Hostilities in the Gaza Strip and Israel | Flash Update #15

KEY POINTS

• Today (21 October), the Rafah crossing with Egypt opened for the first time since 8 October, allowing the entry of 20 trucks carrying food, water and medical supplies. As stated by the UN Secretary-General, these supplies “are the difference between life and death for so many people in Gaza.”
• The volume of goods that entered is equivalent to about four per cent of the daily average of imports into Gaza prior to the hostilities, and a fraction of what is needed after 13 days of complete siege. The UN Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator indicated that it is imperative to increase the access of aid to at least 100 trucks per day.

• Bombardments continue almost unabated as hostilities enter the fifteenth day in Gaza, where an additional 248 Palestinians have been killed in the past 24 hours (as of 17:00), according to the Ministry of Health (MoH) in Gaza. This brings the cumulative fatality toll to 4,385 Palestinians killed, with 62 per cent of the fatalities being children and women, according to the MoH. More than 1,000 people Palestinians have been reported missing and are presumed to be trapped or dead under the rubble.
• At least 42 per cent (164,756) of all housing units in the Gaza Strip have been either destroyed or damaged since the start of the hostilities, according to the Ministry of Housing in Gaza.
• About 1.4 million internally displaced people (IDPs) are estimated in Gaza, with nearly 566,000 sheltering in 148 UNRWA-designated emergency shelters (DES) in increasingly dire conditions. There are reports of displaced families returning to northern Gaza due to ongoing bombardments and an inability to meet basic needs in the south.
• Health partners have detected cases of chicken pox, scabies and diarrhea, attributable to the poor sanitation conditions and consumption of water from unsafe sources. The incidence of such diseases is expected to rise unless water and sanitation facilities are provided with electricity or fuel to resume operations.
• Palestinian armed groups’ indiscriminate rocket firing towards Israeli population centres continued, with no new Israeli fatalities reported (as of 21:00). Overall, about 1,400 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities, the vast majority on 7 October. Israeli media reported that, as of 20 October, the names of 767 of these fatalities have been released, 22 of them children for those whose ages have been provided. The reported fatality toll is over threefold the cumulative number of Israelis killed since OCHA began recording casualties in 2005 (nearly 400).
• According to the Israeli authorities, at least 210 people are currently held captive in Gaza, including Israelis and foreign nationals. The Secretary-General has called upon Hamas to release hostages immediately and unconditionally. Two hostages with United States citizenship were released on 20 October.
• In the West Bank, since the afternoon of 20 October, Israeli forces killed two Palestinian boys during confrontations, bringing the number of Palestinians killed by Israeli forces or settlers since 7 October to 84, including 27 children.
• At least 84 Palestinian households, comprising 545 people, over half of whom are children, have been displaced from 13 herding/Bedouin communities in Area C of the West Bank since 7 October, amid intensified settler violence and access restrictions.

GAZA HUMANITARIAN OVERVIEW

Hostilities and casualties

Israeli airstrikes and shelling across the Gaza Strip have persisted in the past 24 hours (as of 17:00). The bombardment of an entire block in Jabalia neighbourhood resulted in 29 people killed. Additionally, two residential buildings were hit in the Deir al Balah area, killing two entire families and resulting in 46 people killed. In the Rafah area, one residential building was hit, resulting in 16 people killed, including six women and three children. In Gaza city, a seven-story building was destroyed by airstrikes resulting in at least 13 fatalities.

In a press conference held on 21 October, the Israeli military’s spokesperson said that, since the start of hostilities, there had been 550 failed shootings of rockets fired by Palestinian armed groups towards Isrrael which fell short in Gaza, killing a number of Palestinians.

Since 7 October, 4,385 Palestinians have been killed, including at least 1,756 children and 967 women, and about 13,561 have been injured, according to the MoH in Gaza. The reported fatality toll in Gaza during the 15 days of hostilities is about 84 per cent higher than the total number of fatalities during the 50-day escalation of hostilities in 2014 (2,251 Palestinian fatalities).

About 100 unidentified bodies were buried on 15 October in a mass grave in Rafah. About 43 unidentified bodies were buried in a mass grave in Gaza city on 21 October, due to the lack of refrigerated space to store them until recognition procedures are conducted.

According to the MoH in Gaza, as of 21 October, 98 Palestinian families had lost ten or more of their members; 95 Palestinian families had lost 6 to 9 members; and 357 families had lost two to five of their members.

The Gaza Ministry of Public Works reported the destruction of 15,100 housing units and the rendering of 10,656 housing units uninhabitable, as of 21 October. Another 139,000 housing units are said to have suffered minor to moderate damage. The total number of housing units destroyed or damaged accounts for at least 42 per cent of all housing units in the Gaza Strip. Entire neighborhoods have been destroyed, particularly in Beit Hanoun, Beit Lahia, and Shuja’iyeh, the area between Gaza and Shati’ Refugee Camp, and Abbassan Kabeera.

An assessment of the North Gaza Governorate area, by the United Nations Satellite Centre (UNOSAT), identified 927 destroyed structures and 4,337 moderately to severely damaged structures, corresponding to about 15 per cent of all structures in that area. The assessment was based on a comparison of images collected on 15 October 2023 with those from 1 May 2023. New satellite imagery produced by UNOSAT shows the large scope of destruction as of 19 October.

As of 19 October, the World Health Organization (WHO) has documented 62 attacks on health care affecting 29 health care facilities (including 19 hospitals damaged) and 23 ambulances. Seven hospitals, all in Gaza city and northern Gaza, were forced to shut down due to the damage they sustained, lack of power and supplies and/or evacuation orders.

The extent of damage sustained by educational facilities and other civilian infrastructure is a growing concern. As of 21 October, 205 educational facilities have been affected, including at least 29 UNRWA schools. Eight of these schools were used as emergency shelters for IDPs, with one of them being directly hit, resulting in at least eight IDPs killed, and 40 others injured. Additionally, one university building suffered severe damage, and minor damage was reported in one Directorate of Education building and one Rehabilitation Centre for the Visually Impaired.

As of 21:00 on 21 October, no new Israeli fatalities have been reported in the context of hostilities in Gaza and Israel. According to Israeli sources, at least 1,400 Israelis and foreign nationals have been killed in Israel, and at least 4,932 have been injured, the vast majority on 7 October. The reported fatality toll is over threefold the cumulative number of Israelis killed since OCHA began recording casualties in 2005 (nearly 400).

According to Israeli media, as of 20 October, the Israeli authorities have released the names of 767 fatalities, whose identity had been confirmed, including 427 civilians, 282 soldiers, and 58 police officers. Among those whose age has been provided, 22 are children.

Displacement

The cumulative number of IDPs since the start of hostilities in Gaza is estimated at over 1.4 million, including over 565,838 people staying in 148 UNRWA DES, of whom 367,500 are in central and southern Gaza, 101,250 sheltering in the Orthodox Centre churches in Gaza city, and in hospitals and other public buildings, and 70,000 in 67 non-UNRWA schools. In addition, the Ministry of Social Development estimates some700,000 IDPs are residing with host families. Israeli forces have warned IDPs in five UNRWA DES in Gaza city to evacuate. UNRWA have informed the IDPs that the agency is no longer responsible for managing these shelters.

Overcrowding of UNRWADES in the central and southern areas is increasing, with essential resources such as water, food, and medicine in critical short supply. In some DES, UNRWA has been forced to ration down potable water, providing only one litre of water per person per day. The minimum international SPHERE standard is 20 litres. Overcrowding and shortages of basic supplies have triggered tensions among IDPs as have alongside reports of gender-based violence.

On 19 October, UNRWA established the first IDP tent camp in Khan Younis, consisting of 60 tents, hosting hundreds of IDPs. Anecdotal evidence indicates that some IDPs are returning to the north, due to continuous bombardments in the south, as well as the inability to find reasonable accommodation. One Palestinian from Gaza told OCHA:

"When we got to Khan Younis, we found no shelter, electricity, food, water or medical care. Hygiene is non-existent. The south is being bombarded too [...] We realised there that there really is no safe place to go in Gaza [...] Many people that I personally know have taken the difficult decision to return with their children back to Gaza city [….] With death looming everywhere, it may be better to die in our own home, together with those we love."

Over 15 per cent of IDPs are estimated to have disabilities, yet most shelters are not adequately equipped for their needs. Shelters lack the required medical mattresses and beds, causing ulcers and other medical issues that cannot be treated in unsterilized conditions. Similarly, the food distributed does not meet the needs of those with swallowing difficulties.

In Israel, hundreds of thousands of people residing near the Gaza Strip, as well as along the border with Lebanon, have fled or been evacuated, with the Israeli authorities providing for the needs of these IDPs (this report focuses on the humanitarian situation in Gaza).

Basic services and livelihoods

Electricity

For the eleventh consecutive day (since 11 October), Gaza has been under a full electricity blackout, following Israel’s halt of its electricity and fuel supply to Gaza, which in turn triggered the shutdown of Gaza’s sole power plant. This has forced essential service infrastructure to rely on backup generators, which are limited by the scarcity of fuel in the Strip. Goods that entered Gaza today (21 October) via the Rafah crossing did not include fuel.

Health care

Thirteen of the 20 trucks that entered Gaza through the Rafah crossing on the 21 October carried medical supplies. Four of the trucks were from WHO and they announced that “the supplies include trauma medicines and supplies for 1,200 people and portable trauma bags for on-the-spot stabilization of up to 235 injured people. They also include chronic diseases medicines and treatments for 1,500 people and basic essential medicines and health supplies for 300,000 people for three months.” The other nine trucks were with medical supplies from Egyptian Red Crescent and Qatar.

On 21 October, the Israeli military issued evacuation orders to the 17 hospitals still operational in Gaza city, north Gaza, and one hospital in Rafah. So far, these hospitals have not evacuated given this would endanger the lives of vulnerable patients. There is also extremely limited capacity and space to transfer them to other hospitals.

Among those warned is the Palestine Red Crescent Society’s Al Quds Hospital in Gaza city. The hospital accommodates more than 400 patients and about 12,000 IDPs. In a petition against the targeting of the hospital to Israel’s High Court of Justice, filed by Physicians for Human Rights - Israel, the State responded that “for now, we are not planning on attacking the hospital.”

The hospitals that are still operational are on the brink of collapse due to the shortage of electricity, medicine, equipment and specialized personnel. Yet, the number of patients treated or awaiting treatment is at 150 per cent of capacity, given the closure of over 60 percent of primary care facilities in Gaza. Large numbers of patients are being treated on the ground given there are not enough hospital beds. Only eight of UNRWA’s 22 health centres in Middle, Khan Younis and Rafah governorates, are providing primary health care services to critical outpatients and patients in need of treatment.

The MoH in Gaza has been reallocating limited amounts of fuel to hospitals to keep them open and has asked people to donate their personal fuel supplies. Health Cluster partners estimate that mortality rates have been on the rise due to the extremely limited access to essential healthcare services.

Water and sanitation

Two out of the 20 trucks that entered Gaza today via the Rafah crossing carried 44,000 units of bottled water supplied by UNICEF, which is enough for only 22,000 people for one day.

Water production from municipal groundwater sources is at less than five per cent of the pre-hostilities levels. The three seawater desalination plants, which, prior to the hostilities, produced seven per cent of Gaza’s water supply, are currently not operational. Water trucking operations came to a halt in most areas due to the lack of fuel, insecurity and roads being blocked by debris. Bottled water is largely unavailable, and its price has made it unaffordable for most families. Private vendors, who operate small water desalination and purification plants, which are mostly run by solar energy, became the main suppliers of clean drinking water.

People are consuming saline water with over 3,000 milligrams per litre of salt content from agricultural wells. This poses an immediate health risk, raising hypertension levels, especially in babies under six months, pregnant women and people with kidney disease. The use of saline groundwater also increases the risk of diarrhea and cholera.

The average water consumption from all sources and for all needs (including cooking and hygiene) dipped to just three litres per day per person, according to estimates by partners of the Water, Sanitation and Hygiene (WASH) Cluster.

Eastern Khan Younis (Bani Suheila area) is currently one of the few areas where piped water is supplied to households for a few hours per day. This follows the Israeli authorities’ reactivation of one out of three water lines servicing this area on 15 October. The distribution of this water to the rest of Khan Younis city is impaired by the lack of pumping capacity.

Most of the 65 sewage pumping stations are not operational, increasing the risk of sewage flooding. All five wastewater treatment plants in Gaza have been forced to shut down due to lack of power, resulting in substantial amounts of raw sewage being continuously dumped into the sea.

Due to the access restrictions to Gaza’s main landfills, near the perimeter fence with Israel, solid waste has been accumulating in temporary locations and in the streets, posing health and environmental hazards.

Food security

Five of the 20 trucks that entered Gaza through the Rafah crossing on 21 October carried food items, including three with food parcels and two with canned tuna.

Current stocks of essential food commodities within Gaza are sufficient for about 13 days, according to the World Food Program (WFP). However, at the shop level, the available stock is expected to last only for four more days. Despite the availability of essential food items, retailers are facing significant challenges when restocking from local wholesalers due to widespread destruction and insecurity.

Wholesalers are mainly in Gaza city and face difficulties distributing available food stocks to the southern region. Due to the shortage of flour and fuel, bakeries are unable to meet local demand for fresh bread and are at risk of shutting down. The only operative mill cannot transform wheat due to electrical power outages.

The electricity blackout has disrupted food security by affecting refrigeration, crop irrigation, and crop incubation devices, consequently harming various livelihoods, including poultry, cattle, fish, and other commodities.

The lack of access to fodder and damage from the airstrikes have taken a toll on farmers, with many breeders, primarily small-scale ones, reporting substantial losses among their animals, particularly in the poultry sector. Farmers are losing their crops in agricultural lands east of Khan Yunis and other locations.

Telecommunications

Telecommunications enable information gathering on humanitarian needs and is therefore paramount to assistance delivery. Damage to related infrastructure during the hostilities, compounded by the fuel shortages, have severely impaired connectivity, undermining lifesaving operations.

Network monitoring systems of the Paltel Group show that across the Gaza Strip, 83 per cent of fixed line users are disconnected; 54 per cent of fixed line sites are disconnected; and 50 per cent of their main fiberoptic internet lines are not operational due to infrastructure damage and fuel shortage. Hostilities have resulted in cuts in two out of three fiber cables going out of Gaza, one of which was repaired after Israeli authorities granted the company a two-hour window for staff to fix one fiber cable.

Movement and access

For the first time since 8 October, the Rafah crossing with Egypt was open for the passage of a limited number of trucks (as detailed above). The Erez and Kerem Shalom crossings with Israel remain closed. Since 7 October, patients have not been referred to medical appointments in the West Bank or Israel.

Additionally, over 4,000 workers from Gaza have been stranded in Israel since 7 October. Some were arrested by Israeli authorities and others were transferred to public shelters in the West Bank. On 19 and 17 October Israeli forces arrested more than 100 Palestinian workers from Gaza in the Bethlehem and Hebron Governorate in three separate raids

Access to the sea along Gaza has been prohibited by the Israeli military, and all fishing activity has ceased since the hostilities began. Access to areas near Israel’s perimeter fence remains prohibited, and it has expanded from 300 to 1,000 metres from the border, barring entry to key agricultural areas. The extension has led to reduced crop yields affecting hundreds of thousands of people harvesting crops.

Humanitarian operations

All humanitarian agencies and personnel have faced major constraints in providing humanitarian assistance, due to hostilities, movement restrictions and shortages of electricity, fuel, water, medicines and other essential items. The prevailing insecurity is preventing safe access to people in need and essential facilities, such as warehouses. Since the start of hostilities, 16 health workers and 17 UNRWA staff have been killed while on duty, and more than ten others have been injured.

Despite these challenges, humanitarian actors are working around the clock to support the most vulnerable. The major operation entails the hosting of IDPs in UNRWA schools, where basic food, medicine and support is provided to retain dignity and a glimmer of hope. Other interventions include the distribution of food and cash assistance to IDPs and emergency fuel to WASH facilities, psychosocial support helplines, and a mass media campaign to raise awareness about the risks of unexploded ordnance (for further detail, see Humanitarian Needs and Responses).

The reach of operations will remain limited without a humanitarian ceasefire, a secured regular and sustainable access for humanitarian supplies and commodities across the Gaza Strip and significant funding for the humanitarian response.

Following the outbreak of hostilities, the oPt Humanitarian Fund (HF) redirected a total of US$9 million towards the priority needs identified, while the global Central Emergency Response Fund (CERF) allocated another $9 million in Rapid Response funding, supplementing a pre-existing $6 million allocation from the Underfunded Emergencies Window.

On 12 October, the OPT Humanitarian Country Team (HCT) launched a Flash Appeal calling for US$294 million for 77 humanitarian partners to address the most urgent needs of 1,260,000 people in Gaza and the West Bank. This Flash Appeal is set to be revised given the significant increase in humanitarian needs.

WEST BANK HUMANITARIAN OVERVIEW

Casualties

In the West Bank, two additional Palestinian fatalities, were recorded since yesterday afternoon (by 21:00 on 21 October).

On 20 October, Israeli forces shot and killed a 17-year-old boy and injured 15 other Palestinians during a protest held in solidarity with Gaza next to Huwwara checkpoint (Nablus). In a separate incident, Israeli forces shot and killed a 17-year-old boy in the Aqbat Jaber Camp (Jericho) while they attempted to punitively demolish a Palestinian prisoner's home. Confrontations erupted when Palestinians threw stones at the Israeli forces, who responded with live ammunition, teargas and sound bombs.

Since the start of the escalation and by 21:00 on 21 October, Israeli forces and settlers in the West Bank had killed 84 Palestinians, including 27 children. One member of Israeli forces was killed by Palestinians.

Additionally, since 7 October, Israeli forces have injured 1,653 Palestinians, including at least 150 children. Another 35 Palestinians have been injured by settlers. Over 1,100 Palestinians have been injured, mostly by Israeli forces, in the context of demonstrations. Some 27 per cent of the injuries have been caused by live ammunition. The number of Palestinian injuries from live ammunition is almost eight times higher than the biweekly average number of such injuries between 1 January to 7 October 2023.

Settler-related violence

Settler violence across the West Bank, especially in Palestinian communities near Israeli settlements, has been on the rise. Since 7 October, OCHA has recorded 103 settler attacks against Palestinians resulting in casualties or property damage, including some where Israeli forces were involved. This represents an average of almost eight incidents per day, compared with a daily average of three incidents per day since the beginning of this year.

Attacks on health care

Since 7 October, WHO has documented 81 attacks on health care in the West Bank affecting 64 ambulances and including 45 attacks involving obstruction to delivery of health care, 44 involving physical violence towards health teams, 16 involving detention of health staff and ambulances, and nine involving militarized search of health assets.

HUMANITARIAN NEEDS AND RESPONSES

Multi-Purpose Cash Assistance (MPCA)

Priority Needs

• Access to basic needs and services is severely halted by the lack of resources and the security situation. IDPs outside formal shelters have extremely limited access to assistance. Those are prioritized for Emergency MPCA.
• · Banks are temporarily closed, limiting access to cash. The capacities of financial service providers are severely limited and change by the hour (partners currently using PalPay).
• · Depletion of stocked items to be purchased is worsening.

Response to Date

• · Some 6,570 households started receiving Emergency MPCA (NIS754 or US$187 per household) as of 21 October.

Protection

Priority Needs

• An estimated 20,000 people in need of specialized mental health services, including mental health drugs, who are in precarious situations with the disruption to mental health services.
• Documentation of violations of International Human Rights Law and Humanitarian Law.
• Opening roads, safe access to basic needs, medicines, mental health support, and ambulance services in the West Bank.

Response to Date

• Child protection and Mental Health Psychosocial Support (MHPSS) partners are operating for Gaza (four partners in the West Bank) providing remote psychosocial support.
• One partner working on inclusion and persons with disabilities has been able to reach 38 out of the 87 shelters in the south with following activities: distribution of 93 assistive devices, 156 wound dressings, 36 kitchen sets, 45 dignity kits, 435 diapers, and 57 baby blankets.
• In the West Bank, the assigned MHPSS Focal Points are responding to settler violence triggers. The MHPSS Coordination Lead Focal Points at governorate levels are intervening as needed.

Shelter

Priority Needs

• Urgent need to provide services and basic Shelter and Non-Food Items (NFI) to IDPs.
• Provision of non-food items and house maintenance for people displaced in urban centers and with host families.
• Provision of shelter cash assistance for IDPs (reintegration package and belongings loss compensation) for at least 25,000 families.

Response to Date

• About 350,000 IDPs are hosted at 102 UNRWA schools across the Gaza Strip.
• Distribution of 20,000 non-food items in Rafah and Khan Younis, including bedding sets and dignity kits.
• Distribution of 820 hygiene kits to displaced families. ICRC/PRCS distributed 7000 non-food items for displaced families, mainly mattresses and blankets.

Health

Priority Needs

• Improve the nutritional status, particularly of about 283, 000 children under 5 and pregnant or lactating women, in response to the concerning food security and water situation in Gaza.
• Ensuring the provision of Infant and Young Child Feeding in Emergencies, including preventive nutrition interventions, cash voucher assistance, curative nutrition interventions, intact nutrition supplies pipeline, and a functional nutrition coordination mechanism.
• Addressing shortages of medical supplies impacting case management.
• Fuel supply for hospitals and ambulances.
• Urgent need to restock medical supplies given depletion of stocks in the local market.
• Need for short and long-term mental health and psychosocial support services for large numbers of mentally traumatized people.

Response to Date

• Partners continue making efforts to procure from the local market some supplies to support the hospital operations.
• Surge staff remain present in the Hospitals supporting case management.
• UNRWA has medical points in 53 out of the 108 shelters. Through the Humanitarian Fund, PMRS will support primary health care service provisioning the remaining shelters.

Food Security

Priority Needs

• Electricity, fuel, and water sources to maintain agriculture.
• Many shops have food supplies to last less than a week.
• Safe access to farms, livestock, fisheries, and other livelihoods.
• Urgent import of fodder.

Response to Date

• The World Food Program (WFP) reached 122,000 displaced people residing in UNRWA shelters, providing bread across 48 designated shelters.
• 243,291 IDPs received cash-based transfer (CBT) for food. Of those, 13,546 have been redeemed. Some 65 per cent in the northern and 35 per cent in the southern governorates.
• PARC, is ready to provide food assistance to a total of 80,000 to 100,000 IDPs in non-UNRWA shelters.
• Oxfam has already covered 189 households in Gaza governorate, as per a project included in the Humanitarian Response Plan for 2023.
• DanChurchAid has already covered 18,000 households sheltering in UNRWA DES in the Gaza governorate.
• Islamic Relief Palestine is providing food assistance to 10,000 IDP households in non-URWA shelter or in host Families.

Education

Priority Needs

• Safe access to schools and communities.

Planned Responses

• Provision of school-based psychosocial support and recreational activities for at least 70,000 children and school staff as soon as the situation allows.
• Emergency rehabilitation for at least 20 damaged schools, following a cluster rapid needs assessment.
• Provision of emergency supplies and learning kits to 10,000 children in DES and 50,000 children in schools once they reopen.
• Provision of catch-up classes, especially to displaced children (at least 20,000 children).

WASH (Water, Sanitation and Hygiene)

Priority Needs

• Provision of clean drinking water to the population.
• Provision of alternative power supply and 20,000 litres per day of emergency fuel to sustain the operation of WASH facilities, along with replenishing the chlorine supply for water treatment plants.
• Support to restore disrupted municipal services, including solid waste management, water, and sanitation operations, as appealed by the Gaza Strip municipalities.
• Delivery of essential WASH services and provisions to IDPs in collective centers, including drinking water and hygiene kits.

Planned Response to Date

• Some 3,930 hygiene kits were distributed to the families in the UNRWA IDP centres
• Reviewing and checking feasibility of water trucking operations.
• 450 cubic metres of water allocated for water trucking to supply water to IDP centres and hosted families.
• 70 cubic metres of bottled water distributed among IDPs shelters.

Protection against sexual abuse and exploitation (PSEA) remains a cross-cutting priority for all clusters. The SAWA helpline, reachable at 121 and through WhatsApp at +972 59-4040121 (East Jerusalem at 1-800-500-121), operates 24/7. This toll-free number is widely disseminated across all areas of intervention to report cases of SEA and to facilitate emergency counseling and referrals for affected communities to access life-saving services. The PSEA Network monitors calls daily and will increase the number of counselors if necessary.