Hostilities in the Gaza Strip and Israel | Flash Update #39

KEY POINTS

• Only one of the hospitals in Gaza city and northern Gaza (hereafter: the north) is reportedly still operational at a minimum level for those inside the hospital, as of 14 November; all others have ceased operations 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, currently accommodates over 500 patients and is reportedly the sole medical facility able to admit patients in the north. However, it too faces increasing shortages and challenges. 
• Forty patients died in Shifa hospital on 14 November, according to the Ministry of Health (MoH) in Gaza. The hospital reported preparations for a mass grave inside the compound to burry 180 bodies of patients, which cannot be evacuated due to the intense fighting. 
• According to the World Health Organization (WHO), as of 14 November, more than half of the hospitals in Gaza (22 out of 36) were non-functional due to lack of fuel, damage, attacks and insecurity. 
• Hospitals and medical personnel are specifically protected under international humanitarian law (IHL) and all parties to the conflict must ensure their protection. Hospitals 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. WHO has warned that the evacuation of hospitals in the north, as demanded by the Israeli military, would be a “death sentence” for some patients, because operational hospitals in the south cannot admit more patients. 
• On 14 November, UNRWA reported that, in 48 hours, telecommunication companies are expected to run out of fuel to operate data centres and connection sites. In some areas, they have reportedly shut down already. The companies have had to depend on fuel-run generators since Gaza’s black out on 11 October. 
• Although 91 trucks carrying humanitarian aid entered from Egypt on 14 November, the distribution of supplies to shelters, clinics and other beneficiaries has largely come to a halt due to lack of fuel. The Israeli authorities have indicated that, on 15 November, they would allow the entry of a limited amount of fuel into Gaza, to be used exclusively to run trucks for the distribution of incoming humanitarian aid. This represents a fraction of the fuel needs for humanitarian operations. Meanwhile, the entry of fuel for any other use, including the operation of generators at hospitals, and at water and sanitation facilities, remains banned. This will be the first time since 7 October that fuel is allowed into Gaza. 
• Hundreds of thousands of people who are unwilling or unable to move to the south remain in the north amid intense 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. 
• In the West Bank, Israeli forces shot and killed eight Palestinians over the past 24 hours, bringing the fatality toll among Palestinians since 7 October to 182, including 46 children. 
• As of 14 November, Member States have disbursed US$132.1 million against the Flash Appeal made by the UN and its partners to implement its response plan in support of 2.2 million people in the Gaza Strip and 500,000 in the West Bank. This constitutes about 11 per cent of the $1.2 billion requested. Additionally, $335 million has been pledged. 

Hostilities and casualties (Gaza Strip)

• Overnight (13-14 November), clashes continued between Israeli forces and Palestinian armed groups in and around Gaza city as well as in several areas in the North Gaza governorate and in Khan Younis (in the south). 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 13 November, at about 23:00, Israeli airstrikes reportedly hit and destroyed 12 houses near the Jabalia services sports club (in the north), killing 31 Palestinians and injuring others. The following morning, at about 5:30, Israeli airstrikes reportedly hit two buildings in Khan Yunis (in the south), killing 13 Palestinians and injuring 20 others. 
• On 14 November, for the fourth 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 in those areas. Multiple appeals by stranded households and family members underneath struck buildings, including their own homes, have gone unanswered. According to the Palestine Red Crescent Society (PRCS), hundreds of calls have been received at the PRCS 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 due to lack of fuel and insecurity. 
• 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 51, according to official Israeli sources. 
• See the latest snapshot for more breakdowns.

Displacement (Gaza Strip)

• On 14 November, for the twelfth 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. OCHA’s monitoring team estimates that about 5,000* moved on 14 November, significantly less than in the previous days. 
• Numerous reports indicate that Israeli forces have been carrying out arrests among IDPs fleeing through the corridor, alongside allegations of beating, stripping and other forms of violence. On 14 November, IDPs have reported that the Israeli army had established an unstaffed checkpoint where people are directed from a distance to go through two containers, where a surveillance system is thought to be installed. People are reportedly ordered to show their IDs and undergo what appears to be a facial recognition scan. 
• Over the past 24 hours, IDPs staying outside the overcrowded shelters in the south have been affected by intermittent rainfall and related flooding, which have damaged or destroyed tents and makeshifts where they lived. Alongside lower temperatures, this is exposing people to increasing risk of disease. 
• Over 1.5 million people in Gaza are estimated to be internally displaced, including about 787,000 IDPs who are staying in at least 154 UNRWA shelters. 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 91 trucks, carrying food, medicines, health supplies, bottled water, blankets, tents and hygiene products, crossed from Egypt into Gaza on 14 November as of 18:00. This brings the number of trucks that have entered Gaza since 21 October to 1,187, representing a fraction of the needs. 
• On 13 November, the Egyptian border opened 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. According to media reports, the Israeli authorities have rejected requests by Member States to operate this crossing to expedite the entry of humaitarian aid. 

Electricity

• Since 11 October, the Gaza Strip has been under an electricity blackout, after the Israeli authorities cut off the electricity supply, and fuel reserves for Gaza’s sole power plant depleted. The entry of fuel, which is desperately needed to operate electricity generators that run life-saving equipment. 

Health care, including attacks (Gaza Strip)

• The situation of hospitals in the north remains dire. Only of of the hospitals is reportedly operational. Heavy fighting continues around Shifa and Al Quds hospitals. 
• According to WHO, on 14 November, over half of the hospitals in Gaza (22 out of 36) are non-functional due to lack of fuel, damage, attacks and insecurity. The 14 hospitals in the south remaining open have barely enough supplies to sustain critical and lifesaving surgeries and provide inpatient care, including intensive care   
• On 14 November, a power outage affected Al Amal Hospital in Khan Younis, in the south, following a failure of its sole generator, according to PRCS. This put 90 patients at risk, including 25 in critical condition. Additionally, 9,000 IDPs are seeking refuge at the hospital and PRCS premises. 
• On 14 November, the Nursing Director at the European Gaza Hospital was quoted in a media outlet as stating that the hospital had run out of water. This would affect over 400 patients and thousands of IDPs sheltering on the premises.  
• On 14 November, Médecins Sans Frontières reported that live ammunition had been fired into one of three of their premises (near Shifa Hospital), where more than 100 people, including staff and their families, had taken shelter. 
• 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.      
• 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 in those areas. According to PRCS, hundreds of calls have been received at an emergency number from 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, the fuel reserves of the health centres may have been depleted today. 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 or battery failure may cause complete stop of all operation. 

Water and sanitation (Gaza Strip)

• Due to the absence of fuel, on 14 November, UNRWA’s solid waste removal services began shutting 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. 
• 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. 

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. 
• On 14 November, Israeli sources confirmed that one of the captured soldiers had been killed. Hamas had claimed that she was among of 57 hostages killed by Israeli airstrikes. According to the Israeli authorities, 238 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. On 13 November, Humanitarian Coordinator Lynn Hastings renewed her call to release the hostages.

Violence and casualties (West Bank)

• Israeli forces shot and killed eight Palestinians, between 13 November at night and noontime on 14 November. The deadliest incident, which lasted for several hours, took place in Tulkarm Refugee Camp, and resulted in seven Palestinians killed. The operation involved armed clashes with Palestinians, and airstrikes, resulting in extensive infrastructure and residential damage. According to medical sources, during the operation, Israeli forces impeded the work of paramedics. Another Palestinian was killed after he attempted to stab an Israeli soldier positioned at Beit Einun roundabout east of Hebron city. 
• Since 7 October, 182 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 (426). About 65 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 26 per cent were in the context of demonstrations in solidarity with Gaza; two per cent were killed in settler attacks against Palestinians, one per cent during punitive demolitions and the remaining six per cent were killed while attacking or allegedly attacking Israeli forces or settlers. 
• Since 7 October, Israeli forces have injured 2,650 Palestinians, including at least 278 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, OCHA verified four settler attacks. In two of these incidents, armed assailants who, while known by Palestinian residents to be settlers, were wearing Israeli military uniforms, raided the communities of Umm At Tiran and the already displaced community of At Taybe (both in Hebron), where they vandalized a residential structure, agricultural, water tanks and punctured the tires of vehicles. In two other incidents, in Mantiqat Shi'b al Butum in Masafer Yatta (southern Hebron) and the displaced community of Ein ar Rashash (Ramallah), 18 tents used for residential and agricultural purposes were vandalized, along with two solar panel systems, and an electronic generator, and about 10 bags of livestock fodder.  
• Since 7 October, OCHA has recorded 244 settler attacks against Palestinians, resulting in Palestinian casualties (30 incidents), damage to Palestinian-owned property (177 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 have been 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. 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-removal 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 centre to create additional living and covered spaces to decongest the overcrowded conditions in the centre. 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 which 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 beneficiaries, 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, reaching 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 destruction. 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 insufficient clean water, fuel, and electricity  

Logistics 

The Palestine Logistics Cluster continues to monitor the overall situation and provide support to and from surrounding countries to the Egyptian and Palestinian Red Crescent societies and UNRWA to deliver life-saving assistance. On 9 November, three Logistics Cluster staff deployed to Al-Arish together with OCHA, UNRWA, UNDSS, UNICEF and WHO to work with the Egyptian Red Crescent (ERC) to set up an information cell. Moreover, the Palestine Logistics Cluster Coordinator arrived in Jerusalem on 10 November to lead the coordination efforts. To further augment the transport capacity of the ERC, 20 trucks arrived in Al-Arish on 8 November. Additionally, the second and third flights of equipment donated by the Logistics Cluster arrived from the Humanitarian Response Depot in Brindisi on 10 and 11 November. Equipment includes Mobile Storage Units, inflatable cold rooms, temperature-controlled storage and prefabs for ERC volunteers. More information on the Logistics Cluster is available online. 

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.