Hostilities in the Gaza Strip and Israel | Flash Update #35

KEY POINTS

• An estimated 30,000 additional people fled areas north of Wadi Gaza (hereafter: the north) southwards through a “corridor” opened by the Israeli military on 10 November. At about 15:00, several explosions were recorded in that “corridor,” resulting in fatalities and injuries, among those fleeing, according to initial reports 
• Israeli bombardments around hospitals in Gaza city and the North Gaza governorate intensified on 10 November, with several being directly hit. By noon, Israeli ground forces reportedly completed the encirclement of four hospitals in An Nasser area of Gaza city. One of them, a pediatric hospital, stopped operations on 9 November after sustaining significant damage. This brings to 20 (out of 36) the number of hospitals throughout Gaza that are no longer functioning. 
• The head of the International Committee of the Red Cross (ICRC) sub-delegation in Gaza stated today that “the destruction affecting hospitals in Gaza is becoming unbearable and needs to stop. The lives of thousands of civilians, patients and medical staff are at risk.” 
• On 10 November, the Emergency Relief Coordinator, Martin Griffiths, stressed following reports on attacks hitting Shifa: "under international humanitarian law, hospitals must be protected" adding that "acts of war in places of grace must stop.” 
• Hundreds of thousands of people remaining in the north are struggling to survive. Consumption of water from unsafe sources raises serious concerns about dehydration and waterborne diseases. The World Food Programme (WFP) has expressed concern about malnutrition and starvation. 
• The reported fatalities since 7 October include at least 192 medical staff, according to MoH Gaza. Of them, at least 16 were on duty when killed, according to the World Health Organization (WHO). The fatalities further include 101 UNRWA staff; this is the highest number of UN personnel killed in a conflict in the history of the organization. Eighteen Palestinian Civil Defense personnel and 44 Palestinian journalists have also been killed. 
• In the West Bank, 51 Palestinians were displaced from a herding community in Hebron following systematic settler violence and threats, bringing to 1,149 the number of people displaced in this context since 7 October. Another 18 people were displaced on 9 and 10 November following punitive demolitions of homes in Hebron and East Jerusalem; of whom some family members had been convicted or accused of killing Israelis. 
• On 10 November, Israeli forces killed a Palestinian child in the West Bank, bringing the total number of Palestinian children killed by Israeli forces or settlers to 47 since 7 October.  

Hostilities and casualties (Gaza Strip)

• On 10 November, clashes between Israeli forces and Palestinian armed groups were reported in and outside of Gaza city, in several areas in the North Gaza governorate and to a lesser extent in the Middle area. Meanwhile, intense Israeli bombardments from the air, sea, and land continued across the Gaza Strip, while Palestinian armed groups continued launching projectiles toward Israel. Israeli ground troops have maintained the effective severance of the north from the south. 
• Between 9 November (14:00) and 10 November (14:00), 260 Palestinians were killed in Gaza, according to the Ministry of Health (MoH) in Gaza. According to initial information, on 9 November at about 16:20, an airstrike hit a residential building in Rafah, southern Gaza, killing 26 people and injuring 15; on 10 November, in two separate strikes, buildings in Jabalia Refugee Camp in the north of Gaza were hit, reportedly killing eleven and injuring several others. 
• The fatality toll reported by MoH in Gaza since the start of the hostilities stands at 11,078, of whom 4,506 are said to be children and 3,027 women. About 2,700 others, including some 1,500 children, have been reported missing and may be trapped or dead under the rubble, awaiting rescue or recovery. Another 27,490 Palestinians were reportedly injured.  
• As of 10 November, 66 internally displaced persons (IDPs) in UNRWA shelters have been killed and 558 injured. One-third of these fatalities and the majority of those injured (at least 400) occurred in facilities in the south. 
• In the past 24 hours, at least one Israeli soldier was reportedly killed in Gaza and another died from injuries sustained previously, bringing the total number of soldiers killed since the start of ground operations to 42, according to Israeli official sources. 
• See the latest snapshot for more breakdowns.

Displacement (Gaza Strip)

• On 10 November, for the seventh consecutive day, the Israeli military – which has called upon residents of the north to leave southwards – opened a “corridor” along the main traffic artery, Salah Ad Deen Road, between 9:00 and 16:00. It is estimated that over 30,000 people evacuated. 
• These internally displaced persons (IDPs) reached the main junction next to Wadi Gaza on foot or donkey carts, as vehicles were reportedly stopped by the Israeli military at about 4-5 kilometers away from that point. Most were able to carry only few personal belongings. Most IDPs arrived exhausted and thirsty. UN monitors and NGOs distributed water and biscuits next to the junction. 
• “We came from Gaza city; the way was terrifying. They [Israeli soldiers] stopped my elderly father telling him to ask one of the children to leave his bag behind. They also arrested a man in front of us” (IDP interviewed by OCHA monitors). 
• Over 1.5 million people in Gaza are estimated to be internally displaced. Among them, 588,000 IDPs are staying in 94 UNRWA shelters in the south, where overcrowding is a major concern. The average number of IDPs per UNRWA shelter exceeded 6,250, which is nine times higher than their intended capacity. On average, 160 people sheltering in UNRWA schools’ facilities share a single toilet and there is one shower unit for every 700 people. The worsening sanitary conditions, along with the lack of privacy and space, generate health and safety hazards. 
• See the live IDP dashboard for the latest figures and more breakdowns.

Humanitarian Access (Gaza Strip)

• On 10 November, the Egyptian border was closed for the evacuation of foreign nationals and dual citizens, and of injured people. Between 2 and 9 November, 131 injured people were taken for medical care in Egypt. 
• A total of 30 trucks, carrying food, medicines, health supplies, bottled water, blankets, and hygiene products crossed from Egypt into Gaza on 10 November as of 18:00. This brings the number of trucks that have entered Gaza since 21 October to 861. This is far below the quantities needed to meet the needs of over two million people besieged in Gaza.  
• Overnight (9-10 November), a group of 982 Palestinian workers from Gaza who had been stranded in Israel, and then in the West Bank, since 7 October, were transferred back to Gaza via the Israeli Kerem Shalom crossing. After boarding Israeli buses at the West Bank checkpoint of Tarqumiya (Hebron), Israeli forces reportedly cuffed the workers’ hands and legs and took their mobile phones. 
• Otherwise, the Kerem Shalom crossing with Israel, which prior to the hostilities was the main entry point for goods, remains closed, as does the Israeli pedestrian crossing of Erez. 
• In the International Humanitarian Conference held on 9 November in Paris, the UN Emergency Relief Coordinator, Martin Griffiths stated that “the modest number of trucks we have so far managed to get in via the Rafah border crossing is wholly inadequate compared to the vast sea of needs […] We need to get hundreds of trucks per day into Gaza, not dozens, and be allowed to reach every place people are sheltering.” 

Electricity

• Gaza remains under a full electricity blackout since 11 October, following Israel’s halt of its power and fuel supply, which triggered the shutdown of Gaza’s sole power plant. 
• The entry of fuel, which is desperately needed to operate electricity generators to run life-saving equipment, remains banned by the Israeli authorities. 

Health care, including attacks (Gaza Strip)

• Since 9 November afternoon, Israeli bombardments around hospitals in the north intensified. The vicinity of Shifa hospital was hit five times during this period, with at least seven fatalities reported, along with damage to the maternity ward. On the evening of 9 November, buildings surrounding the Indonesian Hospital, in Beit Lahiya (northern Gaza), were repeatedly bombarded from the air, resulting in deaths and injuries. Around the same time, the Rantisi Hospital in Gaza city was directly hit, causing fires and damage. In the early hours of 10 November, the vicinities of Al Awda hospital in Jabalia, and Al Quds hospital in Gaza city were bombarded; the intensive care unit at the latter sustained damage.  
• The ICRC stressed today: “The rules of war are clear. Hospitals are specially protected facilities under international humanitarian law. The ICRC urgently calls for the immediate protection of all civilians, including humanitarian workers and medical personnel. This protection is not only a legal obligation but a moral imperative to preserve human life in these terrible times”.  
• Since 2 November, 12 children with cancer or blood disorders have been evacuated through Rafah crossing, with their companions, to Egypt and Jordan. Before the escalation, about 100 patients were referred for treatment outside of Gaza every day. The two specialized hospitals offering care to cancer patients have been overwhelmed, undersupplied, exposed to attacks and, due to the insecurity, forced to close.  
• WHO warned on 8 November of the risk of the rapid spread of infectious diseases and bacterial infections due to the water shortage and related consumption of contaminated water. Since mid-October, over 33,500 cases of diarrhea have been reported, mostly among children under five; by contrast, the monthly average of diarrhea cases in the latter group in 2021 and 2022 stood at 2,000.  
• Nine (out of 22) UNRWA health centres are still operational in the south, recording 6,530 patient visits on 8 November. These centres also provide medical care for post-natal and high-risk pregnant women. There are an estimated 50,000 pregnant women in Gaza, with more than 180 giving birth every day. A total of 718 post-natal mothers have been attended in UNRWA shelters since the beginning of October. 

Water and sanitation (Gaza Strip)

• On 9 November, following a few days of limited operation, all municipal water wells across the Gaza Strip had to shut down again due to the lack of fuel. As a result, the trucking and pumping of brackish water for non-drinking domestic uses came to a halt.   
• Anecdotal reports indicate that people hosted or living near the sea, are reaching the beaches to bath and wash clothes in the sea, as well as carrying seawater to their homes and shelters for domestic consumption. This practice may carry various negative health ramifications due to the high pollution levels of seawater.  
• In the north, neither the water desalination plant nor the Israeli pipeline is operational. Similarly, no distribution of bottled water among IDPs accommodated in shelters has taken place for over a week. There is serious concern about dehydration and waterborne diseases following water consumption from unsafe sources.  
• In the south, one of the two desalination plants shut down on 9 November due to a lack of fuel, while the other operated at about five per cent of its capacity supplying drinking water to IDP shelters through trucking. Two pipelines from Israel connected to Deir al Balah and Khan Younis are also providing households connected to the network with drinking water for a few hours per day.  
• UNRWA has been providing about 1.5 litres of potable water and 3-4 litres of non-potable water per person per day in all shelters in the south. In the largest shelter located in Khan Younis (over 21,700 IDPs), UNRWA in partnership with UNICEF, installed a desalination plant, which turns brackish water extracted from wells, into potable water. 
• Water entering from Egypt in bottles and jerry cans can only address the drinking needs (three litres per person per day) of about 4 per cent of the people. 
• Transfer of solid waste to landfills has largely stopped across the Gaza Strip, due to lack of fuel and insecurity. Waste is accumulating in the streets and outside IDP shelters, creating a high risk of airborne diseases and infestation of insects and rats.  

Food security

• Lack of food in the north is of increasing concern. Since 7 November, no bakeries have been active, due to the lack of fuel, water, and wheat flour, as well as the damage sustained by many. Wheat flour is reportedly no longer available in the market. Food security partners have been unable to deliver assistance in the north during the past nine days. There are indications of negative coping mechanisms due to food scarcity, including skipping or reducing meals and using unsafe and unhealthy methods for making fire. People are reportedly resorting to unconventional eating, such as combinations of raw onion and uncooked eggplant. 
• Access to bread in the south is also challenging. The only operative mill in Gaza remains unable to grind wheat due to a lack of electricity and fuel. Eleven bakeries have been hit and destroyed since 7 October. Only one of the bakeries contracted by WFP, along with eight other bakeries in the south, intermittently provides bread to shelters, depending on the availability of flour and fuel. People queue for long hours in front of bakeries, where they are exposed to airstrikes. 
• Food supplies entering from Egypt include mainly ready-to-eat food (canned tuna and date bars) and are primarily distributed to IDPs and host families in the south. 
• WFP and its partners report that some essential food items such as rice, pulses, and vegetable oil are nearly depleted in the market. Other items, including wheat flour, dairy products, eggs, and mineral water, have disappeared from the shelves in shops across Gaza over the past two days. Despite limited stock at the wholesale level, these items cannot reach retailers due to extensive damage, security issues, and the lack of fuel. The prices of available food items in the market have increased by 10 per cent since the start of hostilities, according to a WFP survey.  
• While about 9,000 tons of wheat grain are stored in mills in Gaza, a significant portion of it cannot be used, due to massive destruction, security concerns, and shortages of fuel and electricity. 

Hostilities and casualties (Israel)

• The indiscriminate firing of rockets by Palestinian armed groups towards Israeli population centers has continued over the past 24 hours, with no reported fatalities. Overall, about 1,200 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities as cited by the media (the reported estimate has been changed by the Israeli sources), the vast majority on 7 October. As of 10 November, the names of 1,162 of fatalities in Israel have been released, including 845 civilians and police officers. Of those whose ages have been provided, 33 are children.  
• According to the Israeli authorities, 239 people are held captive in Gaza, including Israelis and foreign nationals. Media reports indicate that about 30 of the hostages are children. So far, four civilian hostages have been released by Hamas, and one female Israeli soldier was rescued by Israeli forces. Hamas has claimed that 57 of the hostages had been killed by Israeli airstrikes. The Emergency Relief Coordinator, Martin Griffiths, renewed his call to release the hostages on 9 November.  

Violence and casualties (West Bank)

• On 10 November Israeli forces shot and killed a Palestinian child during a search-and-arrest operation in Ayda Refugee Camp (Bethlehem).  
• Since 7 October, 168 Palestinians, including 46 children, have been killed by Israeli forces; and an additional eight, including one child, have been killed by Israeli settlers in the West Bank, including East Jerusalem. Three Israelis have been killed in attacks by Palestinians.  
• The number of Palestinians killed in the West Bank since 7 October accounts for 42 per cent of all Palestinian fatalities in the West Bank in 2023 (416). About 59 per cent of the fatalities since 7 October occurred during confrontations that followed Israeli search-and-arrest operations, primarily in Jenin and Tulkarm governorates. Some 27 per cent were in the context of demonstrations in solidarity with Gaza; seven per cent were killed in settler attacks against Palestinians, and the remaining seven per cent were killed while attacking or allegedly attacking Israeli forces or settlers. 
• Since 7 October, Israeli forces have injured 2,552 Palestinians, including at least 25 children, over half of them in the context of demonstrations. Sixty-six Palestinians have been injured by settlers. Some 32 per cent of those injuries have been caused by live ammunition. 
• In the past 24 hours, armed settlers opened fire and injured with live ammunition a Palestinian herder in the village of Kisan (Bethlehem). The incident occurred as Palestinian herders were grazing sheep when settlers reportedly from Asfar settlement outpost threatened herders at gunpoint to leave, leading to stone throwing between the Palestinian herders and settlers, before one of the settlers opened live fire.  
• Since 7 October, OCHA has recorded 233 settler attacks against Palestinians, resulting in Palestinian casualties (29 incidents), damage to Palestinian-owned property (168 incidents), or both casualties and damage to property (36 incidents). This reflects a daily average of seven incidents, compared with three since the beginning of the year. Over one-third of these incidents included threats with firearms, including shootings. In nearly half of all incidents, Israeli forces were either accompanying or actively supporting the attackers. 

Displacement (West Bank)

• In recent weeks, ten Palestinian households, comprising 51 people, including seven children, were displaced from At Taybe herding community (Hebron) following several raids by armed assailants, known by Palestinian residents to be settlers, who threatened to kill them if they did not leave.  
• Since 7 October, at least 121 Palestinian households comprising 1,149 people, including 452 children, have been displaced amid settler violence and access restrictions. The displaced households are from 15 herding/Bedouin communities.  
• On 9 and 10 November, Israeli forces demolished on punitive grounds the homes of four families whose members were convicted or accused of killing Israelis in previous months. Three of the targeted homes were in Hebron city and one in the Shu’fat Refugee Camp in East Jerusalem. As a result, 18 people, including eight children, were displaced. Punitive demolitions are a form of collective punishment and are prohibited under international law.   
• In total, 45 Palestinians, including 24 children have been displaced since 7 October, following punitive demolitions, and another 135 Palestinians, including 66 children, following demolitions in Area C and East Jerusalem, due to lack of permits.  

Funding

• On 7 November, the UN and its partners issued a plan that outlines the minimum necessary to scale up humanitarian operations in support of 2.2 million people in the Gaza Strip and 500,000 of the most vulnerable in the West Bank. An estimated US$1.2 billion is required to deliver existing humanitarian services amid ongoing hostilities. The UN has shared its response plan with potential donors and partners as part of an updated Flash Appeal.
• Private donations are collected through the Humanitarian Fund.

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 27,634 households started receiving Emergency MPCA (NIS754 or $187 per household) as of 26 October. Redemption rates were reported as up to 86 per cent.

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.  
• In the West Bank, UNRWA provided psychosocial support services to 155 Palestinian workers from Gaza, in Hebron, Ramallah, and Tulkarm, and to 240 students at Nur Shams Boys’ schools.  
• One partner reached at least 4,000 IDPs in shelters in Gaza and provided psychological first aid 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 the registration of unaccompanied and separated children, to facilitate identification, reunification, and alternative care options at national level (both Gaza and the West Bank).  

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 centres 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

• Some 716,881 IDPs are hosted at 149 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 and 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.  
• Access to mobile clinics for 29 communities in Area C locations in Hebron, Jenin and Qalqiliya who have not had access since escalations began.  

Response to date  

• UNRWA continues to provide primary health-care services in the shelters, through 95 mobile medical units and medical teams.   
• PMRS has eight mobile health teams also providing primary health-care services to IDPs and expects to increase the number to twelve.  
• Partners are continuing to mobilize resources in Cairo; with support from WHO, the Health Cluster has deployed a logistics team based in Cairo to assist partners with health coordination.  

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 2 November, WFP continued to assist UN shelters by distributing bread, tuna, date bars and food parcels for host communities.   
• Oxfam covered 189 households in the Gaza governorate.   
• Dan Church Aid (DCA) covered 18,000 households sheltering in UNRWA designated emergency shelters in the Gaza governorate.   
• Islamic Relief Palestine provided food assistance to 10,000 IDPs in non-UNRWA shelters or with host families.   
• Anera provides hot meals to a total of 120,000 people. Food parcels, 80 per cent to UNRWA DES shelters, 20 per cent to hosting communities and other smaller scale shelters. 2,000 households in North Gaza and 12,000 households in Khan Yunis have already been covered. Ten thousand households in the Middle Area are ongoing. Vegetable baskets to host families and small-scale shelters for 2,000 IDPs (UN shelter) in Khan Younis and 2,000 IDPs (UN shelter) in the Middle Area. Planning food parcels distributed covering 1,000 IDPs in collective shelters and host families.   
• Save the Children is providing food in-kind to 75,000 IDPs outside UNRWA shelters.  
• UPA in partnership with PARC is providing 617 food parcels in five different shelter schools.  

Education

Priority needs

• Safe access to schools and communities.

Response to date

• Provision of emergency education supplies and learning, recreational kits/stationery to 11,250 children.
• Provision of psychosocial support to 28,300 school-aged children
• Provision of recreational activities for school-aged 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 centres, including drinking water and hygiene kits.  

Response to date  

• Since 7 October WASH partners have provided:   
• Some 9,500 hygiene kits to families in the UNRWA IDP centres.   
• 1,950 cubic metres of drinking water trucked to IDP centres and host families.   
• 175 cubic metres of bottled water among IDPs in UNRWA shelters.  
• Four water storage tanks, with a capacity of 10 cubic metres, and twenty others, with a capacity of 1.5 cubic metres each, to be used by communities and shelters.  
• 8,000 units of ten litres of water capacity.   
• 4,000 water purification tools for the hosted families in vulnerable communities and IDP centres.   
• 211 cubic metres of fuel to WASH facilities.  
• 5 cubic metres of anti-scaling to desalination plants.  

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.