Hostilities in the Gaza Strip and Israel | Flash Update #37

KEY POINTS

• Bombardments and armed clashes around the Shifa hospital in Gaza city intensified since the afternoon of 11 November. Critical infrastructure, including the oxygen station, water tanks and a well, the cardiovascular facility, and the maternity ward, was damaged,and three nurses killed. While many internally displaced persons (IDPs) and some staff and patients have managed to flee, others are trapped inside, fearing to leave or physically unable to do so.*
• At Shifa, two premature babies and ten other patients have died since the power outage that started on 11 November, compounded by the lack of medical consumables. Another 36 babies in incubators as well as kidney dialysis patients are at hightened risk of death. On 12 November, the World Health Organization (WHO) indicated that it had lost communication with its contacts in Shifa. 
• On 12 November, the Palestine Red Crescent Society (PRCS) announced that the Al Quds Hospital in Gaza city was no longer operational due to the depletion of available fuel and power outage.  
• On the afternoon of 11 November, an airstrike reportedly hit and destroyed the Swedish clinic in Ash Shati camp, west of Gaza city, were some 500 IDPs were sheltering. The casualty toll remains unclear. Overnight (11-12 November), another airstrike hit Al Mahdi Hospital in Gaza city, reportedly killing two doctors and injuring others.  
• Hospitals and medical personnel are specifically protected under international humanitarian law (IHL). They must not be used to shield military objectives from attack. Any military operation around or within hospitals must take steps to spare and protect the patients, medical staff, and other civilians. All feasible precautions must be taken, including effective warnings, which consider the ability of patients, medical staff and other civilians to evacuate safely.  
• The building of the United Nations Development Programme (UNDP) in Gaza city and an UNRWA school in Beit Lahiya, both of which were hosting IDPs, were hit on 11 and 12 November, respectively, resulting in an unclear number of casualties. 
• The flight of tens of thousands of IDPs southwards from the areas north of Wadi Gaza (hereafter “the north”), through a “corridor” opened by the Israeli military, continued on 12 November. 
• 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. 

Hostilities and casualties (Gaza Strip)

• Clashes between Israeli forces and Palestinian armed groups in and around Gaza city, in several areas in the North Gaza governorate and to a lesser extent in the Middle area continued overnight (11-12 November), alongside Israeli bombardments from the air, sea, and land across the Gaza Strip. Israeli ground troops have maintained the effective severance of the north from the south, except for the “corridor” to the south.
• Other deadly attacks included the following: on 11 November, at about 13:00, a building in the Ash Shabora area of Rafah (in the south) was hit, reportedly killing 13 people and injuring 15 others; on 12 November, at about 2:00 a.m., two consecutive airstrikes in Jabalia camp reportedly killed 18 Palestinians; on 12 November, at about 10:00 a.m., a residential building in Bani Suhaila, east of Khan Yunis (in the south), was hit, reportedly killing at least 13 Palestinians and injuring 20 others.
• On 12 November, for the second consecutive day, following the collapse of services and communications at hospitals in the north, the Ministry of Health (MoH) in Gaza did not update casualty figures. The Palestinian fatality toll in Gaza as of 10 November at 14:00  (latest update provided) stood at 11,078, of whom 4,506 were 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 have reportedly been injured.
• No fatalities among Israeli soldiers operating in Gaza have been reported over the past 24 hours. The total number of soldiers killed since the start of ground operations stands at 47, according to Israeli official sources. 
• See the latest snapshot for more breakdowns.

Displacement (Gaza Strip)

• On 12 November, for the nineth 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. Additionally, the Israeli military announced via its social media channel in Arabic “a tactical halt in military activities” between 10:00 and 14:00 in Jabalia and Izbat Malin, next to Gaza city, to enable people to leave southwards. Tens of thousands of displaced people evacuated. 
• IDPs reached the main junction next to Wadi Gaza on foot or donkey carts, given that the Israeli military reportedly stopped vehicles at about 4-5 kilometres away from that point. Most were able to carry only a few belongings. Most IDPs arrived exhausted and thirsty. UN monitors and NGOs distributed water and biscuits next to the junction. 
• One UNRWA school and one health centre in Gaza city were hit by a strike on 11 November. The health centre was sheltering over 1,000 IDPs, some of whom were able to flee with UNRWA’s coordination southwards. 
• The number of IDPs in the south continues to increase, with UNRWA sheltering 618,000 people in 97 facilities, three of which were recently opened in Rafah. Following these openings, the average number of IDPs per shelter slightly declined. However, UNRWA shelters are accommodating far more people than their intended capacity. Overcrowding is leading to the spread of diseases, including acute respiratory illness and diarrhea, raises environmental and health issues and limits the Agency’s ability to ensure effective and timely services. 
• Over 1.5 million people in Gaza are estimated to be internally displaced, including about 778,000 IDPs who are staying in at least 154 UNRWA shelters. 
• See the live IDP dashboard for the latest figures and more breakdowns.

Humanitarian Access (Gaza Strip)

• A total of 76 trucks, carrying food, medicines, health supplies, bottled water, blankets, tents and hygiene products, crossed from Egypt into Gaza on 12 November as of 18:00. This brings the number of trucks that have entered Gaza since 21 October to 981.  
• As of the time of writing, it is unclear whether the Egyptian border was operated on 12 November for the evacuation of foreign nationals and dual citizens, or injured people. Between 2 and 9 November, 131 injured people were taken for medical care in Egypt. 
• 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

• 11 November marked one month since Gaza has been under an electricity blackout, following Israel’s shutting off the electricity supply and the depletion of fuel reserves for 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)

• Bombardments and clashes between Israeli troops and armed groups around the Shifa hospital in Gaza city intensified since the afternoon of 11 November.  
• The Israeli military has repeatedly alleged that armed groups operate a military compound within and underneath the Shifa hospital. The hospital’s management and the Palestinian MoH have strongly denied this allegation and have called for an independent investigation.   
• An unconfirmed number of IDPs, along with several staff and patients have reportedly fled the Shifa hospital over the past few days, amid the intensified attacks and Israeli calls to evacuate it. The Israeli military has claimed it had opened “a corridor” for people to leave the hospital. However, reports cited by the WHO indicated that some of those fleeing have come under fire, resulting in casualties. Humanitarian agencies have received desperate calls from staff and patients’ relatives willing to leave but fearing reported snipers around the hospital. Others, particularly people with disabilities, are physically unable to leave by themselves.* 
• The last generator at the Shifa hospital ran out of fuel on 11 November. Since the start of the power outage, which is compounded by the lack of medical consumables, two premature babies and ten other patients have died in the hospital, according to the Palestinian MoH in Ramallah. Shifa’s director has stated to the media that by tomorrow 13 November, kidney dialysis patients might die due to the inability to treat them. The MoH has also warned about the inability of the hospital staff to bury the bodies of about 100 fatalities, which began to decompose in the hospital yard, alongside risks associated with the medical waste accumulated inside the departments. 
• The Israeli military has reported that, in the morning of 12 November, its troops attempted to deliver to Shifa hospital 300 litres of fuel for urgent medical purposes, and that the delivery was not taken by the hospital. Shifa’s director has stated to the media that the amount delivered would have been sufficient for 15-30 minutes only, noting that the hospital would have accepted it if was delivered through the International Committee of the Red Cross (ICRC). 
• On 12 November, PRCS reported that the Al Quds Hospital in Gaza city was no longer operational due to the depletion of available fuel and power outage. Medical staff are making every effort to provide care to patients and the wounded, even resorting to traditional medical methods amid dire humanitarian conditions and a shortage of medical supplies, food, and water.  
• As of 11 November, only seven out of 18 PRCS ambulances in the north were still functioning, but at risk of completely ceasing operations due to fuel depletion. 
• UNRWA has continued to provide health care to IDPs at shelters through 124 medical teams deployed to the shelters. Between 10 and 11 November, a total of 18,076 were treated. 

Water and sanitation (Gaza Strip)

• As of 9 November, following a few days of limited operation, all municipal water wells across the Gaza Strip had to shut down again due to 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 bathe 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.  
• 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. 
• Transfer of solid waste to landfills in most municipalities has largely stopped 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. By contrast, solid waste collection from the camps and IDP shelters has continued intermittently: about 100 loads were transferred to temporary dumping sites on 10-11 November. 

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 as access has been largely cut off 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 consuming combinations of raw onion and uncooked eggplant. 
• Women, especially those pregnant or lactating, struggle to find food, putting their families at risk. Their ability to nourish themselves and their children is severely compromised, endangering their health and well-being. 
• 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 lasting over 5 hours in front of bakeries, where they are exposed to airstrikes.  
• 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. Food and beverage prices have surged by 10 per cent since the start of hostilities, with fresh vegetable prices spiking by 32 per cent, potato prices rising by 30 per cent, and fresh fruit prices increasing by 27 per cent. 

Hostilities and casualties (Israel)

• The indiscriminate firing of rockets by Palestinian armed groups towards Israeli population centres has continued over the past 24 hours, with no reported fatalities. In total, over 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 revised by Israeli sources), the vast majority on 7 October. As of 10 November, the names of 1,162 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. On 12 November, the Secretary-General of the United Nations, António Guterres, renewed his call to release the hostages. 

Violence and casualties (West Bank)

• On 12 November, a Palestinian man died of wounds sustained by Israeli forces during a search-and-arrest operation in Burqa village (Nablus). 
• Since 7 October, 172 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 (417). 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 2,586 Palestinians, including at least 267 children, over half of them in the context of demonstrations. An additional, 74 Palestinians have been injured by settlers. Some 33 per cent of those injuries have been caused by live ammunition. 
• In the past 24 hours, Israeli settlers, reportedly from Tappuah, threw stones, physically assaulted and injured three Palestinian farmers, including two women, in the village of Jamma’in (Nablus). 
• Since 7 October, OCHA has recorded 241 settler attacks against Palestinians, resulting in Palestinian casualties (30 incidents), damage to Palestinian-owned property (174 incidents), or both casualties and damage to property (37 incidents). This reflects a daily average of over six 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)

• No new displacements were recorded during the past 24 hours. 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.  
• Additionally, 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 760,000 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.

* This text has changed after the publication.