Hostilities in the Gaza Strip and Israel | Flash Update #48

KEY POINTS

• A humanitarian pause to start on 24 November has been agreed between Israel and Hamas. The agreement will reportedly involve the release of some of the Israeli hostages held in Gaza and some Palestinians held in Israeli prisons.
• Israeli strikes from air, land and sea reportedly intensified over the past 24 hours (as of 23 November afternoon) across most of Gaza, alongside ground battles with Palestinian armed groups in the north, Jabalia in particular. Many casualties have been reported.
• As of 23 November, about 200 patients and medical staff remain at the Indonesian hospital in Beit Lahiya (North Gaza) and are awaiting evacuation. The hospital continues to be surrounded by Israeli tanks. At about 22:00 on 23* November, the hospital was hit again and sustained damage, according to the Ministry of Health (MoH) in Gaza.
• Three children, including an infant in an incubator died in Kamal Odwan Hospital in Jabalia (North Gaza), on 22 November, reportedly due to the lack of electricity. The vicinity of the hospital was heavily bombarded that day, reportedly resulting in dozens of fatalities. This is one of the two hospitals north of Wadi Gaza (hereafter: the north) that are still operational and admitting patients, albeit with limited services.
• 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 22 November, Israeli forces reportedly dropped leaflets in villages east of Khan Younis, in southern Gaza (Al Qarara, Khuza’a, Bani Suheila, and Abasan), ordering residents to evacuate immediately westwards to “known shelters.” So far, there is no evidence of significant numbers of residents fleeing. Similar orders had been issues in this area in previous days.
• On 21 November, 111 Palestinian bodies, including children and women, were buried in a mass grave in Khan Younis. The bodies seem unidentified.

Hostilities and casualties (Gaza Strip)

• Bombardment and ground clashes have intensified over the past 24 hours. Israeli troops have maintained the effective severance of the north from the south along Wadi Gaza, except for the “corridor” to the south.
• On 23 November, at about 2:50, a residential building was struck in eastern Khan Yunis, southern Gaza, reportedly killing at least 14 people and injuring 13 others. On 22 November, at about 23:30, a residential building in Al Junainah area in Rafah, southern Gaza, was also hit, reportedly killing 14 people.
• According to the Government Media Office (GMO), as of 18:00 on 23 November, more than 14,800 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 following the collapse of services and communications at hospitals in the north.
• As of 18:00 on 23 November, the number of Israeli soldiers killed since the start of ground operations has remained 75, according to official Israeli sources.

Displacement (Gaza Strip)

• On 23 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 less than 500 people had moved south, the second-lowest volume of movement observed since the “corridor” was opened. The low volume is largely attributed to the expectations generated by the humanitarian pause to be implemented from 24 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.
• The OCHA monitoring team noted more people, including women, being detained while crossing on November 23 through the 'corridor' compared with previous days. The monitoring team has documented family accounts indicating that women had been detained for several hours and others for days before being released.
• The movement of unaccompanied children and separated families has also been observed in recent days. Humanitarian actors are assisting these children, including through registration of cases.
• Over 1.7 million people in Gaza are estimated to be internally displaced. Of them, about 1 million are staying in at least 156 UNRWA shelters across the Gaza Strip. UNRWA shelters are accommodating far more people than their intended capacity and despite being unable to accommodate new arrivals, people continue to arrive.
• Due to the lack of space in shelters in the south, most displaced men and older boys are sleeping in the open, in school yards or in the streets, next to the external walls of the shelters. At least in one UNRWA shelter in Khan Younis, a few hundred of IDP families have been accommodated in tents outside the shelter premises.
• 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 23 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 23 November as of 18:00. Overall, between 21 October and 23 November at 18:00, at least 1,723 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 23 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 sick, and their medical accompaniers exited Gaza to Egypt.
• The Kerem Shalom crossing with Israel, which prior to the hostilities was the main entry point for goods, has remained closed.

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)

• Israeli forces continue their operation in and around Shifa Hospital for the eighth consecutive day. Some 250 patients and staff members are estimated to remain at Shifa, currently non-operational due to critical shortages of power, water, and medical supplies.
• On 22 November, three paramedics with the Palestine Red Crescent Society (PRCS) and one companion of an injured person were arrested by Israeli forces while being transferred in the convoy that evacuated people from Shifa Hospital. The incident occurred when the convoy reached a checkpoint dividing north and south Gaza. On 23 November, Israeli forces arrested the General Director of Shifa, along with other members of his medical crew, at the same checkpoint.
• Out of 24 hospitals operating in the north prior to the war, 22 are either out of service or unable to admit new patients. Of the 11 medical facilities in the south, eight 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.
• For additional information on hospitals see the Key Points section above.

Water and sanitation (Gaza Strip)

• Sewage flowing in the streets has been reported in several areas across Rafah, over the past three days. This is attributed to a combination of the limited operation of only one wastewater treatment plant due to fuel shortage and damage sustained by the sewage infrastructure.
• On 21 November, UNRWA delivered 19,500 litres of fuel to the Gaza’s main water utility. The following day, fuel was distributed to water and sanitation facilities in the south: two seawater desalination plants, 79 water wells, 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 the north.

Food security

• Since 7 November, and as of the time of writing, 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 have been resorting to consuming the few raw vegetables or unripe fruits that remain available to them. No bakeries are operational, 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 shortage of fodder and water. Crops are being increasingly abandoned and damaged due to 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. About 40 of them are reportedly 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 two Palestinians in the West Bank. On 22 November, a 14-year-old child was shot and killed by Israeli forces during a search-and-arrest operation in Burin (Nablus). Another Palestinian man was killed while travelling in his vehicle on a road east of Ramallah; the circumstances remain unclear. No Israeli casualties were reported in any of these incidents.
• Since 7 October, 211 Palestinians, including 54 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 48 per cent of all Palestinian fatalities in the West Bank in 2023 (452). 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 2,866 Palestinians, including at least 364 children, over half of them in the context of demonstrations. An additional 78 Palestinians have been injured by settlers. Some 33 per cent of those injuries have been caused by live ammunition.
• On 21 and 22 November, OCHA recorded four settler attacks resulting in damage and injuries across the West Bank. In one incident, settlers physically assaulted an elderly Palestinian man in Yatta (Hebron) while he was working on his land. In three incidents, Israeli settlers broke into the Palestinian community of Al Mu’arrajat East (Ramallah), toured between the tents harassing and intimidating residents, and threw stones at a vehicle, causing damage. In Khirbet Zanuta and Susiya (both in Hebron), settlers vandalized 70 trees, damaged water pipelines, and set fire to a basic school, causing damage to two classrooms and the school’s kitchen.
• Since 7 October, OCHA has recorded 281 settler attacks against Palestinians, resulting in Palestinian casualties (33 incidents), damage to Palestinian-owned property (210 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 23 November, Member States have disbursed US$218.2 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 18 per cent of the $1.2 billion requested. An additional $250 million has been pledged. 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.