Hostilities in the Gaza Strip and Israel | Flash Update #19

KEY POINTS

• As hostilities entered the nineteenth day, the reported number of Palestinian fatalities in Gaza reached a new high: 756 people, including 344 children, over the past 24 hours (as of 18:00 on 25 October), according to the Ministry of Health (MoH) in Gaza. Overall, 6,547, of whom 68 per cent are said to be children and women, were killed in Gaza since the start of hostilities, according to MoH. About 1,600 people, including 900 children, have been reported missing and may be under the rubble. Heavy Israeli bombardments have continued throughout the day.
• On the night of 24 October, the Rafah crossing with Egypt opened for the fourth consecutive day, allowing the entry of eight trucks (out of 20 planned) carrying water, food and medical supplies. This brings the total number of trucks with humanitarian aid that entered Gaza since 21 October to 62. Most of this aid has already reached hospitals, ambulances, and internally displaced persons (IDPs). The daily average of trucks allowed into Gaza prior to the hostilities was about 500.

• Fuel, which is desperately needed to run backup generators, remains banned by the Israeli authorities. As a result, UNRWA, the largest humanitarian provider in Gaza, has almost exhausted its fuel reserves and began to significantly reduce its operations.
• On the morning of 25 October, the Israeli military called upon the residents of two neighbourhoods east of Khan Younis and Deir Al Balah (south of Wadi Gaza), with a population of over 40,000, to evacuate westwards to Al Mawasi area, on the seacoast, by 14:00. That area has almost no sheltering capacity. The volume of movement as a result of this call remains unclear.
• An estimated 1.4 million people in Gaza are internally displaced, with some 629,000 sheltering in 150 UNRWA-designated emergency shelters (DES). Overcrowding is a growing concern, as the average number of IDPs per shelter has reached 2.7 times their designated capacity, with the most overcrowded one reaching 11 times its intended capacity.
• Water supply through the network in areas south of Wadi Gaza has temporarily improved. This happened after UNRWA and UNICEF managed to deliver small quantities of fuel they had retrieved from their existing reserves to key facilities. However, the available fuel in these facilities will be exhausted by 26 October and supply of piped water is expected to cease again.
• Palestinian armed groups’ indiscriminate rocket firing towards Israeli population centres continued, reportedly reaching as far as Eilat and Haifa cities, with no reported fatalities. 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, 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. A total of four hostages were released on 20 and 23 October.
• In the West Bank, since the afternoon of 24 October (as of 21:00 today), Israeli forces have killed seven Palestinians, including two children. This brings the number of Palestinian fatalities by Israeli forces or settlers since 7 October to 102, including 31 children.

GAZA HUMANITARIAN OVERVIEW

Hostilities and casualties

The past 24 hours recorded the most intense Israeli bombardment and airstrikes since the escalations began, with the highest number of fatalities in Gaza since the start of the hostilities, as reported by MoH in Gaza. One of the deadliest attacks reported during this period involved the destruction of the At Taj residential building in Gaza city, where 40 people were reportedly killed. According to the Israeli military, many of the airstrikes carried out overnight in the city targeted underground military facilities.

Since 7 October, 6,547 Palestinians have been killed, including at least 2,704 children and 1,292 women, and about 17,439 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 1,600 people, including at least 900 children, have been reported missing and may 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 25 October, 149 Palestinian families had lost ten or more of their members, 123 Palestinian families had lost 6 to 9 members, and 416 families had lost two to five of their members.

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

The Gaza Ministry of Public Works and Housing reported the destruction of 16,441 housing units and the rendering of 11,340 other units uninhabitable, as of 23 October. About 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, satellite imagery produced by UNOSAT shows the large scope of destruction.

As of 23 October, WHO has documented 76 attacks on health care in the Gaza Strip that have resulted in 16 fatalities and 30 injuries among health care workers on duty. The attacks have affected 35 health care facilities (including 20 hospitals damaged) and 24 ambulances.

As of 25 October, 219 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 25 October, the names of 914 of these fatalities have been released, including 587 civilians, 269 soldiers, and 58 police officers. Of those whose ages have been provided, 29 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 629,000 people staying in 150 UNRWA DES, 121,750 sheltering in hospitals, churches, and other public buildings, and nearly 79,000 in 70 non-UNRWA schools. In addition, the Ministry of Social Development estimates that some 700,000 IDPs are residing with host families.

Overcrowding conditions at UNRWA DES in the central and southern areas is severely constraining access to basic assistance and essential services, increasing health and protection risks, and negatively affecting mental health. In many shelters, the number of IDPs has reached 4,400, while they were designed to host 1,500-2,000 IDPs.

The humanitarian supplies that reached Gaza over the past four days via Rafah have slightly alleviated the shortages of water, food, and medicines at UNRWA shelters. Desalination equipment in these shelters have so far continued to operate and provide potable water. However, they are expected to shut down over the next day or two due to the lack of fuel.

UNRWA estimates that 30,000 IDPs have returned 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.

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 sixteenth 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, hospitals and water facilities.

Health care

Twenty-one out of the 62 trucks that entered Gaza through the Rafah crossing since 21 October, including one truck on 24 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. The World Health Organization (WHO) is coordinating with the Palestine Red Crescent Society (PRCS) to facilitate the swift delivery of these supplies to major hospitals. Five of these trucks received by WHO were already distributed to seven hospitals and at least 20 PRCS ambulances.

The distribution plan is based on the needs confirmed on the ground by technical officers in Gaza and approved by the team lead. After delivery into Gaza and reception by WHO, the technical officers accompanied the supplies to each hospital. There is regular post-delivery monitoring to assess consumption.

Since the start of hostilities, 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, increasing the pressure on the remaining health facilities that are still operational.

Hospitals have reached an unprecedented point of devastation due to the influx of injuries combined with severe shortages of essential resources, personnel, electricity, and water. Fuel at the hospitals is being severely rationed and is used to run a selected number of critical facilities. The maintenance and repair of back-up generators, which are not designed for continuous operation, is increasingly challenging due to the lack of spare parts.

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.

According to initial health assessments by UNRWA’s mobile medical teams, there are over 37,000 people with non-communicable diseases (NCDs), over 4,600 pregnant women and about 380 post-natal cases requiring medical attention among the IDPs. In addition, medical teams are increasingly identifying cases of acute respiratory and diarrhea among children under five years old.

Water, sanitation, and hygiene (WASH)

Water supply through the network in the Middle Area, Khan Younis and Rafah temporarily improved, after UNRWA and UNICEF managed to deliver to key water facilities small quantities of fuel they had retrieved from their own reserves within Gaza. Consequently, in the past two days, people in households connected to the network are consuming up to 30 liters per day per person. However, the available fuel in all of these facilities will be exhausted by 26 October and supply of piped water will cease again.

As part of this improvement, on 24 October, an additional seawater desalination plant resumed limited operations in the Middle Area, after another plant in Khan Younis did so on 21 October. Both plants began pumping some 4,000 cubic metres of drinking water per day through the network (the third seawater desalination plant in northern Gaza has remained closed). Supply of piped water to other areas in the south, mostly brackish water, was made possible by the operation of 120 water wells and 20 pumping stations, which also received limited amounts of fuel. This has been benefiting only those households with undamaged water connections.

Additionally, after water supply by Israel to the Khan Younis area was reduced in previous days by 60-80 per cent, on 25 October, this supply resumed at the previous level of 600 cubic metres per hour. This too, has contributed to the availability of piped water in some households. Meanwhile, water supply through two other pipelines from Israel is suspended since 8 October.

On 24 October, five trucks containing 4,000 water jerry cans (10 litres each), 4,500 family hygiene kits, and 12 community water storage tanks acquired by UNICEF, entered Gaza from Egypt. These supplies began to be distributed today to UNRWA DES.

Food security

Since 21 October, 24 trucks carrying food entered Gaza, including ready-to-eat food such as canned tuna, canned meat and other non-perishables. All food items are distributed in UNRWA shelters in the south.

The World Food Programme (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.

Some of the basic food items available in the market, such as rice and lentils, cannot be cooked 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.

Between the 20 and 25 October, three bakeries were forced to shut down due to a lack of fuel. Currently, only 19 bakeries contracted by the WFP and UNRWA 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 will shut over the next few days. During the same five-day period, ten bakeries were struck and destroyed; six in Gaza city, two in northern Jabalia, and two in the Middle Area (Maghazi Camp and Nusseirat).

As a result, people are struggling to obtain a piece of bread. Long queues are reported in front of bakeries, where people are exposed to airstrikes.

Abu Malik, a 51-year-old father of three children (aged 7, 9, and 15), originally from Al Rimal area of Gaza city, is now an IDP in an UNRWA shelter in Khan Younis: “Unfortunately, the quantity of bread we got last night in this shelter was not enough. The kids looked at me and said that they were still hungry. I promised them that tomorrow I would bring them a larger portion of bread,” he reported to OCHA. Abu Malik agreed with his older son (15 years old) that each of them would go to a different bakery to maximize their chances. After two hours of waiting in the queue, the bakery he was at ran out of fuel and had to close before his turn arrived. “As for my son, I still don't know if he succeeded or not. Hopefully, he had a better day than mine.”

Electricity outages are affecting other food suppliers and markets. Cooling chains have been damaged and have run out of electricity and have started disposing of their products. There is a complete closure of food processing shops such as chicken slaughterhouses, shawarma restaurants, frozen food shops, coffee shop cafeterias and popular kitchens.

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 seven per cent of trucks entering Gaza daily carried animal feed; those imports have stopped since 7 October.

Movement and access

On 25 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.

In the past 24 hours, another three UNRWA staff members have been killed, bringing the total to 38, since 7 October. Additionally, at least 16 health workers have been killed while on duty.

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, in the past 24 hours (as of 21:00 on 25 October), Israeli forces shot and killed seven Palestinians and injured eight by live ammunition. The deadliest incident, which resulted in four of these fatalities, including two boys (aged 15 and 17), took place during a search-and-arrest operation in Jenin Refugee Camp. Following the entry of Israeli forces into the camp, clashes with residents began, including exchange of fire. During the incident, Israeli forces launched an air strike, using a drone, which killed at least one of the four.

The other three fatalities were killed during search-and-arrest operations, one in Qalqiliya city, one in Qalandiya Refugee Camp (Jerusalem); and one during confrontations that erupted over the course of a protest in solidarity with Gaza in Anabta village (Tulkarm).

This has brought the total number of Palestinians killed by Israeli forces or settlers since the start of the escalation to 102, including 31 children. Of these Palestinians, 96, including 30 children, were killed by Israeli forces; and six, including one child, by Israeli settlers. One member of Israeli forces was reportedly killed by Palestinians.

Additionally, since 7 October, Israeli forces have injured 1,850 Palestinians, including at least 160 children; an additional 39 Palestinians have been injured by settlers. Over 1,200 Palestinians have been injured, mostly by Israeli forces, in the context of demonstrations. Some 27 per cent of injuries have been caused by live ammunition. The number of Palestinian injuries from live ammunition is almost eight times higher than the average of such injuries between 1 January to 7 October 2023.

Settler-related violence

The high level of Israeli settler violence reported during the first nine months of 2023 has escalated since the start of the Gaza hostilities. Since 7 October, OCHA recorded 138 settler attacks against Palestinians, resulting in Palestinian casualties (20 incidents), damage to Palestinian property (95 incidents), or both casualties and damage to property (23 incidents). This reflects a daily average of seven incidents, compared with three since the beginning of the year.

More than one-third of the incidents (48 incidents) involved threats with firearms, including shooting, by settlers. Almost half of all incidents (68 incidents), involved Israeli forces accompanying or actively supporting Israeli settlers while carrying out the attacks. Many of the latter incidents were followed by confrontations between Israeli forces and Palestinians, where three Palestinians were killed and dozens injured. Affected properties included 22 residential structures, 40 agricultural/animal-related structures, 66 vehicles and more than 400 trees and saplings.

Displacement

In addition, there has been an increase in incidents resulting in the displacement of Palestinians amid settler violence and access restrictions. In the past 19 days, at least 82 households comprising 607 people, including 211 children, have been displaced. The displaced households are from more than 13 herding/Bedouin communities in Ramallah, Hebron, Bethlehem, Tubas and Nablus Governorates.

Attacks on health care

Since 7 October, WHO has documented 96 attacks on health care in the West Bank affecting 77 ambulances and including 53 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 629,000 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

• 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 550,000 people with emergency food and cash assistance since the crisis began, most of them IDPs in UNRWA DES. 490,311 displaced persons in UN shelters received fresh bread and canned food; 243,756 people redeemed WFP’s cash-based transfer assistance in active shops
• 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.
• ACTED: is providing food vouchers to 3250 IDPs in the Middle Area (Khan Younis).

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.

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.