Hostilities in the Gaza Strip and Israel | Flash Update #41

KEY POINTS

• On 16 November, for the second consecutive day, Israeli troops, accompanied by tanks, raided Shifa hospital compound in Gaza city, and reportedly took control of several sections. According to the hospital’s director, the southern section of the compound was damaged, including the radiology department, and the forces took several corpses from within the hospital. The impact of the military operation remains unclear.  
• 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 16 November, at about 16:00, Gaza’s telecommunications services shut down after the providing companies announced that fuel used to run generators had been depleted. Also, several communication infrastructures south of Wadi Gaza (hereafter: the south) were hit and damaged on 14 November. Humanitarian agencies and first responders have warned that blackouts jeopardize the safety of civilians and the provision of life-saving assistance.  
• Heavy airstrikes, shelling and fighting have continued over the past 24 hours. In one of the deadliest attacks on 15 November, at about 18:00, during the evening prayer time, the vicinity of the Ihya’ As Sunna Mosque in As Sabra neighbourhood of Gaza city was hit by an airstrike, reportedly killing 50 people and injuring others. 
• On 16 November, as of 18:00,* for the second consecutive day, no trucks entered Gaza from Egypt. This is due to UNRWA’s inability to receive and distribute additional loads, because of its lack of fuel. The agency’s limited operational capacity was allocated to supplies received in previous days. UNRWA also announced that, due to the communication shutdown, it will be unable to manage or coordinate humanitarian aid convoys starting 17 November.  
• The Palestinian Central Bureau of Statistics (PCBS) estimates that, as of 11 November, there were about 807,000 Palestinians living in areas north of Wadi Gaza (hereafter: the north), constituting about two-thirds of the pre-war population there. The other third of the population, about 400,000 according to PCBS’s estimates, were presumably displaced to the south. 
• The heads of the main UN and NGO humanitarian agencies stated on 16 November that they “will not participate in the establishment of any ‘safe zone’ in Gaza that is set up without the agreement of all the parties,” while stressing the parties’ obligation “to take constant care to spare civilians – wherever they are – and meet their essential needs.” 

Hostilities and casualties (Gaza Strip)

• Overnight (15-16 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 continued 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 16 November in the early hours of the morning, Israeli forces’ shelling reportedly struck the Central Petroleum Station at the northern entrance of Al Maghazi camp where displaced people were reportedly taking shelter, killing nine Palestinians and injuring dozens. 
• On 15 November, for the fifth 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. Another 27,490 Palestinians have reportedly been injured. 
• Active ground operations in the heart of Gaza city have continued to disrupt the movement of rescue teams and ambulances and people to obtain their essential needs, particularly food and water. Households in the western neighbourhoods of Gaza city appealed for help after their remaining food and drinking water had been depleted. Reportedly, they were unable to leave their homes because of the presence of Israeli ground troops and fighting. Multiple appeals by stranded households and family members underneath struck buildings and homes went unanswered; the Palestine Red Crescent Society (PRCS) has been unable to respond to hundreds of calls to assist and evacuate.  
• Since 7 October, at least 71 internally displaced persons (IDPs) were killed, and 571 injured, while sheltering in UNRWA facilities that were hit across the Gaza Strip.  
• Reportedly, as of the 13 November, humanitarian partners working in education have documented the deaths of 3,117 students and 183 teachers since the start of the hostilities. Additionally, 4,613 students and 403 teachers were injured. 
• In the past 24 hours, three Israeli soldiers were reportedly killed in Gaza, bringing the total number of soldiers killed since the start of ground operations to 56, according to official Israeli sources. 
• See the latest snapshot for more breakdowns.

Displacement (Gaza Strip)

• PCBS estimates that, as of 11 November, there were about 807,000 Palestinians in the north, constituting about two-thirds of the pre-war population there. The other third of the population, about 400,000, were presumably displaced to the south, based on PCBS’s estimates. Hundreds of thousands of those staying in the north are also displaced in public facilities, including schools and hospitals, and with host families. 
• On 16 November, the Israeli military – which has called 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 Ash Shujai’yeh and the Turkmen neighbourhoods, between 10:00 and 14:00, to enable the departure of people southward. OCHA’s monitoring team estimates that about 10,000 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, IDPs reported that the Israeli army had established an unstaffed checkpoint where people are directed from a distance to pass through two structures, 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 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 affecting 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)

• UNRWA announced on 16 November that, due to the communication shutdown and lack of fuel, there will not be a cross-border aid operation at the Rafah Crossing on 17 November, as it will be impossible to manage or coordinate humanitarian aid convoys. 
• On 16 November, as of 18:00,* no aid trucks entered via the Rafah Crossing. This is due to the backlog of aid from previous days that has not been transported without fuel. UNRWA used the fuel provided on 15 November to operate trucks and forklifts to clear the backlogs, but fuel has run out again. 
• On 15 November, the Egyptian border opened for the evacuation of 607 foreign nationals and dual citizens, and ten injured people. Between 2 and 15 November, 129 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 banned. 

Health care, including attacks (Gaza Strip)

• Prior to the Israeli military raid into 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 reportedly relocated within the compound.  
• The MoH in Gaza stated that, between 11 November and 16 November, 40 patients, including 3 premature babies, have died in Shifa Hospital due to lack of electricity. On 16 November, a patient who suffered from kidney failure died because dialysis machines at Shifa had stopped working. 
• On 16 November, PRCS stated that Israeli forces, including tanks, had initiated a siege on the only operational hospital in northern Gaza, the Al Ahli Baptist Hospital, in Gaza City. Medical teams are unable to move outside and reach those who are injured safely. 
• On 15 November, at about 20:30, a shell fired by Israeli forces hit the Jordanian field hospital in Gaza city, injuring seven of the medical team, who were members of the Jordanian Royal Medical Services. 
• On 16 November, UNRWA reported that infectious diseases in shelters over the past two weeks have increased. It estimated that skin diseases have increased by 35 per cent and cases of diarrhea have increased by about 40 per cent. 
• According to the MoH in Gaza, as of 16 November, nine out of the 35 hospitals in Gaza are partially functioning, as the rest have shut down their formal medical services. 

Water and sanitation (Gaza Strip)

• Due to the absence of fuel, on 16 November, UNRWA stated that 70 per cent of the people in the south have no access to clean water. Furthermore, raw sewage started flowing in the streets in some areas. 
• With no fuel, public sewage pumping stations, 60 water wells in the south, 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 is two pipelines coming from Israel that supply together about 1,100 cubic metres per hour. A number of still operational private wells and desalination facilities are expected to shut down by 18 November 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

• The north is facing a critical shortage of food. 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. 
• According to the Israeli authorities, on 16 November, Israeli forces found near Shifa Hospital and took back to Israel the body of an Israeli woman who had been taken hostage on 7 October. According to the Israeli authorities, 237 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 immediately and unconditionally. 

Violence and casualties (West Bank)

• On 16 November, three Palestinians carried out a shooting attack at the Tunnels checkpoint (Bethlehem), killing one Israeli soldier and injuring another three, and were subsequently shot and killed by Israeli forces.  
• Since 7 October, 186 Palestinians, including 51 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. Four Israelis have been killed in attacks by Palestinians.  
• The number of Palestinians killed in the West Bank since 7 October accounts for 43 per cent of all Palestinian fatalities in the West Bank in 2023 (430). About 66 per cent of the fatalities since 7 October occurred during confrontations that followed Israeli search-and-arrest operations, primarily in Jenin and Tulkarm governorates; 24 per cent were in the context of demonstrations in solidarity with Gaza; seven per cent were killed while attacking or allegedly attacking Israeli forces or settlers; two per cent were killed in settler attacks against Palestinians; and one per cent during punitive demolitions. 
• Since 7 October, Israeli forces have injured 2,661 Palestinians, including at least 282 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 15 November, Israeli settlers reportedly from Peduel vandalized two agricultural structures, a latrine, water tanks after they broke into the western outskirt of Kafr ad Dik (Salfit). 
• Since 7 October, OCHA has recorded 248 settler attacks against Palestinians, resulting in Palestinian casualties (30 incidents), damage to Palestinian-owned property (182 incidents), or both casualties and damage to property (36 incidents). This reflects a daily average of 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)

• On 15 November, in East Jerusalem, Israeli forces demolished on punitive grounds the family home of a Palestinian who killed seven Israelis in an attack in January 2023, and was subsequently killed by Israeli forces. This house was sealed immediately after the attack and the family was displaced at that time. A total of 48 Palestinians, including 24 children, have been displaced since 7 October following punitive demolitions.  
• On 15 November, one household, comprising eight people, including five children displaced after Israeli forces demolished their home in Area C of Shuqba village (Ramallah), due to the lack of Israeli-issued building permits. Since 7 October, another 135 Palestinians, including 66 children, have been following demolitions in Area C and East Jerusalem, due to lack of permits.  
• Additionally, since 7 October, at least 143 Palestinian households comprising 1,014 people, including 388 children, have been displaced amid settler violence and access restrictions. The displaced households are from 15 herding/Bedouin communities. These numbers were updated on 16 November following the receipt of new information. 

Funding

• As of 15 November, Member States have disbursed US$142.3 million against the updated Flash Appealaunched 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 12 per cent of the $1.2 billion requested. An additional $250 million has 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).  

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 largely halting operations there. 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.