Hostilities in the Gaza Strip and Israel | Flash Update #20

KEY POINTS

• A total of 481 fatalities, including 209 children, were reported over the past 24 hours (as of 18:00 on 26 October) by the Ministry of Health (MoH) in Gaza. Overall, 7,028 Palestinians were killed in Gaza since the start of hostilities, of whom 66 per cent are children and women, according to MoH. About 1,600 people, including 900 children, have been reported missing and may be under the rubble. 
• On 26 October, the Rafah crossing with Egypt opened for the sixth consecutive day, allowing the entry of 12 trucks carrying water, food and medical supplies. This brings the total number of trucks with humanitarian aid that entered Gaza since 21 October to 74. Prior to the hostilities, an average of 500 truckloads entered Gaza every working day.

• The entry of fuel remains banned by the Israeli authorities. As stated by UNRWA’s Commissioner General, Philippe Lazzarini, "without fuel, there will be no humanitarian response, no aid reaching people in need, no electricity for hospitals, no access to clean water, and no availability of bread."
• Around midnight on 25 October, the Israeli military reiterated its call upon the residents of four areas in Gaza city and one area in Al Bureij Refugee Camp to evacuate to Al Mawasi, on the seacoast in the southern Gaza Strip, by 8:00am. The latter area has almost no sheltering capacity.
• The Humanitarian Coordinator for the Occupied Palestinian Territory, Lynn Hastings, stated on 26 October that “the United Nations intends to deliver aid wherever people in need are located. For people who can’t evacuate – because they have nowhere to go or are unable to move – advance warnings make no difference. When the evacuation routes are bombed, when people north as well as south are caught up in hostilities, when the essentials for survival are lacking, and when there are no assurances for return, people are left with nothing but impossible choices.” She stressed that under international humanitarian law, “civilians must be protected and have the essentials to survive, wherever they are and whether they choose to move or stay.” 
• An estimated 1.4 million people in Gaza are internally displaced, with some 641,000 sheltering in 150 UNRWA-designated emergency shelters (DES). The average number of internally displaced people (IDPs) per shelter is almost three times their intended capacity.
• About 45 per cent of housing units in the Gaza Strip have been destroyed (16,441), rendered uninhabitable (11,340) or moderately/lightly damaged (150,000), since the start of the hostilities, according to Gaza’s Ministry of Public Works and Housing.
• Palestinian armed groups’ indiscriminate rocket firing towards Israeli population centres continued, 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, 224 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. His call was reiterated by the Humanitarian Coordinator on 26 October. A total of four hostages were released on 20 and 23 October. On 26 October, Hamas claimed that 50 of the hostages had been killed by Israeli airstrikes. 
• In the West Bank, since the afternoon of October 25 (as of 21:00 on 26 October), Israeli forces have killed one Palestinian child. This brings the total number of Palestinian fatalities by Israeli forces or settlers since 7 October to 103, including 32 children. This represents a third of all Palestinian fatalities in the West Bank so far in 2023. 

GAZA HUMANITARIAN OVERVIEW

Hostilities and casualties

Intense Israeli bombardment and airstrikes continued during the past 24 hours. However, fewer fatalities were reported compared with the previous two days. Overnight, Israeli forces carried out a ground operation in northern Gaza, involving tanks and infantry, reportedly in preparation for a larger incursion.  

Among the deadliest attacks reported in the past 24 hours were airstrikes targeting residential structures in Khan Yunis (40 reported fatalities in two separate airstrikes) and in Rafah (12 reported fatalities, including five children) while search-and-rescue operations are ongoing for dozens of people who are missing under the rubble. 

Since 7 October, 7,028 Palestinians have been killed, including at least 2,913 children and 1,709 women, and about 18,482 have been injured, according to the MoH in Gaza.  

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 26 October, 171 Palestinian families had lost ten or more of their members, 124 Palestinian families had lost 6 to 9 members, and 436 families had lost two to five of their members. 

According to the Israeli military, between 7 and 21 October, 550 Palestinian rockets 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.

Displacement

The cumulative number of IDPs since the start of hostilities in Gaza is estimated at over 1.4 million. This figure includes nearly 641,000 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 six days through Rafah have slightly alleviated the shortages of water, food, and medicine 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 few days due to the lack of fuel. 

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

Um Ashraf, a 60-year-old woman, originally from Gaza city, is now an IDP in an UNRWA shelter in the Middle area. "I am lying on this blanket all day and cannot move because the wheelchair was broken during the evacuation," she told OCHA. 

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.  

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  seventeenth 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. 

Health care

Twenty-two out of the 74 trucks that have entered Gaza through the Rafah crossing since 21 October, carried vital medical supplies. While limited in volume, these supplies play a crucial role in bolstering trauma response and sustaining essential healthcare services. Five of these truckloads have already been 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 accompany the supplies to each hospital. Post-delivery monitoring is carried out regularly to assess consumption.  

Hospitals are facing an unprecedented level of devastation, primarily driven by the overwhelming number of injuries and critical shortages of vital resources, including medical personnel, electricity, and water. 

The ongoing hostilities have displaced most of the medical professionals forcing the hospitals to operate with less than one-third of their normal staffing levels, according to MoH in Gaza. The hospitals continue to suffer from a severe fuel shortage, leading to stringent rationing and limited use of generators for only the most essential functions. Moreover, maintaining and repairing backup generators, originally not intended for continuous operation, is growing increasingly challenging due to the scarcity of spare parts. 

In many hospitals, the situation has been compounded by the presence of large numbers of IDPs, including some 50,000 seeking refuge in Shifa hospital, in Gaza city. 

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 or lack of fuel, increasing the pressure on the remaining health facilities that are still operational.  

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

According to initial health assessments by UNRWA’s mobile medical teams,  over 37,000 IDPs have non-communicable diseases, and over 4,600 pregnant IDPs and about 380 newborns in displacement require medical attention. 

In addition, medical teams are increasingly identifying cases of acute respiratory disorders and diarrhea among children under five years old. 

Water, sanitation, and hygiene (WASH)

Water supply through the Middle Area network, Khan Younis, and Rafah has shown temporary improvement for the second consecutive day, after UNRWA and UNICEF managed to deliver an additional 25,000 liters of fuel to crucial water facilities, sourced from their reserves within Gaza. However, unless additional fuel is delivered to these facilities, operations will be halted again soon. 

In this context, two seawater desalination plants in the Middle Area and Khan Younis continue limited operations, pumping about 4,000 cubic metres of drinking water per day through the network, representing 30 per cent of their full capacity (the third seawater desalination plant in northern Gaza remains closed). Furthermore, the supply of piped water to other areas in the south, primarily 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 benefitted only those households with undamaged water connections. 

Additionally, after water supply by Israel to the Khan Younis area 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 the other hand, a leakage of about 70 percent was identified in one of the main pipelines between Rafah and Khan Younis, due to the damage it had sustained. This has compelled water providers to halt distribution to the network to a large area, and resort to less efficient and limited water trucking. 

Out of the 74 trucks that have entered Gaza through the Rafah crossing since October 21, eleven carried at least 4,000 water jerry cans (10 litres each), 4,500 family hygiene kits, and 12 community water storage tanks procured by UNICEF. These supplies have been distributed to UNRWA DES. 

Food security

Between 20 and 26 October, three bakeries contracted by the World Food Programme (WFP) were forced to shut down due to a lack of fuel. Currently, only 18 bakeries contracted by 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 six-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 bread. Long queues are reported in front of bakeries, where people are exposed to airstrikes.  

The 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. 

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. 

Out of the 74 trucks that have entered Gaza through the Rafah crossing since 21 October, 34 carried food, including ready-to-eat food such as canned tuna, canned meat and other non-perishables. All food items are being distributed in UNRWA shelters. 

Movement and access

Twelve trucks with humanitarian supplies entered on 26 October through the Rafah crossing with Egypt after passing through Nitzana crossing between Israel and Egypt (about 40 kilometres south of Rafah) for security checks by the Israeli authorities. About 3,000 truckloads are still waiting on the Egyptian side to enter Gaza. 

The Erez and Kerem Shalom crossings with Israel remain closed.  Prior the hostilities, patients, including some 2,000 cancer patients from Gaza had been referred for regular treatment to hospitals in East Jerusalem and Israel. However, this practice has been halted since 7 October. 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’s shore has been prohibited by the Israeli military, and all fishing activity ceased when 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 UNRWA staff member has been killed, bringing the total to 39, 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 26 October), Israeli forces shot and killed a 17-year-old Palestinian child and injured eight by live ammunition during confrontations with school students in Al Jalazun Refugee Camp (Ramallah).  

Since 7 October, Israeli forces or settlers in the West Bank have killed 103 Palestinians, including 32 children. Of these 97, including 30 children, were killed by Israeli forces; and six, including one child, by Israeli settlers. One member of Israeli forces was killed by Palestinians.  

Additionally, since 7 October, Israeli forces have injured 1,913 Palestinians, including at least 168 children; an additional 43 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 the 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 and 7 October 2023. 

Settler-related violence

The already high level of Israeli settler violence recorded during the first nine months of 2023 has sharply increased since the start of the Gaza hostilities. Since 7 October, OCHA has recorded 146 settler attacks against Palestinians, resulting in Palestinian casualties (22 incidents), damage to Palestinian property (100 incidents), or both casualties and damage to property (24 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 involved threats with firearms, including shooting, by settlers. Almost half of all 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 24 residential structures, 40 agricultural/animal-related structures, 67 vehicles and more than 400 trees and saplings. 

Displacement

Since 7 October, 14 Palestinian households, including 65 people and 31 children, were displaced following the demolitions of their homes in East Jerusalem and Area C of the West Bank on grounds of lack of Israeli building permits.  

In addition, there has been an increase in the displacement of Palestinians amid settler violence and access restrictions. Since 7 October, at least 82 households comprising 607 people, including 211 children, have been displaced in this context. The displaced households are from more than 13 herding/Bedouin communities in Ramallah, Hebron, Bethlehem, Tubas and Nablus Governorates. 

The last such recorded incident occurred on 21 October, when a family of 16 was displaced from the Khirbet Ar Ratheem community in southern Hebron. This followed an attack by armed settlers, reportedly from the Meitarim settlement outpost, which involved the vandalizing of a residential structure, an animal shelter, and a solar panel. One of the family members, Abu Safi, 76-year-old, said: 

“I was terrified for my family and fearing for their safety. We decided to leave. We were threatened at gunpoint after they vandalized our properties. Leaving was the only option for me to protect my family.” 

Attacks on health care

Since 7 October, WHO has documented 108 attacks on health care in the West Bank affecting 88 ambulances and including 59 attacks involving obstruction to delivery of health care; 55 involving physical violence towards health teams; 17 involving detention of health staff and ambulances; and 12 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 13,241 households started receiving Emergency MPCA (NIS754 or $187 per household) as of 26 October. Redemption rates reported as up to 86%. 

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. 
• Partners provided about 700 psychological, social and legal consultations for gender-based violence (GBV) incidents). Furthermore, 1,144 first psychiatric medical services were provided for GBV cases. 
• UNICEF is leading the mapping of orphanages and shelters which host children with a view to support Unaccompanied and Separated Children (UASC) registration, to facilitate identification, reunification and alternative care options at national level (both Gaza and WB). 

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 641,000 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. 

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. 
• 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. 
• 1,950 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.