Hostilities in the Gaza Strip and Israel | Flash Update #51

KEY POINTS

• The humanitarian pause, agreed upon by Israel and Hamas, which took effect on 24 November, has been largely maintained for the third consecutive day. This pause has enabled the UN to enhance the delivery of assistance into and across Gaza.  
• On 26 November, aid convoys reached areas north of Wadi Gaza (hereafter: the north). UN agencies and the Palestine Red Crescent Society (PRCS) distributed 1,062 metric tonnes (MT) of ready-to-eat food to four UNRWA shelters in Jabalia camp; 185 MT of tents and blankets and 890 MT of bottled water to various sites; as well as 164 MT of medical supplies to Al Ahli hospital in Gaza city. The convoys were carefully inspected by Israeli forces deployed at a checkpoint near Wadi Gaza before proceeding northwards.  
• The mission that reached Al Ahli Baptist Hospital evacuated at least 17 patients and wounded people, along with 11 of their companions, to the European Hospital in Khan Younis (in the south). Despite enormous shortages and constraints, Al Ahli remains operational and admitting patients. 
• Aid distribution in areas south of Wadi Gaza, where the bulk of an estimated 1.7 million internally displaced persons (IDPs) are currently staying, has been accelerated over the past three days. Key service providers, including hospitals, water and sanitation facilities, and IDP shelters, have continued receiving fuel on a daily basis to operate generators.    
• Over the past three days, cooking gas has entered Gaza, contrary to the time before the pause. However, the amounts fall well below the needs. Queues at a filling station in Khan Younis have reportedly extended for about 2 kilometres, with people waiting at them overnight. Meanwhile, reports indicate that people are burning doors and window frames to cook. 
• On 26 November, 17 hostages held in Gaza and 39 Palestinian detainees held in Israeli prisons were released. The released hostages included 13 Israelis – four women and nine children – and four foreign nationals. Among the Palestinian detainees were 39 boys. Since the start of the pause, 39 Israelis, 117 Palestinians and 19 foreign nationals have been released. 
• Between 25 and 26 November, Israeli forces in the West Bank killed seven Palestinians, including four children, bringing to 230 the Palestinian death toll since 7 October; 222 by Israeli forces and eight by settlers. 

Hostilities and casualties (Gaza Strip)

• Since the humanitarian pause entered into force at 7:00 on 24 November, airstrikes, shelling, and ground clashes have reportedly ceased.  
• In one incident involving Israeli tank fire east of the Al -Maghazi refugee camp, in the Middle Area, one Palestinian man was reportedly killed and another injured; the circumstances remain unclear. 
• According to the Government Media Office, 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 de facto authorities in Gaza, has been reporting casualties since the Ministry of Health in Gaza stopped doing so on 11 November, following the collapse of services and communications at hospitals in the north. 
• As of 18:00 on 25 November, 75 Israeli soldiers have been killed in Gaza since the start of the Israeli ground operations, according to official Israeli sources. 

Displacement (Gaza Strip)

• Upon the entry into force of the pause, Israeli forces announced that the movement of people from the south to the north is forbidden.  
• On 26 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 during the day estimated that less than 400 people crossed south.  
• The OCHA monitoring team observed many people with injuries crossing through the “corridor” on 26 November. A man interviewed by OCHA at the crossing point revealed that they had to leave Kamal Odwan hospital, in the north, after it was hit the night prior to the pause.  
• Israeli forces had 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 into a facial recognition scan.  
• The movement of unaccompanied children and separated families has also been observed in the “corridor”. Humanitarian actors are assisting these children, including through registration of cases. However, urgent measures are required to augment the presence of child protection teams in shelters; enhancing registration efficiency and addressing the specific needs of these children. 
• The number of displaced people continues to increase. Over 1.7 million people in Gaza, or nearly 80 per cent of the population, are estimated to be internally displaced. Of them, nearly 927,000 IDPs are sheltering in 99 facilities in the south. 
• Due to the overcrowding and poor sanitary conditions at UNRWA shelters, there have been significant increases in some communicable diseases and conditions such as diarrhoea, acute respiratory infections, skin infections and hygiene-related conditions like lice.  

Humanitarian Access (Gaza Strip)

• The total number of trucks that entered Gaza on 26 November is unclear at the time of writing as many continued to be processed during the evening hours. On 25 November, 200 trucks were dispatched from Nitzana. 
• The Rafah crossing with Egypt has been also open on 26 November for the exit of wounded and sick people and dual and foreign nationals, as well as for the entry of Gaza residents who had been stranded in 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)

• On 26 November, a joint UN convoy collected 7,600 doses of vaccines for various diseases from the Ministry of Health warehouse in Gaza city and transported them to southern Gaza. The need for this transfer arose due to the lack of refrigeration capacity in the north. After thorough inspections to ensure their validity, the vaccines will be utilized to enhance routine immunization, which has been hampered by a shortage of supplies and ongoing hostilities. As of 25 November, 1,205 children were vaccinated at seven health centres according to the national vaccination programme, bringing the total number to 11,622 since 4 November. 
• Kamal Odwan hospital in Jabalia, one of the four small hospitals still operational in the north, is facing immense pressure. Supplies and medical staff are particularly urgent in the fields of obstetrics, paediatrics, neonatology, surgery, and orthopaedics. Eighty patients require immediate transfer to a better equipped facility in the south for their survival. On 22 November, the vicinity of the hospital was heavily bombarded, reportedly resulting in dozens of fatalities and injuries; many of the latter are still waiting to receive treatment.  
• 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 as of 20 November, amid a surge in those seeking treatment. Only one of the currently functional hospitals in the south has the capacity to treat critical trauma cases or perform complex surgery, according to the World Health Organization (WHO). 
• As of 25 November, nine (out of 22) UNRWA health centres were still operational in the south, recording 10,802 patient visits. 

Water and sanitation (Gaza Strip)

• Since the start of the humanitarian pause, UNRWA has collected and disposed hundreds of tons of solid waste that had been accumulating inside and outside its shelters in the south, benefiting about 1 million people. 
• On 26 November, technicians visited water, sanitation and hygiene (WASH) facilities in the north, carrying out an initial assessment of the damage sustained, and the repairs needed to reactivate them.  
• UNRWA continued delivering fuel to the Gaza’s main water utility, which in turn distributed it 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. 
• On 26 November, the first delivery of bottled water reached IDP shelters in the north since the Israeli ground operation began. Partners were previously unable to reach the northern areas due to intense ground operations and lack of fuel for truck distribution. However, concerns about dehydration and waterborne diseases persist due to water consumption from unsafe sources, as the water desalination plant and the Israeli pipeline supplying water to the north are not functioning. 

Food security

• The ready-to-eat food distributed at UNRWA shelters in Jabalia, in the north, on 26 November, included about 7.6 metric tons of high-energy biscuits provided by the World Food Programme (WFP). This covers the minimal daily food intake for 23,616 people for one day. 
• Since 24 November, WFP has provided essential food assistance to 110,000 people in UNRWA shelters and host communities through the distribution of bread, food parcels, and electronic vouchers. Since 25 November, one WFP bakery has resumed operations on an ad-hoc basis allowing the provision of bread to about 90,000 people in UN shelters in the south. 
• 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. 
• Despite the increase in food aid through Rafah, many people still lack food and fuel to cook. No additional 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. This is heightened in the north, which is more difficult to reach.  
• 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 to keep them alive. This practice poses an additional threat to food security as it leads to the depletion of productive assets. 

Hostilities and casualties (Israel)

• On 25 November, no rocket fire from Gaza towards Israel was reported. In total, over 1,200 Israelis and foreign nationals have been killed in Israel, according to the Israeli authorities, the vast majority on 7 October. As of 20 November, the names of most of these fatalities have been released, including 859 civilians and police officers. Of those whose ages have been provided, 33 are children. 
• Following the release of 17 hostages on 26 November, 178 people remain captive in Gaza, including Israelis and foreign nationals, according to the Israeli authorities. Before the pause, four civilian hostages had been released by Hamas, one Israeli soldier had been rescued by Israeli forces, and three bodies of hostages had reportedly been retrieved by Israeli forces. On 25 November, the UN reiterated its call for the immediate and unconditional release of all hostages. 

Violence and casualties (West Bank)

• On 25 and 26 November, Israeli forces shot and killed seven Palestinians, including four children during Israeli forces operations. The deadliest incident, which lasted for ten hours, took place in Jenin Refugee Camp, and resulted in five Palestinians killed. The operation involved armed clashes with Palestinians, and airstrikes, resulting in extensive infrastructure and residential damage. According to medical sources, during the operation, Israeli forces impeded the work of paramedics, denied access to two hospitals, and arrested two people injured in one of the hospitals. Another Palestinian boy was killed by Israeli forces in Al Bireh (Ramallah) during stone throwing confrontations. Another Palestinian man was killed while inside his vehicle during an operation carried out by undercover Israeli forces in Yatma (Nablus). No Israeli casualties were reported. 
• Since 7 October, 222 Palestinians, including 58 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. 
• 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 2,904 Palestinians, including at least 369 children, over half of them in the context of demonstrations. An additional 73 Palestinians have been injured by settlers and 18 others either by forces or settlers. Some 33 per cent of those injuries have been caused by live ammunition. 
• On 25 November, three settler attacks resulted in damage to property and injuries. In one incident, a group of settlers accompanied by Israeli forces broke into Burqa village (Nablus), which was followed by confrontations with Palestinians; Israeli forces opened live fire, injuring one Palestinian. In another two incidents, according to Palestinian eyewitnesses, a group of Israeli settlers vandalized 155 olive trees in the outskirt of Immatin (Qalqiliya) and Qaryut (Nablus). 
• Since 7 October, OCHA has recorded 284 settler attacks against Palestinians, resulting in Palestinian casualties (34 incidents), damage to Palestinian-owned property (212 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, 181 Palestinians, including 93 children, have been displaced since 7 October following demolitions in Area C and East Jerusalem, due to lack of permits; and 52 Palestinians, including 25 children, have been displaced following punitive demolitions. 

Funding

• As of 25 November, Member States have disbursed US$256.4 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 21 per cent of the $1.2 billion requested. An additional $250 million has been pledged by 23 November. Private donations are collected through the Humanitarian Fund.

HUMANITARIAN NEEDS AND RESPONSES: 13-19 November

Health

On 18 November, WHO 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 counselling and referrals for affected communities to access life-saving services. The PSEA Network monitors calls daily and will increase the number of counsellors if necessary.

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