Hostilities in the Gaza Strip and Israel | Flash Update #47

KEY POINTS

• On 22 November, 190 wounded and sick people, their companions, and a number of medical teams from Shifa hospital, in Gaza city, were evacuated in an ambulance convoy to the south, in coordination with UN and humanitarian agencies. The Palestine Red Crescent Society reported that, the evacuation lasted for almost 20 hours as the convoy was obstructed and subjected to inspection while passing through the checkpoint that separates northern and southern Gaza, “hence putting the lives of the wounded and sick people in danger.” Some 250 patients and staff members are estimated to remain at Shifa, which is no longer operational.  
• On 21 November, at about 23:00, heavy strikes were reported on and around the Indonesian Hospital, Beit Lahiya (North Gaza), hitting the surgery department. According to the Ministry of Health (MoH) in Gaza, there are about 60 corpses lying near the hospital. Earlier in the day, some 500 patients and staff were evacuated from the hospital to a hospital in Khan Younis (in the south), in coordination with humanitarian agencies. 
• On 22 November, the vicinity of Kamal Adwan Hospital in Beit Lahia was heavily bombarded, resulting in dozens killed, according to media reports. This is one of the two hospitals north of Wadi Gaza (hereafter: the north) that are still operational and admitting patients. Since last night, it has admitted more than 60 dead and some 1,000 wounded people.  
• The remaining 22 hospitals in the north are out of service. Of the 11 medical facilities in the south, seven are currently functional. The bed capacity across Gaza has declined from 3,500 prior to the war to 1,400 presently, amid a surge in those seeking treatment. Only one of the currently functional hospitals has the capacity to treat critical trauma cases or perform complex surgery, according to the WHO. 
• 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.  
• UNRWA confirmed that 15 IDPs were killed in the 21 November incident, where a school in Al Bureij Camp serving as a shelter was directly hit (reported in Flash Update #46). Of them, nine were children and four were women; and another 20 people were injured. The school was hosting about 1,000 IDPs who were subsequently evacuated. Since 7 October, at least 191 people sheltering in UNRWA schools have been killed and 798 reported injured.  

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 other areas in the north, Jabalia in particular. 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.  
• On 22 November, at about 9:30, ten buildings in Ash Shuja’iyeh area of Gaza city were struck, reportedly killing 30 people. On 21 November, at about 20:50, residential buildings were struck in the Abu Shamas area, in Deir Al Balah (Middle Gaza), reportedly killing at least 19 people and injuring more than 20. 
• According to the Gaza Media Office, as of 14:00 on 22 November, more than 14,500 people have been killed in Gaza, including about 6,000 children and 4,000 women. This office, which is under the local authorities in Gaza, has assumed MoH’s role after the latter stopped updating fatality tolls. 
• In the 24 hours preceding 18:00 on 22 November, two Israeli soldiers were reportedly killed in Gaza, bringing the total number of soldiers killed since the start of ground operations to 75, according to official Israeli sources. 

Displacement (Gaza Strip)

• On 22 November, the Israeli military continued calling and exerting pressure on residents of the north to leave southwards through a “corridor” along the main traffic artery, Salah Ad Deen Road, between 9:00 and 16:00. OCHA’s monitoring estimated that 250 people had moved south, the lowest volume of people documented since the “corridor” was opened. The decline is largely attributed to the expectations generated by the humanitarian pause to be implemented from 23 November.  
• Israeli forces have been arresting some 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 ordered to show their IDs and undergo what appears to be a facial recognition scan.  
• One man interviewed by OCHA reported that his wife had been detained and forced to hand over their baby to him. The monitoring team has documented a few similar cases over the past few weeks, including instances where a mother was ordered to leave her baby with strangers. 
• The movement of unaccompanied children and separated families has also been increasingly observed. An interagency plan is being developed to respond to this situation, including the registration of cases.  
• Over 1.7 million people in Gaza are estimated to be internally displaced, including almost 945,000 IDPs who are staying in at least 156 UNRWA shelters across the strip. UNRWA shelters are accommodating far more people than their intended capacity and are unable to accommodate new arrivals.  
• In recent days, UNRWA, in cooperation with the ‘Humanity and Inclusion’ NGO, has provided 3,830 persons with disabilities, injured people, children and the elderly with hygiene kits, assistive devices, eyeglasses, first aid kits and baby kits.  

Humanitarian Access (Gaza Strip)

• On 22 November, 75,000 litres of fuel entered Gaza from Egypt, following an Israeli decision from 18 November to allow the daily entry of small amounts of fuel for essential humanitarian operations. Fuel is being distributed by UNRWA to support food distribution, and the operation of generators at hospitals, water and sanitation facilities, shelters, and other critical services. 
• A total of 80 trucks carrying humanitarian supplies entered from Egypt on 22 November as of 20:00. Overall, between 21 October and 22 November at 18:00, at least 1,479 truckloads of humanitarian supplies (excluding fuel) have entered Gaza through the Egyptian border, compared with a monthly average of nearly 10,000 truckloads of commercial and humanitarian commodities (excluding fuel) entering Gaza before 7 October. 
• On 22 November, the Egyptian border opened for the evacuation of 433 dual and foreign nationals and 17 wounded and sick people. Between 2 and 20 November, 9,576 dual and foreign nationals and 425 wounded and medical accompaniers 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)

• Dialysis patients who were evacuated on 22 November from Shifa hospital were transferred to Abu Youssef An Najjar Hospital in Rafah, while other patients were evacuated to the European hospital in Khan Younis. 
• In the coming days, UN and health partners are planning to conduct an assessment at Al Ahali Hospital, in Gaza city, which reportedly hosts hundreds of trauma patients with little to no medical support. During the visit, basic supplies and self-help medical items will be provided. The hospital is no longer admitting new patients and is not considered functional but is still in need of assistance. 
• According to UNRWA, midwives are providing care for post-natal and high-risk pregnant women at the nine operational health centres. There are an estimated 50,000 pregnant women in Gaza, with more than 180 giving birth every day. A total of 231 post-natal and high-risk pregnancy cases were attended to at the health centres on 20 November.
• For additional information on hospitals see the Key Points section above. 

Water and sanitation (Gaza Strip)

• On 21 November, UNRWA delivered 19,500 litres of fuel to the Gaza’s main water utility. The following day, these were distributed to water and sanitation facilities in the south: two seawater desalination plants, 79 waterwells, 15 water pumping stations, 18 sewage pumping stations, and one wastewater treatment plant. Supply of potable water in the south via two pipelines coming from Israel has continued. 
• In the north, grave concerns of dehydration and waterborne diseases due to water consumption from unsafe sources continue. The water desalination plant and the Israeli pipeline supplying water to the north are not functioning. There has been no distribution of bottled water among IDPs accommodated in shelters for about two weeks due to partners’ inability to access north. 

Food security

• Since 7 November, members of the Food Security Sector have been unable to deliver assistance in the north, as access has been largely cut off. Due to the lack of cooking facilities and fuel, people are resorting to consuming the few raw vegetables or unripe fruits that remain available to them. No bakeries are 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 Cluster members have raised serious concerns about the nutritional status of people, especially lactating women, and children. 
• Also in the north, livestock is facing starvation and the risk of death due to the shortage of fodder and water. Crops are being increasingly abandoned and damaged due to the lack of fuel required to pump irrigation water. 
• Across Gaza, farmers have been slaughtering their animals due to the immediate need for food and the lack of fodder. This practice poses an additional threat to food security as it leads to the depletion of productive assets. 
• Food prices in the market have experienced an unprecedented surge. According to the Palestinian Central Bureau of Statistics, during October, food and beverages prices increased by 10 per cent; with vegetables increasing by 32 per cent, wheat flour by 65 per cent, and mineral water by 100 per cent.  

Hostilities and casualties (Israel)

• The indiscriminate firing of rockets by Palestinian armed groups towards Israeli population centres has continued over the past 24 hours, with no reported fatalities. In total, over 1,200 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities as cited by the media, the vast majority on 7 October. As of 20 November, the names of most 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, 235 people are held captive in Gaza, including Israelis and foreign nationals, of whom 40 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 22 November, the Emergency Relief Coordinator, Martin Griffiths, reiterated his call for the immediate and unconditional release of all hostages. 

Violence and casualties (West Bank)

• Over the past 24 hours, Israeli forces killed eight Palestinian men in three separate operations across the West Bank. Six fatalities occurred in the Tulkarm Refugee Camp, in an operation that involved armed clashes with Palestinians and Israeli airstrikes, resulting in extensive infrastructure and residential damage. Another Palestinian was killed in Azzun (Qalqiliya), when Israeli forces raided the area and opened fire at a vehicle he was traveling in, also injuring and arresting the other person in the vehicle. The other fatality was recorded during a search-and-arrest operation in Balata Refugee Camp (Nablus). No Israeli casualties were reported in any of these incidents. 
• Since 7 October, 209 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 47 per cent of all Palestinian fatalities in the West Bank in 2023 (450). 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 concerning  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 2,831 Palestinians, including at least 364 children, over half of them in the context of demonstrations. An additional 75 Palestinians have been injured by settlers. Some 33 per cent of those injuries have been caused by live ammunition. 
• In the past 24 hours, two settler attacks resulted in damage and injuries. In one incident, a group of settlers accompanied by Israeli forces broke into a cemetery in Al Fundaqumiya village (Jenin), which was followed by confrontations with Palestinians; Israeli forces opened live fire, injuring two Palestinians. In another incident, armed assailants known by Palestinian residents to be settlers, yet wearing Israeli military uniforms, opened fire and physically assaulted a group of Palestinians harvesting their olives in Yanun village (Nablus), injuring one man, and smashing 12 bags of produce.  
• Since 7 October, OCHA has recorded 277 settler attacks against Palestinians, resulting in Palestinian casualties (38 incidents)*, damage to Palestinian-owned property (207 incidents), or both casualties and damage to property (38 incidents)*. This reflects a daily average of almost 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)

• 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, 162 Palestinians, including 82 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 22 November, Member States have disbursed US$190.4 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 15.5 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: 13-19 November

Health

On 18 November, the World Health Organization led a joint UN team that visited Shifa Hospital, in Gaza city to conduct a rapid situational analysis, assess medical priorities, and establish logistics options for the evacuation of patients. 

Since 1 November, Cluster partners have delivered the following items across Gaza:  

• various medical supplies to ten hospitals and the ambulances; 
• assistive and mobility devices, wound dressing kits and first aid kits to 805 people;  
• 87 reproductive health kits to hospitals to enable safe deliveries;  
• cash transfers to 724 vulnerable women in Gaza, including pregnant and lactating women, breast cancer patients, and survivors of gender-based violence (GBV);  
• 600 postpartum kits;  
• 900 family hygiene kits distributed in one IDP shelter in An-Nusseirat and 120 host community shelters;  
• 1,070 dignity kits to women staying in IDP shelters. 

During the same period, there have been an average of 10,000 consultations a day at mobile primary healthcare providers in shelters; 2,925 children were vaccinated after this service resumed in November; 132 wound dressing and 60 physiotherapy sessions were provided. Limited mental health and psychosocial services are being provided by partners, mainly in shelters. Cluster partners are also working to strengthen disease surveillance and early warning systems. 

Main factors that have been impeding operations include limited access to the north; shortage of fuel, medical supplies, water, food, and other essential supplies; displacement of partners, their staff and families; and overcrowding in IDP shelters. NGO partners have experienced difficulties with their logistics capacity in Egypt. So far, only 19 per cent of funding required to respond has been committed. 

Protection

Mine contamination is already widespread and poses devastating risks for people in Gaza. Despite challenges, during the reporting period, 18 Explosive Ordnance Risk Education (EORE) focal points were deployed in UNRWA shelters in the south and will begin awareness raising. The UN Mine Action Service is developing a training course for 20 UNRWA staff in Khan Younis and Rafah. Planning for the expansion of risk education outreach in non-UNRWA shelters is underway. One NGO also reached 4,900 people with risk education about unexploded ordnances and sent 500,000 SMS related messages.  

A mapping of GBV-related service providers and responders has been completed. The main priority in this context is to reduce overcrowding in shelters, which increase stressors, reduce privacy, and exacerbate risks of violence towards women and girls. Of concern is the significant gap in dignity kits supplies and access for women of the reproductive age. There are 3,000 kits in Egypt ready to move into Gaza once approved, and a further 6,000 in the pipeline. Funding is urgently needed to meet the soaring needs of women and girls in Gaza. 

Cluster partners are assessing needs and available supply of assistive devices and kits in UNRWA southern governorate shelters. While demand for assistive devices continues to increase, the remaining stockpiles in northern Gaza are inaccessible. Further supplies are being procured and in the pipeline via Egypt. Significant damage to rehabilitation facilities has cut critical services.  

Mental health care needs are skyrocketing, especially for persons with disabilities, children, and those with pre-existing complex conditions. However, many services have been destroyed and many staff are unable to work. Only limited psychosocial support (PSS) services and psychological first aid is being provided in some shelters across Gaza where protection actors are sheltering and have capacity to respond. 

Despite extreme overcrowding at shelters, UNRWA has been able to provide some recreational activities, PSS support, and mine risk awareness sessions. They have also conducted child protection assessments and been assessing how to implement activities with children and young adults and scale up these activities across all their shelters.  

Food security

Since 7 October, the World Food Programme (WFP) has reached an estimate of 550,300 IDPs in UN shelters with daily fresh bread, canned food, or date bars. Additionally, food parcels were distributed to 38,659 displaced people in host communities to support their food needs over a 15-day period. In addition, WFP has provided cash-based transfers. In November, redemption rates decreased compared with October, due to the closure of the majority of WFP-contracted shops, stock depletion, or connectivity disturbances preventing assistance activities across Gaza. WFP is piloting a programme relying on the existing electronic voucher platform to distribute food parcels at shops and partner distribution points. Overall, 73.5 WPF truckloads entered Gaza carrying 1,296 metric tons of food assistance. This falls short of meeting the necessary needs of food in the Strip.  

In addition to in-kind food distribution, UNRWA has been distributing flour to bakeries for producing bread for distribution. To date, 88 UNRWA trucks containing food entered Gaza, carrying 1,760 metric tons of food assistance.  

Twenty international and local NGOs have jointly reached 1,9 million people since the beginning of the war (cumulative). Partners have used different modalities, including food parcels, hot meals and e-vouchers 

Water, Sanitation and Hygiene (WASH)

During the reporting period, WASH Cluster partners delivered the following items. In the absence of safe access to the north, distribution has been made possible in areas south of Wadi Gaza only. 

• Some 165 cubic metres of bottled water at IDP centres, addressing drinkable water needs of about 100,000 people. 
• Some 1,733 cubic metres of water through water trucking for hosting communities and IDP centres from the municipal and private desalination plants in the south, addressing the drinking and domestic water needs of 300,000 people (less than 5 litres a day per person).  
• Four cleaning kits for four IDP centres in Rafah, hosting about 10,000 people. 
• Some 6,500 family hygiene kits for IDPs (3,800 in the north and 2,700 in the south), serving about 40,000 people. 
• Additional sanitary units for UNRWA IDPs. 

The situation in the north is of extreme concern and the highest priority for the WASH Cluster: the water desalination plant and the Israeli pipeline are not functioning, while there has been no distribution of bottled water among IDPs accommodated in shelters, raising grave concerns about dehydration and waterborne diseases due to water consumption from unsafe sources. 

The average water production from all Gaza water sources does not exceed 12 per cent of its usual capacity before the escalation. WASH Cluster issued a document outlines the Water Supply and Fuel Relationship.

WASH partners have secured US$6 million, representing some 15.6 per cent of the need for immediate response to the current situation.

Shelter and Non-Food Items (NFI)

During the reporting period, Shelter Cluster partners delivered the following items. In the absence of safe access to the north, distribution has been made possible in areas south of Wadi Gaza only.  

• 7,600 bedding sets (blankets, mattresses, and mats),
• 2,000 kitchen sets,
• 2000 washing kits,
• 370 tarps, 1000 dignity kits in public schools and buildings, including hospitals,
• 350 tents donated to UNRWA to decongest overcrowded shelters.

Due to limited supplies, cluster partners only covered less than 7 per cent of the estimated Shelter and NFIs 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, including UNRWA shelters; and winterized tents to protect homeless IDPs from harsh weather conditions.  

Education

Since 7 October, eight Education Cluster partners have reached 45,867 students and teachers. The main deliverables included emergency learning and recreational supplies (42,533 people reached), psychosocial support (30,018 reached), and recreational activities (8,082 reached). The response has been focusing on Khan Younis, Rafah and Middle governorates, as North Gaza and Gaza governorates are inaccessible. 

Logistics

16 November marked one month since the activation of the Palestine Logistics Cluster. The Palestine – Gaza Response Operation Overview and One Month Infographic are available on the dedicated operation webpage. 

During the reporting period, the entry of limited amounts of fuel for UNRWA has been coordinated, for the first time since the start of hostilities, with regular daily deliveries expected from 19 November. fewer trucks entered Gaza for several days during the week due to a backlog of aid from previous days, shortage of fuel and a communication shutdown leading to an inability to effectively manage or coordinate humanitarian aid convoys under these circumstances. 

Three staff members based in Gaza joined the Logistics Cluster to support UNRWA, the Palestine Red Crescent Society (PRCS) and a partner NGO in receiving shipments crossing from Rafah.  

The Logistics Cluster has also conducted a Storage Needs and Capacity Survey in Gaza and Egypt. Results show that about 165,000 cubic metres of storage space is available inside Gaza, the majority of which is in Gaza city and Rafah. Sixteen organizations require storage inside Gaza, while 14 organizations require storage in Egypt. The Logistics Cluster will continue following up with the organizations to ensure needs are met. 

Emergency Telecommunications

The Emergency Telecommunications Cluster (ETC) coordination team continues to engage all parties ― the Egyptian Red Crescent, OCHA, the International Telecommunications Union (ITU), and the Egyptian authorities ― to fast-track the importation process of telecommunications equipment through either Egypt or Israel into Gaza. Liaison with OCHA continues the importation of equipment into Gaza via Israel. To coordinate a collective approach among partners for the importation of equipment, a survey was launched on 16 November and is currently ongoing. A security communications services implementation plan is being developed. 

Reliable communications networks are needed to enable humanitarians to stay connected in high-risk situations, restore security communications networks for UN staff, and coordinate response activities. 

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.