An overwhelmed medical worker in Gaza rests his head in his hands. Photo by Médecins Sans Frontières

Hostilities in the Gaza Strip and Israel | Flash Update #159

29 Apr 2024

The OCHA oPt Flash Update is published every Monday, Wednesday, and Friday, with an update on the West Bank included every Wednesday. The next update will be issued on 1 May.

Key Highlights

Intense and long-term exposure to traumatic events is having a psychological toll on Gaza’s health workers, reports Médecins Sans Frontières.
UNICEF and the Coastal Municipalities Water Utility inaugurate a solar-powered water desalination plant in Rafah, with the latter warning that the entire water and sanitation system is nearing collapse.
Nearly 37.5 million tons of conflict-generated debris are estimated to be present throughout Gaza, UN agencies assess.

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. Intensive strikes on Rafah also continue to be reported, with at least 36 reported fatalities since 27 April (see below).
Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Martin Griffiths, has recently emphasized the need to restrict the global use of explosive weapons in line with the 2022 Political Declaration on Strengthening the Protection of Civilians from the Humanitarian Consequences Arising from the Use of Explosive Weapons in Populated Areas (EWIPA). Globally, some 50 million people are currently affected by urban warfare, including 2.3 million people in Gaza, where thousands of tons of munitions have been dropped with wide-ranging short-term and reverberating effects. Such effects have included disruption of services critical to people’s survival, environmental contamination, as well as physical, psychological, and psychosocial harm to civilians.
Between the afternoons of 26 and 29 April, according to the Ministry of Health (MoH) in Gaza, 132 Palestinians were killed and 275 injured, including 34 killed and 68 injured in the last 24 hours. Between 7 October 2023 and 12:30 on 29 April 2024, at least 34,488 Palestinians were killed in Gaza and 77,643 Palestinians were injured, according to MoH in Gaza.
The following are among the deadliest incidents between 25 and 29 April:
- On 25 April, at about 19:40, eight Palestinians were reportedly killed when a minibus was hit at Al Maliya Junction in Tal al Hawa area, in Gaza city. The casualties were reportedly involved in aid distribution, but no additional information is available on their exact roles.
- On 25 April, at about 16:00, three Palestinian children were reportedly killed and two injured in strikes near the Indonesian Hospital in Beit Lahiya.
- On 26 April, in the afternoon, a woman, her husband and their two new-born babies were reportedly killed when a residential apartment was hit near Al Rimal clinic, in Gaza city.
- On 26 April, at about 23:45, nine Palestinians, including three females, were reportedly killed and 30 injured when a house was hit in An Nuseirat Refugee Camp, in Deir al Balah. Seven nearby houses were also reportedly damaged during the same incident.
- On 27 April, at about 1:05, six Palestinians, including four children and a woman, were reportedly killed and others injured when a house was hit in As Saudi neighbourhood, in western Rafah.
- On 27 April, at about 16:10, ten Palestinians, including at least two children and a woman, were reportedly killed when a house was hit in An Nasser area in northeastern Rafah.
- On 28 April, at about 23:00, three Palestinians were reportedly killed and others injured when a house was hit in Al Junaina area in eastern Rafah. According to media reports, the fatalities include a child and a woman.
- On 29 April, at about 0:35, ten Palestinians, including three children and three women, were reportedly killed and others injured when a house was hit in Al Jawazat area in eastern Rafah. According to media reports, the fatalities include three children and three women.
- On 29 April, at about 0:35, seven Palestinians were reportedly killed and eight injured when a house was hit in Ash Shaboura area in Rafah. According to media reports, fatalities include a child and three women.
Between the afternoons of 26 and 28 April, no Israeli soldiers were reported killed in Gaza. As of 28 April, 260 soldiers have been killed and 1,586 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 28 April, Israeli authorities estimate that 133 Israelis and foreign nationals remain captive in Gaza, including fatalities whose bodies are withheld.
A mental health crisis is unfolding in Gaza, fuelled by constantly acute traumatic events, ongoing displacement, an absent sense of safety, and fear and anxiety about the future. According to the Health Cluster, prior to the onset of hostilities, about 485,000 people suffered from mental health disorders in Gaza. Over 200 days of relentless violence and devastation have further exacerbated psychosocial needs, particularly among more than a million children estimated by UNICEF as requiring mental health and psycho-social support. Health workers in Gaza, already deeply worried about the safety and security of their families, are also enduring high levels of psychological stress and exhaustion that “will leave scars for years to come,” highlighted Médecins Sans Frontières (MSF) on 26 April. Shedding light on the mental health impact of the conflict on Gaza’s healthcare workers, MSF said that health workers described receiving “repeated large numbers of casualties with crushed limbs and burns from explosions, and having to perform amputations without sufficient pain medication or anaesthesia.” At other times, bombardments or insecurity have forced these professionals to evacuate hospitals, tragically leaving patients behind. Like other Palestinians across Gaza, they are “in a state of constant alert. They can’t sleep, they think that at any moment they are going to die, that if they fall asleep, they won't be able to react quickly and run away, or protect their family,” MSF added. They are working under conditions that are “beyond human,” experiencing “anxiety, insomnia, depression, intrusive thoughts, emotional avoidance and nightmares, all of which can heighten the risk of mental health issues,” warned MSF, emphasizing that “healthcare workers and [other] civilians ... are [now] haunted and distressed by the prospect of an impending Israeli offensive in Rafah.” Since October 2023, MOH reports that 491 health workers have been killed in Gaza.
In Rafah, where about half of the Gaza Strip's 2.3 million people are currently seeking shelter, the situation remains dire. Residents face severe challenges in accessing basic services such as health care, clean water, and sanitation facilities, amid a noticeable surge in fatalities and heightened anxiety about an imminent large-scale Israeli ground operation. To address the rising need for potable water, the Coastal Municipalities Water Utility (CMWU) and UNICEF inaugurated last week a solar-operated water desalination station, the fourth to be established in southern Gaza, to produce potable water for 400 families at the Taha Hussein School shelter for internally displaced persons (IDPs). At the same time, on 28 April, CMWU cautioned that the entire water and sanitation system is nearing collapse; after the Israeli authorities cut off the electricity supply, damage to water networks and facilities, overuse of existing generators, and shortages of spare parts and fuel continue to significantly reduce people's access to safe water and undermine sewage management. On 29 April, CMWU informed OCHA that the lack of power supply for Rafah’s wastewater treatment plant has now resulted in sewage overflow. Earlier, MoH in Gaza has warned that the suspension of operations at the public health laboratory, along with Israeli restrictions on chlorine entry, has impaired water testing and disinfection processes. According to MoH, this has compromised water safety, placing people’s lives at risk.
Khan Younis, the second largest city in Gaza which prior to the conflict was home to over 200,000 people, is now a “ghost town”, reported Save the Children International (SCI) on 25 April following an assessment mission to the area. Similar to scenes of total devastation in Gaza city recently described by OCHA and UNRWA, SCI stressed that every single building that they observed was “either severely damaged or rubble on the ground,” with some people returning to protect what has remained of their properties and belongings. According to an interim assessment by the World Bank, over 60 per cent of residential buildings and nearly 80 per cent of commercial facilities had been damaged or destroyed in Gaza between October 2023 and January 2024, with 80 per cent of total damage concentrated in the governorates of Gaza, North Gaza and Khan Younis. SCI additionally observed that many children were walking “all by themselves,” in destroyed streets and being in dangerous proximity to destroyed or semi-destroyed buildings, with many carrying heavy containers, likely of water. Already in February, UNICEF estimated that at least 17,000 children were unaccompanied or separated from their parents throughout Gaza and the spokesperson of SOS Children’s Villages UK noted that the “creation of a new acronym – WCNSF, which stands for Wounded Child, No Surviving Family – is a sobering reminder of the heavy price children are paying.”
Nearly 37.5 million tons of conflict-generated debris are present throughout Gaza, with 3.2 million tons attributed to damaged roads, according to a preliminary joint analysis by UN-Habitat and UNEP, which integrates the findings of a UNOSAT Damage Assessment as of 29 February with building data as of May 2023. The analysis reveals a 63 per cent increase in the amount of debris present in Gaza as of 29 February, compared with just seven weeks prior on 7 January. The northern areas have suffered the largest scale of damage and destruction, with over 15 million tons of debris having accumulated in the Gaza governorate, nearly nine million in North Gaza and almost eight million in Khan Younis, followed by Deir al Balah (over 2 million tons) and Rafah (509,000 tons). UNMAS reports that much of this debris is laced with unexploded ordinance (UXO); while determining the exact amount of UXOs throughout Gaza is impossible, at least 10 per cent of ammunition fails to detonate when fired, UNMAS explains, estimating that up to 14 years might be required to clear all explosive threats and make Gaza safe again.

West Bank Update

On 27 April, Israeli forces shot and killed two Palestinians driving in a vehicle near the Salem Barrier checkpoint in Jenin governorate and have withheld their bodies. According to the Israeli military, a vehicle approached the checkpoint and opened fire at Israeli forces, who responded by firing at the car.

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 22 and 28 April, please visit: Humanitarian Needs and Response Update | 22–28 April 2024. It is updated throughout the week to reflect new content.