People amid a destroyed area in Khan Younis. Photo by OCHA, 17 April 2024

Hostilities in the Gaza Strip and Israel | Flash Update #157

24 Apr 2024

The OCHA oPt Flash Update is published three times a week, with an update on the West Bank included once a week on Wednesdays. The next update will be issued on 26 April.

Key Highlights

Palestinian Civil Defense teams have recovered 324 dead bodies at Nasser Hospital as of 24 April; the UN Human Rights Chief calls for independent investigations into these deaths.
Dire shortages of medications and basic supplies are endangering the lives of patients with blood diseases and genetic disorders, warns a Palestinian NGO.
Israeli forces’ operation in Nur Shams Refugee Camp resulted in 14 people killed, 50 injured, at least 11 households displaced, and an estimated 4,000 people currently affected by water and electricity supply cut-offs.

Gaza Strip Updates

Israeli bombardment from the air, land, and sea continues to be reported across much of the Gaza Strip, resulting in further civilian casualties, displacement, and destruction of houses and other civilian infrastructure. On 22 April, at about 10:20, Israeli authorities reportedly released 34 Palestinians, including a woman and four elderly people, who had been detained from various locations across Gaza, at Kerem Shalom Crossing.
Between the afternoons of 22 and 24 April, according to the Ministry of Health (MoH) in Gaza, 111 Palestinians were killed and 145 injured, including 79 killed and 86 injured in the last 24 hours. Between 7 October 2023 and 13:30 on 24 April 2024, at least 34,262 Palestinians were killed in Gaza and 77,229 Palestinians were injured, according to MoH in Gaza.
- On 21 April, at about 14:50, seven Palestinian men were reportedly killed and others injured when a house was hit in western An Nuseirat Refugee Camp, in Deir al Balah. Others reportedly remain under rubble.
- On 22 April, at about 9:30, three Palestinians were reportedly killed and 11 injured when a group of people were hit near Abu Salim Mosque in Deir al Balah.
- On 22 April, at about noon, six Palestinians were reportedly killed and others injured when a house was hit in Al Bureij Refugee Camp in Deir al Balah.
- On 22 April, at about 15:30, a Palestinian girl was reportedly killed when a house was hit in Deir al Balah.
Between the afternoons of 22 and 24 April, one Israeli soldier was reported killed in Gaza. As of 24 April, 260 soldiers have been killed and 1,584 soldiers have been injured in Gaza since the beginning of the ground operation, according to the Israeli military. In addition, over 1,200 Israelis and foreign nationals, including 33 children, have been killed in Israel, the vast majority on 7 October. As of 24 April, Israeli authorities estimate that 133 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies are withheld.
On 23 April, the Israeli military announced an order for residents of seven blocs in Beit Lahiya, in North Gaza governorate, to evacuate to two adjacent blocs. The seven blocs, with an area of 1.85 square kilometres, were home to 18,300 Palestinians before 7 October. The two blocs to which residents were ordered to evacuate have an estimated area of 0.85 square kilometres and currently encompass three schools, including one UNRWA school, and the Indonesian Hospital, which reportedly host internally displaced persons (IDPs). Since 7 October 2023, 246 square kilometres, which amount to 67 per cent of the Gaza Strip, have been placed under evacuation orders; this includes all areas north of Wadi Gaza, whose residents were ordered to evacuate in late October, as well as specific areas south of Wadi Gaza slated for evacuation by the Israeli military since 1 December.
Efforts to recover dead bodies in Nasser Medical Complex in Khan Younis continue; on 24 April, the Palestinian Civil Defense announced that 324 bodies, including women, elderly persons and patients, have been recovered since 19 April, of whom only few were identified. The Government Media Office (GMO) in Gaza said on 22 April that some bodies were reportedly found with their hands-cuffed and stripped of their clothes. GMO added that the whereabouts of about 2,000 people believed to have been present at the hospital, when it was raided by the Israeli military on 14 February, remain unknown. Earlier this month, the Gaza Civil Defense reported that 381 bodies had been recovered from the area surrounding Al Shifa Medical Complex in Gaza city, and 10 bodies were reportedly discovered in front of the hospital’s surgery building on 15 April. On 23 April, UN Human Rights Chief, Volker Türk, decried the “harrowing killings” of mainly women and children in a series of recent Israeli strikes on Rafah. He also said he was “horrified by the destruction” at Shifa and Nasser hospitals and “the reported discovery of mass graves” in and around these locations. Calling for independent, effective and transparent investigations into the deaths, Türk added: “Hospitals are entitled to very special protection under international humanitarian law, and the intentional killing of civilians, detainees, and others who are hors de combat is a war crime.”
On 22 April, a wastewater pump was reportedly hit in western Beit Hanun, in North Gaza governorate, compounding the already dire water and sanitation crisis. In eastern Gaza city, two schools and a medical clinic sheltering IDPs in the Ash Shuja’iyeh neighbourhood were also purportedly struck in separate incidents on 22 April, injuring an unconfirmed number of Palestinians. In Deir al Balah, the fifth floor and roof of the administration building of Al Awda Hospital were reportedly hit on 22 April, disrupting the solar energy system that supplies the hospital with electricity and causing damage to water and fuel tanks. Highlighting that 31 out of 36 hospitals in Gaza have sustained damage since October 2023, WHO warned that “access to healthcare continues shrinking every day due to attacks, hostilities and the lack of sustained deconfliction making it extremely challenging to resupply hospitals to strengthen and restore services.” An analysis by Save the Children based on WHO data concludes that, since the onset of the hostilities, 73 attacks on healthcare have been recorded on average every month in Gaza, a rate “higher than in any other conflict globally since 2018.”
According to the Health Cluster, as of 24 April, only 54 per cent of cases for which medical evacuations were requested have been approved by Israeli authorities (5,263 out of 9,817). Out of all approved patients, 82 per cent have been evacuated outside Gaza (4,325). The remaining 18 per cent could not yet be evacuated due to movement restrictions or limitations on individuals who may accompany them. These limitations span from age restrictions, which have at times prevented essential evacuations of newborn babies, to the requirement for companions to have passports, in a context in which an estimated 30 to 40 per cent of people in Gaza have lost their identification documents during displacement, according to the Protection Cluster. The criteria for selecting patients who may be evacuated also remain unclear, with only eight per cent of male patients aged 19 to 60 years approved for evacuation, compared to 74 per cent of women of the same age range. The overwhelming number of conflict-related injuries has also strained evacuation resources, resulting in injuries being prioritized over chronic illnesses like kidney failure and heart diseases. This has led to tragic consequences; the Health Cluster reports that nine children who urgently required kidney dialysis died in February 2024, while waiting for evacuation.
The remaining health facilities have shortages of personnel and basic supplies. On 18 April, Medical Aid for Palestinians (MAP) stressed that doctors are now forced to “re-use medical equipment that is designed for single use,” citing instances in which external fixators, which hold together fractured bones, were removed from deceased individuals and re-used on living patients. In addition, shortages of strong pain relief medications, steroid creams and antibiotic ointments are hampering the treatment of simple diseases and forcing children to endure limb salvage surgeries with inadequate pain relief, reported Save the Children. The lack of food is also rendering patients too weak to heal properly or fight infections. On 17 April, the Palestinian Centre for Human Rights (PCHR) shed light on the plight of patients with blood diseases and genetic disorders amid a critical shortage of medications. According to PCHR, over 300 people suffering from thalassemia, including 80 children, lack the needed medicines and are at risk of developing hemochromatosis, an iron overload in body organs. PCHR noted that 18 thalassemia patients have already died since the onset of hostilities and another ten are in critical condition. The lack of medications, therapeutic milk formulas, and vitamins has also endangered the lives of patients suffering from cystic fibrosis; 23 patients have died since October, and only six of about 20 critical patients referred for treatment abroad have so far been medically evacuated, added PCHR.
Access constraints continue to hamper the scaling up of critical aid to health facilities. WHO reports that, due to severe delays at checkpoints and ongoing fighting, a planned mission by WHO and its partners to Kamal Adwan and Al Awda hospitals on 20 April was only partially completed; the mission team evacuated four patients and their caregivers from Kamal Adwan, including a nine-year-old boy suffering from a head tumor and hydrocephalus, for medical evacuation abroad. However, fuel and medical supplies could not be delivered to Kamal Adwan hospital for the second consecutive time in seven days and needs assessments to help restore services could not be undertaken at Al Awda Hospital. In total, between 13 and 20 April, WHO and the NGO CADUS evacuated 13 patients from Kamal Adwan Hospital to the International Medical Corps (IMC) field hospital in Rafah and the European Government Hospital (EGH) in Khan Younis.
On 24 April, the two Israeli military checkpoints on both Salah El Din and Al-Rasheed roads leading to northern Gaza were closed by the Israeli army due to troop movements. As a result, humanitarian missions and other movements to northern Gaza were halted as of the time of reporting. Between 1 and 24 April, 57 per cent (39 out of 69) of humanitarian aid missions to northern Gaza were facilitated by Israeli authorities, 35 per cent (24) were denied or impeded, 7 per cent were cancelled (5) due to logistical constraints, and one remains pending as of the time of reporting. During the same period, out of 160 humanitarian aid missions to areas in southern Gaza that require coordination, 78 per cent (125) were facilitated by the Israeli authorities, 13 per cent (20) were denied or impeded, and nine per cent (15) were cancelled due to logistical constraints.

West Bank Update, 16-22 April

Latest development: In the early morning hours of 23 April, Israeli forces shot and killed a 44-year-old Palestinian man during a search-and-arrest operation in Aqbet Jaber Refugee Camp in Jericho. The man was reportedly standing in front of his house and no clashes were taking place at the time of the incident.

Between 18 and 22 April, 18 Palestinians, including three children, were killed in the West Bank, including 14 killed by Israeli forces in Nur Shams Refugee Camp in Tulkarm governorate. In addition, during the reporting period, 75 Palestinians, ten Israeli soldiers, and one Israeli settler were injured in the West Bank and two Israelis were injured in West Jerusalem.

Between 18 and 21 April, Israeli forces killed 14 Palestinians, including three children, injured at least 50 (including 17 by live ammunition), and arrested over 20, in a large-scale operation that lasted about 55 hours in Nur Shams Refugee Camp. Ten Israeli soldiers were also wounded, according to Israeli military sources cited in the Israeli media. During the operation, heavy sounds of exchanges of fire and explosions were reported, and Israeli forces besieged the camp, preventing entry and exit of at least 65,000 people who reside in the camp and the surrounding area of Tulkarm city. Medical teams were also denied access; the Palestine Red Crescent Society (PRCS) reported that the Israeli army prevented their ambulances from reaching the wounded and sick people for several hours to transport them to hospitals, one PRCS volunteer was shot and injured by live ammunition inside the camp, and an emergency medical team was detained for about half an hour.
The initial findings of an inter-cluster assessment conducted in Nur Shams Refugee Camp following the withdrawal of the Israeli army show that at least 11 households comprising 55 people, including 16 children, were displaced when their homes were rendered uninhabitable by bulldozers or explosives. Eight additional homes sustained severe damage, but their residents had already been displaced in previous operations by Israeli forces in the camp. In addition, about 500 homes sustained minor to moderate damage and multiple livelihood and commercial structures were destroyed. The UNRWA camp office, the disability rehabilitation centre, and the women’s association had also been raided and sustained minor damage. The operation entailed massive bulldozing of several vital road sections inside the camp and those leading to Tulkarm city, causing severe damage to water, sewage, electricity, and telecommunication networks. Water and electricity supplies were cut off, initially affecting the majority of the camp’s residents and currently affecting some 4,000 people, or about 30 per cent of nearly 14,000 people who live in the camp.
On 20 April, a 49-year-old Palestinian paramedic and driver of a Red Crescent ambulance was shot and killed in a settler violence incident in As Sawiya village in Nablus governorate, while transporting two wounded Palestinians, either by Israeli forces or settlers when they raided the village.
In two separate incidents, Israeli forces shot and killed three Palestinians in attacks or alleged attacks on Israeli forces in the West Bank. These include a 43-year-old woman, a mother of four, who was shot at Hamra checkpoint in the Jordan Valley on 19 April, after she reportedly carried out a stabbing attack. Her body is being withheld by Israeli authorities. Moreover, two men, aged 18 and 19 years, were killed at Beit Einun military gate near Hebron city on 21 April after Israeli forces suspected that they were planning to attack them. According to Israeli forces, one of the assailants had a locally made gun in his possession.
On 21 April, an Israeli settler was injured by explosives when he tried to remove a Palestinian flag off Road 458 in the Ramallah governorate. In West Jerusalem, two Israelis were injured on 22 April in a car-ramming attack carried out by two Palestinian boys from Hebron (both aged 17 years). The boys fled the scene but were subsequently arrested by Israeli forces, along with six members of their families.
On 21 April, six Palestinians were injured by Israeli forces or settlers when about 100 settlers, protected by Israeli forces, raided the village of Burqa in Ramallah governorate and set fire to an animal pen that shelters at least 200 sheep, killing at least four sheep. There were six other incidents of stone-throwing by settlers at Palestinian vehicles and physical assault of Palestinians across the West Bank. Since 7 October 2023, OCHA has recorded 794 Israeli settler attacks against Palestinians that resulted in Palestinian casualties (82 incidents), damage to Palestinian-owned property (622 incidents), or both casualties and damage to property (90 incidents). 
During the reporting period, Israeli forces injured 12 Palestinians in search-and-arrest operations across the West Bank, of whom three (including two women) while driving their vehicle in Halhoul village in Hebron governorate and three others in clashes in Beita village in Nablus governorate. Based on Israeli military sources, in one of the operations in Duma village in Nablus governorate, Israeli forces arrested a 21-year-old Palestinian suspected of killing an Israeli settler boy on 12 April near Al Mughayyir village in Ramallah governorate.
Since 7 October, 469 Palestinians have been killed and 4,974 injured in the West Bank, including East Jerusalem, with at least one third of the injuries sustained by live ammunition (1,660). Fatalities include 452 Palestinians killed by Israeli forces, ten by Israeli settlers, and seven where the responsible parties—whether Israeli forces or settlers—have not been determined. About 38 per cent of the fatalities (176) took place in 16 refugee camps. Nine Israelis have also been killed and 104 were injured in the West Bank; these include five members of Israeli forces killed and 69 injured. Since the beginning of 2024, 160 Palestinians and five Israelis have been killed across the West Bank, compared to 95 Palestinians and 16 Israelis in the same period of 2023.
On 16 April, 12 Palestinians, including six children, were displaced due to the demolition of two houses in Bani Na’im town in Hebron governorate; the houses belonged to two Palestinians who had been arrested after perpetrating a stabbing and ramming attack in Ra’anana, Israel, on 15 January 2024, which resulted in the killing of an Israeli woman. On the same day, four Palestinians were affected by the punitive demolition of a house in Beit Hanina in East Jerusalem that belonged to a man who was shot and killed by Israeli forces on 6 November 2023 while shooting at Israeli forces stationed at one of the gates leading to the Old City of Jerusalem. The house had been sealed off immediately following the event and an Israeli court ordered the evacuation of its residents in February 2024. In addition, on 16 and 17 April, five livelihood and agricultural structures were demolished by their owners or sealed off by Israeli authorities in East Jerusalem, affecting 20 people. Since 7 October, over 1,760 Palestinians have been displaced due to the demolition of their homes by Israeli authorities, of which 37 per cent were displaced because their homes lacked difficult-to-obtain building permits from Israeli authorities, nine per cent on punitive grounds, and 54 per cent within the context of operations by Israeli forces.

Funding

On 17 April, the Humanitarian Country Team released a new Flash Appeal for the occupied Palestinian territory (oPt), which requests US$2.8 billion to meet the most critical needs of 2.3 million people in Gaza and 800,000 people in the West Bank, including East Jerusalem, between April and December 2024. The figure reflects what is deemed most likely to be implemented over the next nine months, under access constraints and security challenges that limit the rapid scale-up of the humanitarian response, and represents only a part of the requirement that the UN and its partners estimate is needed to meet the scale of humanitarian needs across the oPt. This Flash Appeal replaces the previous appeal launched in October 2023 and extended until March 2024, which sought $1.23 billion; roughly half of this amount was utilized in the last quarter of 2023 and the remaining half in the first quarter of 2024.
The oPt HF has 118 ongoing projects, for a total of $72.5 million, addressing urgent needs in the Gaza Strip (85 per cent) and West Bank (15 per cent). In light of the updated Flash Appeal, the HF has allocated an additional $22 million to bolster prioritized HF-funded projects in Gaza to enhance the operational capacity of humanitarian partners as well as ensure the continuity and expansion of essential services amid escalating challenges. In the West Bank, the oPt HF has allocated $5 million for key partners to enhance system readiness and responsiveness to sudden-onset emergencies. Since 7 October, the oPt HF has mobilized $90 million from Member States and private donors, designated for programmes throughout Gaza. A summary of the oPt HF activities and challenges in March 2024 is available through this link and the 2023 Annual report of the oPt HF can be accessed here. Private donations are collected directly through the Humanitarian Fund.

For the Humanitarian Needs and Cluster Response Update for the period between 16 and 22 April, please visit: Humanitarian Needs and Response Update | 16–22 April 2024. It is updated throughout the week to reflect new content.