Hostilities in the Gaza Strip and Israel | Flash Update #43

KEY POINTS

• On 18 November, some 2,500 internally displaced persons (IDPs), along with a number of mobile patients and hospital staff vacated Shifa hospital in Gaza city. This followed orders issued by the Israeli military, which continued its operations within the compound for the fourth consecutive day. According to the World Health Organization (WHO), by the afternoon hours, 25 health workers and 291 patients remained at the hospital. The latter includes 32 babies in critical condition, two people in intensive care without ventilation, and 22 dialysis patients. The hospital is no longer operational or admitting new patients.  
• A joint UN humanitarian assessment team led by WHO visited Shifa on 18 November to assess the situation on the ground and conduct a rapid situational analysis, assess medical priorities, and establish logistics options for further missions. The team was requested to evacuate health workers and patients to other facilities. WHO and partners are urgently developing plans for the immediate evacuation of the remaining patients, staff and their families. 
• 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.    
• In the past 24 hours, three schools serving as IDP shelters to the north of Wadi Gaza (hereafter: the north) have been reportedly hit, resulting in many fatalities. In the Tal Az Za’atar school, in Beit Lahia, more than 50 people were killed on 18 November, according to media reports. The same day, scores, including children, were killed in UNRWA’s Al Fakhouri school in Jabalia, which shelters over 4,000 IDPs. On 17 November, another UNRWA school in Az Zaitoun neighborhood of Gaza city was also hit. Between 7 October and 16 November, at least 71 IDPs were killed and 573 injured, while sheltering in UNRWA facilities across the Gaza Strip.  
• On 18 November, Emergency Relief Coordinator, Martin Griffiths, deplored the news on children, women and men killed while sheltering at Al Fakhouri school, reminding that, “Shelters are a place of safety. Schools are a place for learning,” and adding that “Civilians cannot and should not have to bear this any longer.” 
• On 18 November, 123,000 litres of fuel entered Gaza from Egypt. The Israeli authorities confirmed that they would start allowing the entry of a daily amount of nearly 70,000 litres of fuel from Egypt, which is well below the minimum requirements for essential humanitarian operations. Fuel is set to be distributed by UNRWA to support food distribution, and the operation of generators at hospitals, water and sanitation facilities, shelters and other critical services.  
• Overnight (17-18 November), telecommunications services within Gaza were gradually restored after providers received a limited amount of fuel. The shutdown of services lasted for some 30 hours and brought the already challenging delivery of humanitarian assistance to nearly a halt, including life-saving assistance to people injured or trapped under the rubble as a result of airstrikes and clashes. 

Hostilities and casualties (Gaza Strip)

• Intense ground clashes between Israeli forces and Palestinian armed groups continued in and around Gaza city, as well as in several areas in the North Gaza governorate, as well as in Khan Younis and east of Rafah (in the south). Airstrikes and shelling by Israeli forces also continued in multiple areas across Gaza. Israeli ground troops have maintained the effective severance of the north from the south along Wadi Gaza, except for the “corridor” to the south.  
• The following are among the deadliest attacks reported in the past 24 hours, apart from those concerning the three schools mentioned above: on 18 November, at about 1:15  an apartment in Hamad town, Khan Yunis, was hit, reportedly killing 28 people and injuring 23 others; the same day, at about midday, at least ten people were reportedly killed when a building in the An Nuseirat Camp was hit; on 17 November, at about 06:00 a building in the Al Qarara area, northeastern Khan Yunis, was hit, reportedly killing 14 and injuring 20 others; the same day, at about 8:00, a building in eastern Rafah was hit, reportedly killing nine and injuring 10 others. 
• Since 11 November, following the collapse of services and communications at hospitals in the north, the Ministry of Health (MoH) in Gaza has not updated cumulative casualty figures. Their reported fatality toll 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. 
• According to the Palestine Journalists Syndicate in Gaza, 45 Palestinian journalists have been killed since 7 October. According to MoH, more than 198 Palestinian medical staff have been killed. According to the Palestinian Civil Defense, at least 12 of its members have been killed. And according to UNRWA, 103 of their staff have been killed since 7 October. 
• In the past 24 hours, as of 18:00 today, six Israeli soldiers were reportedly killed in Gaza, bringing the total number of soldiers killed since the start of ground operations to 62, according to official Israeli sources. 
• On 18 November, the Israeli military announced a “tactical halt in military activities” for humanitarian purposes in the Ash Shabura area of Rafah. 
• See the latest snapshot for more breakdowns.

 

Displacement (Gaza Strip)

• On 18 November, the Israeli military continued calling on residents in the north to evacuate and move south through a “corridor” along the main traffic artery, Salah Ad Deen Road, between 7:00 and 16:00. OCHA’s monitoring team estimates that about 10,000 people moved during the day, most of whom arrived at Wadi Gaza by donkey carts and buses, and some on foot.  
• Israeli forces have reportedly been arresting some of the people moving through the “corridor.” IDPs interviewed by OCHA reported that Israeli forces 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. The movement of unaccompanied children, as well as separated families, has been increasingly observed.  
• Over 1.6 million people in Gaza are estimated to be internally displaced, including about 830,000 IDPs who are staying in at least 154 UNRWA shelters. UNRWA shelters are accommodating far more people than their intended capacity and are unable to accommodate new arrivals. According to preliminary reports, thousands of IDPs are seeking security and safety by sleeping against the walls of shelters in the south, out in the open.  
• Overcrowding is contributing to the spread of diseases, including acute respiratory illness and diarrhea, prompting environmental and health concerns. On average, there is one shower unit for every 700 people and a single toilet for every 150 people. The congestion is affecting UNRWA's ability to provide effective and timely services. 
• See the live IDP dashboard for the latest figures and more breakdowns.

Humanitarian Access (Gaza Strip)

• Apart from the three fuel trucks, no humanitarian supplies entered Gaza through Egypt on 18 November, as of 18:00. Backlogs and congestions have been created over the past days, with the depletion of fuel to operate forklifts and trucks in the receiving end, alongside logistical and safety challenges associated with the shutdown of telecommunications, and other factors. Since 21 October, 1,139 trucks of humanitarian supplies have entered Gaza via Egypt (excluding fuel). 
• On 17 November, the Egyptian border opened for the evacuation of 689 dual and foreign nationals and 41 wounded people. Between 2 and 17 November, nearly 6,500 dual and foreign nationals have exited Gaza to 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.  

Health care, including attacks (Gaza Strip)

• On 17 November, at about 21:15, Wafa Geriatric Hospital in  An Nuseirat, Middle Area (south of Wadi Gaza), was reportedly hit by an airstrike killing two people, including the director, and injuring 15 others. 
• On 18 November, the Palestine Red Crescent Society (PCRS) stated that its emergency medical teams remain trapped at Al Ahli Baptist Hospital in Gaza city for the third consecutive day, amid heavy bombardment and gunfire. The teams have been unable to move outside and reach those who are injured safely.According to WHO, as of 17 November, 25 out of 36 hospitals in Gaza were non-functional due to lack of fuel, damage, attacks and insecurity. The other 11 hospitals were only partially operational and admitting patients with extremely limited services. 
• For information about Shifa hospital see Key Points above. 

Water and sanitation (Gaza Strip)

• In the past few days, with no fuel, operations have halted in 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. 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.  
• In the north, the situation is even grimmer with grave concerns of dehydration and waterborne diseases due to water consumption from unsafe sources. 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 World Food Programme (WFP) has reported an increase in cases of dehydration and malnutrition and warned about the threat of starvation due to the collapsed food supply chain and insufficient aid delivery. Only 10 per cent of necessary food supplies have entered Gaza since the beginning of the hostilities. 
• In the north, since 7 November, no bakeries have been active, due to the lack of fuel, water, and wheat flour, as well as 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, 237 people are held captive in Gaza, including Israelis and foreign nationals. Media reports have indicated that about 30 of the hostages are children. So far, four civilian hostages have been released by Hamas, one Israeli soldier was rescued by Israeli forces, and three bodies of hostages have reportedly been retrieved by Israeli forces. On 17 November, the Emergency Relief Coordinator, Martin Griffiths, reiterated his call for the immediate and unconditional release of all hostages. 

Violence and casualties (West Bank)

• On 18 November, Israeli forces killed six Palestinians in two separate incidents, while an additional Palestinian died of wounds sustained on 9 November. Five of these fatalities, including one child, were recorded in the Balata Refugee Camp (Nablus), during a military operation that involved armed clashes with Palestinians and Israeli airstrikes, which also resulted in extensive residential and infrastructure damage. Another fatality was recorded during confrontations while search-and-arrest operations were underway in Tubas city. 
• Since 7 October, 198 Palestinians, including 52 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 (439). About 66 per cent of the fatalities since 7 October have occurred during confrontations that followed Israeli search-and-arrest operations, primarily in Jenin and Tulkarm governorates; 24 per cent have been in the context of demonstrations in solidarity with Gaza; seven per cent have been killed while attacking or allegedly attacking Israeli forces or settlers; two per cent have been killed in settler attacks against Palestinians; and one per cent during punitive demolitions. 
• Since 7 October, Israeli forces have injured 2,778 Palestinians, including at least 347 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. 
• Since 7 October, OCHA has recorded 253 settler attacks against Palestinians, resulting in Palestinian casualties (31 incidents), damage to Palestinian-owned property (186 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)

• No new displacements have been recorded during the past 24 hours. 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.   
• Additionally, 143 Palestinians, including 72 children, have been displaced since 7 October following demolitions in Area C and East Jerusalem, due to lack of permits; and 48 Palestinians, including 24 children, have been displaced following punitive demolitions. 

Funding

• As of 17 November, Member States have disbursed US$146.6 million against the updated Flash Appeal launched 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.