Hostilities in the Gaza Strip and Israel | Flash Update #38

KEY POINTS

• All but one of the hospitals in Gaza city and northern Gaza (hereafter: the north) are reportedly out of service, as of 13 November, due to the lack of power, medical consumables, oxygen, food and water, compounded by bombardments and fighting in their vicinities. Al Ahli Hospital, in Gaza city, which currently accommodates over 500 patients, is reportedly the sole medical facility able to receive patients, amid increasing shortages and challenges.
• In Shifa hospital, 32 patients, including three premature babies, have reportedly died since 11 November, following the power cut and amid dire conditions. As of midnight, between 12 and 13 November, some 600-650 inpatients, 200-500 staff, and 1,500 internally displaced persons (IDPs) were believed to have remained in the hospital. Among the patients at heightened risk of death were reportedly 36 babies in incubators and a number of kidney dialysis patients.
• Hospitals and medical personnel are specifically protected under international humanitarian law (IHL) and all parties to the conflict must ensure their protection. And 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 Israeli authorities have called for the evacuation of hospitals in the north. However, as the World Health Organization (WHO) has warned, this would be a “death sentence,” given that the entire medical system is collapsing and hospitals in southern Gaza cannot admit more patients.
• On 13 November, UNRWA warned that its humanitarian operations, including the distribution of aid entering through the Rafah crossing, are expected to halt within the next 48 hours, following the total depletion of its fuel reserves. In this context, two primary water distribution contractors working for the agency in the south ceased operations on 13 November, leaving 200,000 people without access to potable water. Furthermore, humanitarian organizations are facing severe communication breakdowns, which is also associated with fuel depletion.
• The Israeli military continued calling and exerting pressure on residents of the north to move southwards. An estimated 200,000 have moved since 5 November through a “corridor” opened by the Israeli military, according to OCHA monitoring. Overcrowding and limited access to shelter, food and water, in the south, are of increasing concern.
• Hundreds of thousands of people, who are either unwilling or unable to move to the south remain in the north, remain amid intensified hostilities. They are struggling to secure the minimum amount of water and food for survival. The 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.
• UNRWA is verifying reports that Israeli forces entered one of its schools, and two of its health centres, in the north and forced IDPs that were sheltering there to leave southwards. Subsequently, the two health centres were reportedly struck with artillery fire. In Rafah, an UNRWA guest house serving as a residence for UN staff was directly hit by Israeli naval strikes, severely damaging it but resulting in no casualties. The coordinates of these facilities had been shared in advance with the Israeli military.
• UN offices globally lowered flags to half-mast on 13 November, mourning the loss of 102 UNRWA staff killed since the start of the escalation of hostilities in Gaza. This is the highest death toll among UN staff in such a short period in the history of the UN.

Hostilities and casualties (Gaza Strip)

• Clashes between Israeli forces and Palestinian armed groups in and around Gaza city continued overnight, in several areas in the North Gaza governorate. Intense strikes by Israeli forces also continue in the south, and ground incursions appear to continue in the area south-east of Khan Yunis. Israeli ground troops have maintained the effective severance of the north from the south, except for the “corridor” to the south.
• Deadly attacks included the following: on 12 November, at about 04:00 p.m., a building in Khan Younis (in the south) was hit, reportedly killing 11 people and injuring 25 others; on 13 November, at about 02:00 a.m., a house was hit in As Sabra area, in Gaza city, reportedly killing 12 Palestinians; on 13 November, at about 11:00 a.m., a residential building in An Nuseirat was hit, reportedly killing seven Palestinians and injuring others.
• On 13 November, for the third 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 reported fatality toll of Palestinians 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.
• Active ground operations in the heart of Gaza City and near the hospitals along with the lack of fuel have halted the movement of rescue teams and ambulances. Multiple appeals by stranded households and family members underneath struck buildings and homes went unanswered. According to the Palestine Red Crescent Society (PRCS), hundreds of calls have been received at the emergency number from besieged Palestinians in Gaza city, urgently requesting ambulances for the wounded, evacuation for trapped families, and assistance for those under rubble. Many of these calls for help have gone unanswered.
• In the last 24 hours, two Israeli soldiers were reportedly killed in Gaza, bringing the total number of soldiers killed since the start of ground operations to 49, according to official Israeli sources.
• See the latest snapshot for more breakdowns.

Displacement (Gaza Strip)

• On 13 November, for the tenth consecutive day, the Israeli military – which has called and exerted pressure on 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 hrs. The Israeli military also announced on its social media platforms in the Arabic language, “a tactical halt in military activities,” in selected areas for a few hours, to enable the departure of people southwards.
• 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. The UN and NGOs distributed water and biscuits next to the junction. Numerous accounts highlight that Israeli forces made arrests while people were passing through the corridor. Additionally, there are reports of some people being subjected to acts of violence, including being stripped, beaten, and, in some instances, fired upon.
• As a result of strikes near an UNRWA school in Deir Al Balah, three IDPs were injured. The school shelters about 4,000 IDPs. In the north, another UNRWA school was directly hit, damaging the building, with no injuries reported.
• 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. The number of IDPs in the south continues to increase, with UNRWA sheltering 627,000 people in 97 facilities, three of which were recently opened in Rafah. 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, raising environmental and health concerns and limiting the Agency’s ability to deliver effective and timely services.
• See the live IDP dashboard for the latest figures and more breakdowns.

Humanitarian Access (Gaza Strip)

• A total of 115 trucks, carrying food, medicines, health supplies, bottled water, blankets, tents and hygiene products, crossed from Egypt into Gaza on 13 November as of 18:00 hrs. This brings the number of trucks that have entered Gaza since 21 October to 1,096. According to UNRWA, humanitarian operations at Rafah crossing are expected to cease by 14 November, due to the depletion of fuel to operate trucks and machinery to take supplies from the border and unload them in Gaza; if no additional fuel comes in, other supplies will not come in either.
• On 13 November, the Egyptian border operated for the evacuation of about 600 foreign nationals and dual citizens, and four injured people. Between 2 and 13 November, some 135 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.

Electricity

• Since 11 October, the Gaza Strip 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)

• The situation of hospitals in the north remains dire. All but one of the hospitals are no longer operational. Shifa and Al Quds hospitals are being subject to heavy strikes.
• In the past 24 hours, bombardments and clashes between Israeli troops and Palestinian armed groups around Shifa hospital continued. People in and near the hospital, including a technical worker, a patient and IDPs, have reportedly been shot by snipers. The ICU facility, the maternity ward, and the top floor of the surgery building, were hit and damaged A fire broke near the department treating patients with kidney disorders. .
• The Israeli military has repeatedly alleged that Palestinian armed groups operate a military compound within and underneath the Shifa hospital. The hospital’s management and the Palestinian MoH have strongly denied these allegations and have called for an independent investigation.
• Today, according to the Israeli military, a Palestinian armed group opened fire from the vicinity and from within Al Quds hospital compound, run by Palestine Red Crescent Society (PRCS), while civilians were fleeing the facility; dozens of members of these Palestinian armed gGroups were reportedly killed by Israeli forces. The PRCS strongly denied the Israeli claims about armed individuals launching projectiles from inside the hospital.
• On 13 November, a joint convoy of the PRCS with the International Committee of the Red Cross (ICRC) heading to Al Quds hospital in Gaza city to evacuate patients, was forced to return after it left Khan Younis, due to the relentless bombardment and insecurity around the hospital. The medical team, patients, and their families, reportedly remain besieged in the hospital with no food, water, or electricity.
• Active ground operations in the heart of Gaza city and near the hospitals in North Gaza governorate, have halted the movement of rescue teams and ambulances. According to PRCS, hundreds of calls has been received at emergency number from besieged Palestinians in Gaza city, urgently requesting ambulances for the wounded, evacuation for trapped families, and assistance for those trapped under rubble.
• UNRWA has continued to provide health care to IDPs at shelters through 124 medical teams deployed to the shelters. However as of 14 November, the fuel reserves of the health centres will be depleted if no additional fuel is provided. UNRWA operations will entirely depend on solar energy, which is designed only to cater for minimum operation. Functionality of the solar energy is not guaranteed as any malfunction and/or battery failure will cause complete stop of all operation.

Water and sanitation (Gaza Strip)

• In the absence of fuel, as of 14 November, UNRWA solid waste removal services will begin to shut down, posing an environmental hazard, with about 400 tons of rubish per day accumulating in overcrowded camps and IDP shelters.
• Due to lack of fuel, public sewage pumping stations, 60 water wells in the south, the two main desalination plants in Rafah and the Middle Area, the two main sewage pumps in the south, and the Rafah wastewater treatment plant have all ceased operations. Coupled with the shutdown of municipal sanitation work, this is posing a serious threat to public health, increasing the risk of water contamination and the outbreak of diseases.
• 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, the water desalination plant and the Israeli pipeline are not functioning. There has been no distribution of bottled water among IDPs accommodated in shelters for over a week, raising grave concerns about dehydration and waterborne diseases due to water consumption from unsafe sources.

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, and structural damage. 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 functioning 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 the World Food Programme (WFP), along with eight other bakeries in the south, intermittently provides bread to shelters. This is dependent on the availability of flour and fuel. People queue an average of over five 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 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. According to some media reports, 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 13 November, Humanitarian Coordinator Lynn Hastings renewed her call to release the hostages.

Violence and casualties (West Bank)

• On 13 November, Israeli forces shot and killed a Palestinian man while he was inside his vehicle during a search-and-arrest operation in Hebron city.
• Since 7 October, 173 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 (418). 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 2,625 Palestinians, including at least 275 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.
• No settler-related incidents against Palestinians were reported in the past 24 hours.
• 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: 6-12 November

Protection

Mine action is one of the most critical life-saving activities for protection at present. right now is mine action. Core actions include Explosive Remnants of War (ERW) risk assessments in UNRWA shelters and some Explosive Ordnance Risk Education (EORE) messaging in the south. Scale up of assessments and clearance is planned once hostilities end, and work to bolster EORE information is being planned, including printed materials, training for focal points and use of media. Current insecurity, access restrictions, and communication blackouts greatly curtail mine work.

Further, a technical working group (comprising eight partners) is working to identify unaccompanied and separated children and processes to unite families. The group is developing an interagency registration system, documentation and tracing process and alternative care arrangements and reunification procedures. Critical challenges are the absence of safe spaces inside Gaza. An advocacy brief on Unaccompanied Children in Gaza and messages on risk mitigation for children are available.

During the reporting period, over 2,000 locally procured dignity kits were distributed to vulnerable women in Rafah, Khan Yunis and Al Remal, and cash transfers were done to 724 women including survivors of gender-based violence (GBV). Supply lines are grossly inadequate to meet burgeoning women’s needs, especially menstrual hygiene. Power shortages and unstable communications mean that many women cannot access remote services addressing GBV. However, nation-wide hotlines (24/7) are operating for GBV case management and Mental Health and Psychosocial Support (MHPSS). Available online information including PriorityLife-SavingActions; GBV Pocket Guide (English and Arabic); GBV Guidelines (English and Arabic) and Gaza Crisis - GBV Concerns and Priorities.

Shelter and Non-Food Items (NFI)

During the reporting period, cluster partners distributed limited quantities of NFIs. These included 5,000 kits containing bedding sets, tarps, and dignity kits in public Palestinian Authority schools and public buildings, including hospitals, as well as 500 tents donated to UNRWA, of which the majority were installed in the Khan Younis training centere to create additional living and covered spaces to decongest the overcrowded conditions in the center. Due to limited supplies, cluster partners only covered less than 5 per cent of the overall needs. There is still a major gap in shelter winterization materials and essential NFIs, including sealing off kits for damaged houses and creating additional living spaces; a high shortage in bedding sets, including mattresses and blankets to cover the needs of the IDPs in different settings; and lastly, winterized tents to protect homeless IDPs from upcoming harsh weather conditions.

Health

The loss of communication with key focal points in health who normally provide regular updates is making it difficult for partners to have an overview of information on the latest casualties

The high insecurity, displacement, and lack of supplies in the north, has resulted in Partner operations in the north have largely halted due to high insecurity, displacement, and insufficient supplies. The majority of health response activities are now concentrated in the south, with a focus on supporting the nine hospitals, 18 primary health-care centres, and 130 mobile teams whicho are still partially functioning.

Partners are working to strengthen disease surveillance in the shelters to facilitate early detection of outbreak-prone diseases and ensure rapid response. Due to the high insecurity and lack of equipment, the dead bodies remain exposed or unsafely buried under the rubble.

Food Security

From the onset of the crisis, 15 Food Security Sector partners have delivered assistance to some 2 million benefiaries, including food parcels, ready-to-eat meals, and hot meals, to various shelters (UNRWA and non–UNRWA) and host families, mobilising approximatelyabout $7.5 million (excluding activities within the Flash Aappeal).

WFP has delivered fresh bread, and tuna, among other foods. and has provided Gaza residents with cash-based transfers. On 2 November, WFP commenced distribution of date bars, reachinged an estimated 550,300 IDPs situated in UN shelters.

For the last two weeks, partners in the north have been unable to distribute any assistance. Partners are also facing significant challenges in providing food assistance due to insufficient supplies, widespread destructionr. Most bakeries are inactive due to destruction, lack of fuel, or lack of clean water.

Food insecurity is growing by the day. Food availability on the market is limited, prices have increased, and purchasing power has decreased. Gaza residents have no means to make use of the limited available quantities of food, due to insuffient clean water, fuel, and electricity

Emergency Telecommunications

The Emergency Telecommunications Cluster (ETC) was activated on 31 October, and is currently based in Cairo pending access to Gaza. ETC has prepared solar panels, satellite connectivity solutions, radios, and equipment to provide independent access to communications in Gaza for the humanitarian response. The ETC is focused on establishing pathways to import critical telecommunications equipment into Gaza to set up services for humanitarian workers. Efforts are underway to obtain necessary authorizations from the authorities, identify a route through either Egypt or Israel, and to consolidate this information for partners.

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.