Fuel delivery to power lifesaving operations at Kamal Adwan Hospital, the only paediatrics hospital in the north of Gaza. Photo by OCHA, 19 March 2024

Hostilities in the Gaza Strip and Israel | Flash Update #143

20 Mar 2024

Key Highlights

Patients and medical doctors lack food and water as hospitals across Gaza struggle to maintain operations and save lives, the World Health Organization (WHO) warns.
The UN High Commissioner for Human Rights calls for unfettered humanitarian and commercial access into and across Gaza to prevent famine.
Some 25 patients are scheduled to be returned to Gaza from East Jerusalem on 21 March.

Gaza Strip Updates

Intense Israeli bombardment and ground operations as well as heavy fighting between Israeli forces and Palestinian armed groups continue to be reported across much of the Gaza Strip, particularly in southeastern Gaza city and areas surrounding Al Shifa Hospital. This has resulted in further civilian casualties, displacement, and destruction of houses and other civilian infrastructure.
Between the afternoon of 19 March and noon on 20 March, according to the Ministry of Health (MoH) in Gaza, 104 Palestinians were killed and 162 Palestinians were injured. Between 7 October 2023 and noon on 20 March 2024, at least 31,923 Palestinians were killed in Gaza and 74,096 Palestinians were injured, according to MoH in Gaza.
The following are among the deadly incidents reported on 18 and 19 March:
- On 18 March, at about 19:10, at least eight Palestinians were reportedly killed when a group of people in Beit Hanun, in North Gaza, was hit.
- On 18 March, at about 19:05, eight Palestinians, including a Palestinian Lieutenant Colonel responsible for securing the entry of aid trucks to northern Gaza, his wife and children, were reportedly killed when a residential building in Jabalya city, in North Gaza, was hit.
- On 18 March, at about 19:20, one Palestinian was reportedly killed, and at least six others were injured, when the building of Al Bureij Municipality, in Deir al Balah, was hit and reportedly destroyed.
- On 18 March, at about 21:30, six Palestinians including a woman and a young girl, were reportedly killed, and others injured, when a house in western An Nuseirat refugee camp, in Deir al Balah, was hit.
- On 18 March, at about 23:50, five Palestinians including three children and a woman were reportedly killed when an apartment in Az Zohour neighbourhood, in Rafah, was hit.
- On 18 March, at about 22:00, six Palestinians were reportedly killed, and others injured, when a house belonging to a Palestinian journalist in Al Amin area of Sheikh Radwan neighbourhood, in Gaza city, was hit.
- On 19 March, in the morning, nine Palestinians were reportedly killed when a house on Al Jalaa Street, in Gaza city, was hit.
- On 19 March, at about 11:50, 15 Palestinians were reportedly killed when a house in central Gaza city was hit.
Between the afternoons of 19 and 20 March, one Israeli soldier was reported killed in Gaza. As of 20 March, 250 soldiers have been killed and 1,496 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 20 March, the Israeli authorities estimate that 134 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies are withheld.
The Israeli military operation inside and around Al Shifa hospital in Gaza city continued for the third successive day, with reports of heavy exchange of fire between Israeli forces and Palestinian armed groups. According to the Israeli military, some 90 armed Palestinians were killed and 300 suspects were detained including 160 who were transferred to Israel for further questioning. The Gaza Government Media Office reported that civilians, including children, were among the fatalities. The MoH in Gaza called on international organizations to help protect the wounded and sick patients and medical staff at Al Shifa Hospital, also noting that they have been unable to break their fast due to the lack of water and food as Israeli forces continue to besiege the hospital. Expressing concern about the sporadic and slow access to hospitals, WHO stated on 18 March that they and their partners “have been carrying out high-risk missions to deliver medicines, fuel and food for health workers and their patients, but … requests to deliver supplies are often blocked or refused. Damaged roads and continuous fighting, including in and close to hospitals, mean deliveries are few and slow.” WHO further highlighted that when teams do reach hospitals, they “meet exhausted and hungry health workers who ask us for food and water. We see patients trying to recover from life-saving surgeries and losses of limbs, or sick with cancer or diabetes, mothers who have just given birth, or newborn babies, all suffering from hunger and the diseases that stalk it.” In a briefing on 18 March, Humanitarian Coordinator ad interim, Jamie McGoldrick, described “the industrial scale destruction” he had recently witnessed on his way to visit Al Shifa hospital, where there was very limited fuel for generators to run hospital equipment, doctors were struggling to address the needs of injured and ill patients, and many displaced people were seeking shelter.
Sounding the alarm about the projected imminent risk of famine in Gaza, the UN High Commissioner for Human Rights, Volker Türk, stated on 19 March, that this human-made catastrophe “can and must be prevented,” calling on Israel, as the occupying power, “to facilitate the unimpeded entry and distribution of needed humanitarian assistance and commercial goods.” The High Commissioner particularly highlighted the impact starvation has on children, who have been reportedly sent unaccompanied from northern to southern Gaza to desperately search for food. On 18 March, WHO also emphasized the immediate and long-term health impacts of malnutrition and disease on children: “Malnutrition makes people more vulnerable to getting severely ill, experiencing slow recovery, or dying when they are infected with a disease. The long-term effects of malnutrition, low consumption of nutrient-rich foods, repeated infections, and lack of hygiene and sanitation services slow children’s overall growth. This compromises the health and well-being of an entire future generation.”
Some 25 patients from Gaza, along with their companions , are scheduled to be returned to Gaza from hospitals in East Jerusalem on 21 March, as ordered by the Israeli authorities, reportedly because they no longer require in-patient medical treatment. In late October 2023, WHO estimated that at least 400 patients from Gaza had been stranded in the West Bank, including East Jerusalem, after the movement between Gaza and the West Bank came to a halt. Until 7 October, patients and their companions were among the few categories of people from the Gaza Strip eligible to apply for Israeli-issued permits to exist Gaza, with the vast majority of Palestinians in Gaza largely banned from exiting via Israel, including for passage to the West Bank. Between January and August 2023, according to the Palestinian General Authority of Civil Affairs , there were at least 1,700 monthly exits of patients from Gaza to the West Bank via Beit Hanoun/Erez crossing. During the same period, about 80 per cent of the 1,645 Gaza patient applications submitted to the Israeli authorities on average every month were approved for exiting Gaza, of which nearly half were for gaining access to health care facilities in East Jerusalem. Cancer patients comprised the largest category of those seeking referral to hospitals outside Gaza, constituting about 36 per cent of applicants. According to the MoH in Gaza, there are currently some 9,000 cancer patients who are at risk of death. The only hospital specialized in treating cancer patients in Gaza was the Turkish-Palestinian Friendship Hospital, which became non-operational in November 2023 after its fuel supply was depleted and it sustained heavy damage.

West Bank Updates

Just before sunset on 19 March, a 43-year-old Palestinian herder, a father of four, was shot and killed in Khirbet Tell al Khashaba herding community near Aqraba village in Nablus. According to community sources and eyewitnesses, the Palestinian man was grazing his livestock when three Israeli settlers from a nearby settlement outpost wearing army uniforms approached him and forcefully pushed him to the ground. Community sources added that as he attempted to defend himself and pushed one of the attackers back, he was fatally shot in the chest by another settler. According to an Israeli army source, cited by a media outlet, the Palestinian man was shot by an Israeli soldier.
On 19 March, a Palestinian man opened fire at and injured two Israeli security officers in a natural reserve near Gush Etzion settlement junction next to the entrance to Beit Fajjar village in Bethlehem. The man was subsequently shot and killed by Israeli forces.
Since 7 October, 422 Palestinians have been killed, including 410 by Israeli forces, nine by settlers and three by either Israeli forces or settlers, across the West Bank, including East Jerusalem. These include 114 Palestinians killed since the start of 2024 (compared with 85 during the same period in 2023), the vast majority by Israeli forces. Some 4,690 Palestinians have been injured, including 724 children, since 7 October in the West Bank, including East Jerusalem.
Since 7 October, 15 Israelis, including four members of Israeli forces, have been killed and 101 injured in the West Bank, including East Jerusalem, and Israel.
Since the beginning of 2024, displacement due to home demolitions during operations carried out by Israeli forces accounts for 55 per cent of displacement in the West Bank, followed by displacement by demolitions due to the lack of Israeli-issued building permits (38 per cent) and displacement due to demolitions on punitive grounds (7 per cent).
Since 7 October 2023 and as of 19 March 2024, OCHA has recorded 660 Israeli settler attacks against Palestinians that resulted in Palestinian casualties (59 incidents), damage to Palestinian-owned property (526 incidents), or both casualties and damage to property (75 incidents). Almost two-thirds of these incidents took place between October and December 2023.

Funding

The Flash Appeal for the occupied Palestinian territory (oPt), which requests US$1.2 billion to meet the 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 15 March, member states disbursed nearly $974 million for the updated Flash Appeal (79 per cent); this includes about $616 million out of $629 million (98 per cent) requested for October-December 2023 and about $358 million out of $600 million (60 per cent) requested for January-March 2024. For funding analysis, please see the Flash Appeal Financial Tracking dashboard.
The oPt Humanitarian Fund (oPt HF) is currently supporting 122 projects, for a total of US$ 74.5 million, addressing urgent needs in the Gaza Strip (83 per cent) and West Bank (17 per cent). Despite logistical hurdles, safety and security concerns, and fuel scarcity that hinder the procurement and transport of supplies, implementation is led by 77 international NGOs, 20 national NGOs, and 16 UN agencies. Of the projects implemented by international NGOs or UN agencies, 56 per cent are in partnership with national NGOs. For a summary of the oPt HF activities and challenges in February 2024, please follow this link.
The oPt HF has recently finalized its First Reserve Allocation of US$ 3.5 million for 2024, which aims at boosting the aid transport capacity to enable humanitarian partners to increase the delivery of vital aid and services to people across the Gaza Strip. This is in addition to a total of $88 million received by the Fund since 7 October from member states and private donors and allocated for programming across Gaza, including 43 per cent in Rafah, 21 per cent in Deir al Balah, 20 per cent in Khan Younis, and 16 per cent in Gaza and North Gaza governorates. Private donations are collected directly through the Humanitarian Fund. In addition, the Central Emergency Relief Fund (CERF) has recently allocated US$ 700,000 to a project led by UN Women that aims to strengthen gender-responsive and inclusive accountability to affected people, bringing to $18.7 million the total CERF allocation to oPt since 7 October.

For the Humanitarian Needs and Cluster Response Update for the period between 12 and 18 March, please visit: Humanitarian needs and response update | 12-18 March 2024. The update for a given week is initially published on Mondays and is updated throughout the week to reflect new content.