Hostilities in the Gaza Strip and Israel | Flash Update #40

KEY POINTS

• On 15 November, Israeli troops, including tanks, entered Shifa hospital compound in Gaza city and reportedly took control of several sections, searched them and interrogated people. Due to the disruption of communications in the area, the impact of the military operation remains unclear.
• Out of 24 hospitals with in-patient capacity in the north, only one, Al Ahli in Gaza city, is presently operational and admitting patients. Eighteen hospitals have shut down and evacuated since the start of hostilities, including three – An Nasr, Ar Rantisi and Al Quds – over the past three days.
• Another five hospitals, including Shifa, are providing extremely limited services to patients who have already been admitted.These hospitals are not accessible, do not have electricity and supplies and are not admitting new patients.
• The Palestine Red Crescent Society (PRCS) reported that it has been unable to respond to hundreds of calls to assist and evacuate people wounded or trapped under the rubble. IDPs fleeing from the north are reporting the presence of dead bodies in the streets. As of 10 November, about 2,700 people, including some 1,500 children, remain missing and presumed to be trapped or dead under the rubble, according to the MoH in Gaza.
• 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.
• On 15 November, some 23,000 litres of fuel entered Gaza from Egypt, the first such delivery since 7 October. The Israeli authorities have restricted the use of this fuel only to use for UNRWA trucks distributing aid. The entry of fuel for all other purposes remains banned including for hospital generators and water and sanitation facilities. Given UNRWA requires about 160,000 litres of fuel per day to runbasic humanitarian operations. It has had to halt key services.
• On 15 November, around midday, the As Salam Mill in Deir Al Balah was reportedly hit and destroyed. This was the last functioning mill in Gaza, and its destruction means that locally produced flour will not be available in Gaza in the foreseeable future.
• Also on 15 November, Gaza’s telecom companies announced the gradual cessation of all communication and internet services in the Strip, following the exhaustion of fuel reserves to operate generators. Humanitarian agencies and first responders have warned that blackouts jeopardize the provision of life-saving assistance.
• Also on 15 November, the Israeli military reportedly dropped leaflets in areas east of Khan Younis, in southern Gaza, ordering the residents of Al Qarara, Khuza’a, Bani Suheila and Abasan towns, to evacuate immediately to “known shelters.”
• In the north, hundreds of thousands of people who are unwilling or unable to move to the south remain amid intense hostilities. They are struggling to secure the minimum amount eof 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.
• The UN Emergency Relief Coordinator, Martin Griffiths, stated today that “the carnage in Gaza cannot be allowed to continue,” presenting a ten-step plan to address the unfolding humanitarian crisis, including agreeing on a humanitarian ceasefire, respecting international humanitarian law, and allowing the entry of fuel.

Hostilities and casualties (Gaza Strip)

• Overnight (14-15 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. Israeli ground troops have maintained the effective severance of the north from the south, except for the “corridor” to the south.
• Deadly attacks over the past 24 hours included the following: on 14 November, in the afternoon, airstrikes reportedly hit Al Mohophin School, in Sheikh Radwan neighbourhood, Gaza city, killing 17 people; the same day, at about 20:30, airstrikes reportedly hit a residential building in As Saftawi area, north of Gaza city, killing 13 people, including six women; on midday 14 November, airstrikes reportedly hit a building in Al Qarara, east of Khan Yunis, killing nine people; on 15 November, at around midday, airstrikes reportedly hit As Salhi Towers area, in Nuseirat, killing 14 people.
• On 15 November, for the fifth consecutive day, following the collapse of services and communications at hospitals in the north, the 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. Another 27,490 Palestinians have reportedly been injured.
• In the past 24 hours, two Israeli soldiers were reportedly killed in Gaza, bringing the total number of soldiers killed since the start of ground operations to 53, according to official Israeli sources.
• See the latest snapshot for more breakdowns.

Displacement (Gaza Strip)

• On 15 November, the Israeli military – which has called on residents in the north to evacuate to the south – continued opening a “corridor” along the main traffic artery, Salah Ad Deen Road, between 9:00 and 16:00. The Israeli military also announced a “tactical halt in military activities,” in As Salam and An Nour neighbourhoods of Jabaliya between 10:00 and 14:00, to enable the departure of people southward. OCHA’s monitoring team estimates that about 8,000 people moved during the day.
• Israeli forces have reportedly been arresting some IDPs fleeing through the “corridor.” There are anecdotal and eyewitness reports of some IDPs being beaten and stripped of their clothing. On 14 November, internally displaced persons (IDPs) reported that the Israeli army had established an unstaffed checkpoint where people are directed from a distance to pass through go through two checkpoints, where a surveillance system is thought to be installed. IDPs are reportedly ordered to show their IDs and undergo what appears to be a facial recognition scan.
• Over the past 48 hours, IDPs staying outside the overcrowded shelters in the south have been affected by intermittent rainfall and flooding, which have damaged or destroyed tents and makeshift areas where they are seeking shelter. These conditions are subjecting these IDPs to an increasing risk of illness and waterborne disease
• Over 1.5 million people in Gaza are estimated to be internally displaced, including about 813,000 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 disease, including acute respiratory illness and diarrhea, raising environmental and health concerns. The overcrowding is impacting 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)

• On the afternoon of 15 November, one truck of fuel entered Gaza, leaving an insufficient amount of time to refuel the trucks needed to distribute the humanitarian aid that had been delivered to warehouses in Rafah on 14 November. Given the warehouses were at capacity, the Agency was not able to receive additional humanitarian shipments.
• Dozens of trucks waiting on the Egyptian side of the Rafah crossing are expected to enter on 16 November. Since 21 October, 1,139 trucks carrying mainly medicines, food and water have entered Gaza via the Rafah crossing with Egypt, representing a fraction of the needs.
• On 14 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 increase the entry of humanitarian 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, is still banned.*

Health care, including attacks (Gaza Strip)

• Prior to the Israeli military raid into the Shifa hospital compound, according to the MoH in Gaza, bombardments hit and damaged parts of it, including the specialized surgeries department, the coronary care division, and a warehouse. After the troops entered, patients, staff and IDPs were reporteldy relocated within the compound.
• On 14 November, some 200 people, including medical staff and 25 patients were evacuated by the Palestine Red Crescent Society (PRCS) from Al Quds hospital in Gaza city, to a hospital in Khan Younis, in the south. The trip, which reportedly lasted seven hours, was partially done on foot amid rain and muddy streets. The vicinities of the hospitals had been bombarded over the past week and, since 11 November, the hospital has been under an electricity blackout.
• For the third consecutive day, the main generator at Al Amal hospital in Khan Younis shut down due to lack of fuel. The hospital has been running one small generator which is supplying electricity to the labour room and the lights in the reception area. Over 8,000 IDPs are sheltering in this highly overcroweded facility.
• The MoH in Gaza stated that, on 15 November, 179 bodies held at Shifa, which could not be evacuated or properly maintained, were buried in a mass grave inside the compound.
• 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.
• 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 rubbish 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 a desalination plant in the Middle Area, the two main sewage pumps in the south, and the Rafah wastewater treatment plant have all ceased operations in the past few days. The seawater desalination plant in Khan Younis is operating at 5 per cent of its capacity (some 300 cubic metres per day). 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.
• The main source of potable water in the south are two pipelines coming from Israel that supply together about 1,100 cubic metres per hour. A number of private wells and desalination facilities which are still operational are expected to shut down over the coming two days due to the lack of fuel.
• 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. Members of the Food Security Sector have been unable to deliver assistance in the north, as access has been largely cut off. There are indications of negative coping mechanisms, 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 15 November, the names of 1,162 fatalities in Israel have been released, including 859 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 15 November, Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator, Martin Griffiths, renewed his call to release the hostages unconditionally.

Violence and casualties (West Bank)

• On 14 November, a Palestinian child died of wounds sustained after being shot by Israeli forces during a search-and-arrest operation in Jenin Refugee Camp on 29 October.
• Since 7 October, 183 Palestinians, including 47 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 (427). 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 2,655 Palestinians, including at least 279* 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.
• On 13 and 14 November, assailants believed to be Israeli settlers uprooted an unconfirmed number of Palestinian-owned olive trees in As Sawiya village (Nablus), next to the Rehelim settlement. Access to this area by Palestinians requires permission by the Israeli authorities.
• Since 7 October, OCHA has recorded 246 settler attacks against Palestinians, resulting in Palestinian casualties (30 incidents), damage to Palestinian-owned property (180 incidents), or both casualties and damage to property (36 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, 48 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

• As of 15 November, Member States have disbursed US$132.1 million against the updated 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. An additional $250 million have been pledged, which if materialized, would bring the Flash Appeal funding level to 32 per cent.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 approximately $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.

* Asterisks indicate that a figure, sentence, or section has been rectified, added, or retracted after the initial publication of this update.