, and the fishing sector grounded to a halt. On 28 February, the International Rescue Committee (IRC) and Medical Aid for Palestinians (MAP) highlighted that the significant damage incurred by the agricultural sector in Gaza combined with limited commercial food imports have led to food scarcity and soaring prices at a time when people’s purchasing power has declined. To prevent starvation in Gaza, the two aid organizations emphasized the criticality of safe and unimpeded aid flow via all possible routes, reactivating essential services in Gaza, and upscaling aid responses toward the early restoration of agrifood systems.
• Citing the danger of a “looming man-made famine,” UNRWA Commissioner-General Philippe Lazzarini stated that the Agency has been unable able to deliver food to northern Gaza since late January due to security incidents affecting the few aid convoys that are permitted to reach northern Gaza from the south via Israeli military checkpoints, and growing incidents of chaos and robbery. On 20 February, the UN World Food Programme (WFP) announced that it had paused deliveries of food aid to northern Gaza, following incidents where WFP convoys were unable to deliver aid largely due to a breakdown in civil order. The convoys had resumed on 18 February after a three-week suspension following a strike on an UNRWA truck and due to the absence of a functioning humanitarian notification system. In his address to the UN Security Council on 27 February, Ramesh Rajasingham, the Director of OCHA’s Coordination Division cited the warning by food security experts of “complete agricultural collapse in northern Gaza by May if conditions persist, with fields and productive assets damaged, destroyed, or inaccessible.” Reiterating the UN call for a ceasefire, Mr. Rajasingham cautioned that “if nothing is done, we fear widespread famine in Gaza is almost inevitable.”
• The health care system in Gaza is struggling to remain functional, amid severe shortages of fuel and medications, spread of infectious diseases, and access constraints. On 28 February, MoH in Gaza reported that Kamal Adwan Hospital in northern Gaza, has been rendered out of service due to the lack of electricity and fuel for its generator. According to UNICEF, Kamal Adwan Hospital is the primary hospital serving children and offering maternal health services in northern Gaza, and has been severely damaged amidst increased hostilities. Hundreds of thousands of Palestinians in the area, including IDPs, also continue to face rising food insecurity, overcrowding, and lack of clean water. PRCS reports that their medical point in Jabalya, in northern Gaza, which is managed by the association’s volunteers, has been receiving an average of 100-150 cases of Hepatitis A per day as well as many cases of infectious skin diseases.

West Bank Updates

• On 29 February, Israeli forces shot and killed a 17-year-old Palestinian child during a search-and-arrest operation in Beit Furik village in Nablus that involved clashes between Israeli forces and Palestinian stone throwers.
• On 29 February, a Palestinian man died of injuries sustained on 19 October 2023 during an Israeli military operation in Nur Shams Refugee Camp near Tulkarm city, which resulted in the killing of 13 other Palestinians, including the man’s 12-year-old son.
• Since 7 October 2023, 406 Palestinians have been killed, including 103 children, and 4,606 Palestinians have been injured, including 709 children, in conflict-related incidents across the West Bank, including East Jerusalem, and Israel. Since the beginning of the year, 93 Palestinians have been killed, including 26 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.
• On 28 February, the Israeli authorities demolished three homes in Al Walaja village in Bethlehem due to the lack of Israeli-issued building permits, displacing three families comprising 16 people, including six children. Since 7 October 2023, 592 people, including 282 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, OCHA has recorded 601 Israeli settler attacks against Palestinians that resulted in Palestinian casualties (53 incidents), damage to Palestinian-owned property (481 incidents), or both casualties and damage to property (67 incidents).
• Movement restrictions affecting an estimated 7,000 residents of H2 area in Hebron continue to be in place since 7 October, with checkpoints that control access to the area only open for Palestinian pedestrians between 7:00 and 19:00. Residents have also reported facing restrictions while moving between neighbourhoods within the H2 area.

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 Appealfor 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.