Hostilities in the Gaza Strip and Israel | Flash Update #18

KEY POINTS

• A total of 704 Palestinians, including 305 children, have been killed over the past 24 hours (as of 18:00 on 24 October), according to the Ministry of Health (MoH) in Gaza. This is the highest fatality toll reported in a single day in Gaza during this round of hostilities. The cumulative number of Palestinians killed in Gaza has reached 5,791, of whom 68 per cent are children and women, according to MoH. About 1,550 people, including 870 children, have been reported missing and may still be under the rubble. This follows the most intense Israeli bombardment and airstrikes in Gaza since the escalations began.
• UNRWA, by far the largest humanitarian provider in Gaza, warned that unless fuel is allowed into Gaza immediately, the agency will be forced to halt all operations as of tomorrow, 25 October, at night. Since 11 October, Gaza has been under a full electricity blackout, rendering hospitals and water facilities dependent on backup generators run by fuel. 

• Over one-third of hospitals in Gaza (12 of 35) and nearly two-thirds of primary health care clinics (46 of 72) have shut down due to damage from hostilities or lack of fuel.
• On 24 October, the World Health Organization (WHO) delivered 51 pallets of lifesaving medicines, surgical equipment and other supplies to Shifa Hospital, the largest medical centre in Gaza, located in Gaza city. This is one out of seven hospitals that benefitted from the medical supplies allowed into Gaza via the Rafah crossing between 21 and 23 October.  
• 44,000 units of bottled water entered on 22 October, addressing the drinking needs of 22,000 people for one day. Three of the trucks that entered Gaza on 23 October via the Rafah Crossing carried 4,000 jerrycans of drinking water (10 litres each), 2,400 hygiene kits, and 2,000 water purification devices. The water will cover the drinking needs of about 13,000 people for one day. Eleven out of the 20 trucks that entered Gaza through the Rafah crossing on 23 October carried food items, including food parcels and canned tuna. Overall, food supplies, water and non-food items that entered on 21-23 October have been distributed mainly in UNRWA DES shelters in southern Gaza.
• An estimated 1.4 million people in Gaza are internally displaced (IDPs), with nearly 590,000 sheltering in 150 UNRWA-designated emergency shelters (DES). Overcrowding is a growing concern, as the average number of IDPs per shelter has reached 2.6 times their designated capacity, with the most overcrowded one reaching 11 times its intended capacity. 
• Palestinian armed groups’ indiscriminate rocket firing towards Israeli population centres continued, reportedly reaching as far as the northern West Bank. Overall, about 1,400 Israelis and foreign nationals have been killed since 7 October, according to the Israeli authorities, the vast majority on the first day. 
• According to the Israeli authorities, at least 220 people are held captive in Gaza, including Israelis and foreign nationals. The UN Secretary-General has called upon Hamas to release hostages immediately and unconditionally. Two hostages with United States citizenship were released on 20 October, and two Israelis were released on 23 October. 
• No Palestinian fatalities were recorded in the West Bank since the afternoon of 23 October (as of 21:00 on 24 October). In total, 95 Palestinian have been killed by Israeli forces or settlers since 7 October, including 28 children. 

GAZA HUMANITARIAN OVERVIEW

Hostilities and casualties

Massive Israeli bombardments from the air and land intensified overnight across the Gaza Strip. The day resulted in the highest number of fatalities in Gaza since the start of the hostilities, as reported by MoH in Gaza. The Israeli military indicated that they have attacked 400 targets, a new high since the start of hostilities. 

In one of the airstrikes, a residential building in Rafah was destroyed, killing 48 people and injuring dozens. In Ash Shati refugee camp, airstrikes destroyed three residential buildings overnight, resulting in 36 fatalities, with many others reportedly missing, presumably under the rubble.  

Airstrikes also struck Souq An Nuseirat with at least 20 fatalities. The incident took place at noon when the market was the busiest. Shoppers were hit while they were inside a large supermarket. 

Since 7 October, 5,791 Palestinians have been killed, including at least 2,360 children and 1,292 women, and about 16,297 have been injured, according to the MoH in Gaza. Some 68 per cent of the total number of Palestinian fatalities were reported in Gaza city and North Gaza governorates.  

Additionally, about 1,550 people, including at least 800 children, have been reported missing and are presumed to be trapped or dead under the rubble, awaiting rescue or recovery. Rescue teams, primarily from the Palestinian Civil Defense, are struggling to carry out their mission, amid continuous airstrikes, severe shortage of fuel to run vehicles and equipment, and with limited or no connection to mobile networks. 

According to the MoH in Gaza, as of 24 October, 133 Palestinian families had lost ten or more of their members, 108 Palestinian families had lost 6 to 9 members, and 403 families had lost two to five of their members. 

According to the Israeli military’s spokesperson, between 7 and 21 October, there had been 550 failed shootings of rockets fired by Palestinian armed groups towards Israel, which fell short in Gaza killing a number of Palestinians. 

The Gaza Ministry of Public Works reported the destruction of 16,441 housing units and the rendering of 11,340 other units uninhabitable, as of 23 October. Another 150,000 housing units sustained minor to moderate damage. The total number of housing units reported as destroyed or damaged accounts for at least 45 per cent of all housing units in the Gaza Strip. Entire neighbourhoods have been destroyed, particularly in Beit Hanoun, Beit Lahia, and Ash Shuja’iyeh, the area between Gaza and Ash Shati’ Refugee Camp, and Abbassan Kabeera. As of 19 October, new satellite imagery produced by UNOSAT shows the large scope of destruction. 

As of 23 October, WHO has documented 72 attacks on health care in the Gaza Strip that have resulted in 16 fatalities and 30 injuries of health care workers on duty. The attacks have affected 34 health care facilities (including 19 hospitals damaged) and 24 ambulances.  

As of 24 October, 207 educational facilities have been hit, 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.  

According to Israeli sources, at least 1,400 Israelis and foreign nationals have been killed in Israel, and at least 5,431 have been injured, the vast majority on 7 October. Israeli media reported that, as of 23 October, the names of 860 of these fatalities have been released, including 554 civilians, 269 soldiers, and 58 police officers. Of those whose ages have been provided, 28 are children. 

Displacement

The cumulative number of IDPs since the start of hostilities in Gaza is estimated at over 1.4 million. This figure includes nearly 590,000 people staying in 150 UNRWA DES, 101,500 sheltering in hospitals, churches, and other public buildings, and nearly 79,000 in 67 non-UNRWA schools. In addition, the Ministry of Social Development estimates that some 700,000 IDPs are residing with host families.  

Overcrowding of UNRWA DES in the central and southern areas has been a major concern. The number of IDPs has reached in many shelters 4,400, while they were designed to host 1,500-2,000 IDPs per shelter. In many shelters, up to 70 people are accommodated in one classroom. To ensure a safer environment, at night, women and children remain in the classrooms, while men and adolescent boys stay outdoors in the schoolyard. Overcrowding and shortages of basic supplies have triggered tensions among IDPs, alongside reported gender-based violence. 

Essential resources such as water, food, and medicine are in critical short supply. Despite the limited availability of fuel, desalination equipment in the UNRWA shelters have so far continued to operate and provide potable water. This has been supplemented by water trucked from a desalination plant that resumed operations recently, alongside bottled water, some of which has entered recently via the Rafah crossing (see WASH section below).

Anecdotal evidence indicates that hundreds, and possibly, thousands, of IDPs are returning to the north, due to continuous bombardments in the south, and the inability to find adequate shelter. Since the beginning of hostilities, 12 IDPs sheltering at UNRWA schools have been killed and about 180 have been injured. The Humanitarian Coordinator for the Occupied Palestinian Territory stated: “When it comes to decisions on whether and where to flee, civilians are damned if they do and damned if they don’t.” 

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 fifteenth 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 entering Gaza since 21 October through the Rafah crossing have not included fuel. On 22 October, UNRWA coordinated with the Israeli and local authorities the transport of fuel stored in a facility within Gaza, adjacent to the Rafah crossing, and its distribution to DES and hospitals.  

On 24 October, UNRWA warned that unless fuel is allowed into Gaza immediately, the agency will be forced to halt all operations, as of 25 October, at night. 

Health care

Four out of the 20 trucks that entered Gaza through the Rafah crossing on 23 October carried vital medical supplies. While limited in volume, these supplies will play a crucial role in bolstering trauma response and sustaining essential healthcare services. WHO is coordinating with the Palestine Red Crescent Society (PRCS) to facilitate the swift delivery of these supplies to major hospitals. Since 21 October, 13 trucks with medical supplies have successfully made their way into Gaza. So far, medical supplies have reached seven hospitals and several PRCS facilities.  

In total, 66 per cent of medical facilities across Gaza are still functioning while 34 per cent have stopped functioning. According to the MoH in Gaza, “the health care system has reached the worst stage in its history.” 

UN personnel visiting a number of hospitals, noted hundreds of wounded men, women, and children in one of the hospitals. Many of them were unconscious, with open wounds, lying on beds, stretchers and on the floor, with limited medical attendance. In the yard, there was a tent with tens of dead bodies, including children. Many of the dead are kept there because the morgues are full. 

The hospital has reached an unprecedented point of devastation due to the influx of injuries combined with severe shortages of essential resources, such as medical supplies, personnel, electricity, water, and fuel. Fuel at the hospitals is being severely rationed and is used to run a selected number of critical facilities. The back-up generators are not designed for continuous operation and are therefore likely to break. 

Due to food insecurity, women and children, especially pregnant and lactating women, are at risk of malnutrition, which will negatively affect their immune health, increasing their susceptibility to contracting maternal nutrition-related illnesses such as anemia, preeclampsia, hemorrhage. This increases the risk of death for both mothers and babies. 

Water and sanitation

The WASH Cluster reported that, since 22 October, the volume of water supplied from Israel to the western Khan Younis area was reduced to some 20 per cent of the previous supply (from about 600 to 120 cubic metres per hour). On 24 October, supply increased to 200 cubic metres per hour. Meanwhile, water supply through two other pipelines from Israel is suspended since 8 October, including one line reaching Deir Al Balah town, located south of Wadi Gaza.  

On 21 October, one of the three seawater desalination plants in Khan Younis resumed operations at less than 7 per cent of its capacity. This was made possible after UNRWA managed to coordinate the retrieval and distribution of fuel from one of its storage facilities in Gaza. The newly available water (some 450 cubic metres per day) is being trucked to UNRWA DES south of Wadi Gaza, providing for the drinking needs of about 40,000 IDPs per day. The other two plants remain non-operational.  

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. 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. 

Food security

The World Food Program (WFP) estimates that current stocks of essential food commodities in Gaza are sufficient for about 12 days. However, at the shop level, the available stock is expected to last for only five days. Retailers are facing significant challenges when restocking from wholesalers due to widespread destruction and lack of security. Five of the 202 shops contracted by the WFP as redemption points of food vouchers for beneficiaries have so far been destroyed and another 19 were forced to close. 

Some of the basic food items available in the market, such as rice and lentils, cannot be used due to the inability to cook them, given the shortage of water and fuel/cooking gas. UNRWA reported that many IDPs have adopted one-meal-per-day as a coping strategy due to the food shortage. 

Currently, only four out of the 24 bakeries contracted by the World Food Programme (WFP) are operational and supplying bread to shelters. The shortage of fuel is the primary obstacle preventing these bakeries from meeting local demand. Unless fuel is allocated to them, most bakeries may shut down within three days. 

Hostilities have completely disrupted the agri-food value chain and livestock sector, affecting supply and demand. The consequences are expected to be felt beyond the immediate conflict period, further affecting food security. Prior to the hostilities, some 7 per cent of trucks entering Gaza daily carried animal feed; those imports have stopped since 7 October. 

Movement and access

On 24 October, as of 22:00, the Rafah crossing with Egypt remained closed. A number of trucks with humanitarian supplies that were expected to enter, were still stationed at the Nitzana crossing between Israel and Egypt (about 40 kilometres south of Rafah) for security checks by the Israeli authorities. 

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. 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.  

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 significant constraints in providing humanitarian assistance, due to ongoing hostilities, movement restrictions and shortages of electricity, fuel, water, medicines, and other essential items. Humanitarian partners cannot safely access people in need and warehouses where aid supplies are stored. 

Since the start of hostilities, at least 16 health workers have been killed while on duty, along with 35 UNRWA staff. 

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). 

As of 23 October, about $99.6 million worth of pledges have been confirmed in support of the inter-agency Flash Appeal launched on 12 October by the oPt Humanitarian Country Team. This represents about 34 per cent of the $294 million estimated as required when the Appeal was first launched. About $70.6 millions of these pledges were earmarked for UNRWA. 

Private donations to the Occupied Palestinian Territory Humanitarian Fund are collected online through this link: crisisrelief.un.org/opt-crisis. 

WEST BANK HUMANITARIAN OVERVIEW

Casualties

In the West Bank, no Palestinian fatalities have been recorded since the afternoon of 23 October (by 21:00 on 24 October). The total number of Palestinians killed by Israeli forces or settlers since the start of the escalation has reached 95, including 28 children. During this period, one member of Israeli forces was killed by Palestinians in the West Bank.  

Additionally, since 7 October, Israeli forces have injured 1,795 Palestinians, including at least 160 children, in the West Bank. Another 38 Palestinians have been injured by settlers. Over two-thirds of all injuries occurred in the context of demonstrations in solidarity with Gaza. Some 28 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 136 settler attacks against Palestinians resulting in casualties or property damage, including some where Israeli forces were involved. This represents an average of eight incidents per day, compared with a daily average of three incidents per day since the beginning of this year.  

Settler violence has also disrupted the ongoing olive harvest season. On 22 October, Israeli settlers, accompanied by Israeli police, stole bags of harvested olives, and intimidated three Palestinian families while they were picking their olives. On the same day, a group of settlers, reportedly from Asfar settlement, accompanied by Israeli forces, vandalized five agricultural structures, 20 water tanks, and a metal fence surrounding a piece of land in the Susiya community (Hebron). 

Since 7 October, at least 82 Palestinian households, comprising 607 people, over half of whom are children, have been displaced from 13 herding/Bedouin communities in Area C of the West Bank, amid intensified settler violence and access restrictions.

Attacks on health care

Since 7 October, WHO has documented 96 attacks on health care in the West Bank affecting 77 ambulances and including 49 attacks involving obstruction to delivery of health care; 53 involving physical violence towards health teams; 17 involving detention of health staff and ambulances; and ten 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 10,492 households started receiving Emergency MPCA (NIS754 or $187 per household) as of 21 October. Redemption rates reported as up to 58%.

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

• Some 3,000 IDPs have received psychosocial support and social work intervention services from UNRWA social workers and counsellors since the crisis began. 
• Committees led by the displaced persons have been established in all shelters to ensure the participation, engagement, and contribution of the displaced population in the management of the shelters. 
• One partner reached at least 4,000 IDPs in shelters and provided psychological first aid (PFA) and needs assessment for non-food items (NFIs) and assistive devices. 
• One partner distributed food parcels and water to 70 households in the south.  
• One partner opened space for some 300 IDPs in central Gaza, providing supplies, cash and MHPSS support. 
• One partner supported 25 IDPs of whom the vast majority were persons with disabilities, with cash and MHPSS.  
• Partners provided PFA in south of Gaza, financial support to AWDA Hospital, and cash transfer, food and NFIs in Rafah. 
• In the West Bank, a humanitarian needs assessment was conducted in Nur Shams refugee camp (Tulkarm), following the Israeli forces operation where PFA was delivered and various humanitarian needs assessed, including mental health and psychological and protection needs.  

Shelter

Priority Needs

• Urgent need to provide services and basic Shelter and NFI to IDPs.  
• Provision of NFIs 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 590,000 IDPs are hosted at 150 UNRWA schools across the Gaza Strip. 
• Distribution of 20,000 NFIs in Rafah and Khan Younis, including bedding sets and dignity kits. 
• Distribution of 820 hygiene kits to displaced families.  
• ICRC/PRCS distributed 15,500 NFIs for displaced families, mainly mattresses and blankets.

Health

Priority Needs

• Improve the nutritional status, particularly of about 283,000 children under five 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 psychologically 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 services 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

• On 23 October, 63,903 IDP across 15 UN shelters were reached with 6.52 MT of fresh bread. 
• UNRWA started distributing corned beef, together with the canned tuna distributed by WFP in the DES operating in the Khan Younis Training Center. 
• The World Food Program (WFP) reached some 536,000 people with emergency food and cash assistance since the crisis began, most of them IDPs in UNRWA DES.  
• PARC is planning to provide food assistance to 80,000 to 100,000 IDPs in non-UNRWA shelters. 
• Oxfam has already covered 189 households in Gaza governorate. 
• Dan Church Aid (DCA) 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. 
• ANERA provides hot meals and food parcels to 120,000 IDPs - 80 percent to UN shelters, and 20 per cent to hosting communities and other small-scale shelters.

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. 
• 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 9,000 hygiene kits were distributed to the families in the UNRWA IDP centres since 7 October. 
• 1,800 cubic metres of drinking water have been trucked to IDP centres and host families since 7 October. 
• 175 cubic metres of bottled water distributed among IDPs in UNRWA shelters since 7 October. 

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.