Hostilities in the Gaza Strip and Israel | Flash Update #55

Key points

• On 30 November, the humanitarian pause entered its seventh consecutive day. It has enabled a major increase in the delivery of basic supplies into and across Gaza, primarily by the Egyptian and Palestinian Red Crescent Societies and UN agencies. However, as stressed by the UN Secretary-General on 29 November, the level of aid remains completely inadequate to meet the needs. 
• Aid convoys to areas to the north of Wadi Gaza (hereafter: the north), which prior to the pause have received almost no supplies, continued on 30 November. Since the start of the pause until 29 November, approximately 4,850 metric tons (MT) of food, (primarily wheat flour, rice and canned food), 1,700 MT of blankets and mattresses, 1,110 MT of bottled water, 148 MT of medical supplies and 29,500 litres of fuel were delivered to UNRWA shelters, hospitals and warehouses in the north. About 88 per cent of this assistance was delivered by the Palestine Red Crescent Society (PRCS), in coordination with the UN, and the remainder by UN agencies.  
• South of Wadi Gaza (hereafter: the south), where most internally displaced persons (IDPs) are staying, enhanced aid distribution, including fuel to hospitals, water and sanitation facilities, and shelters, also continued on 30 November. Between 24 and 29 November, 630 MT of wheat flour were distributed to 224,000 people in the south, along with 63,000 blankets and mattresses. Cooking gas has been entering daily from Egypt during this period and has been available in the market at one distribution centre in the south, albeit in quantities well below the demand.  
• On 29 November, the Director-General of the World Health Organization (WHO) reiterated his concern about the high risk of infectious diseases in IDP shelters, attributing this to severe overcrowding and the disruption of health, water, and sanitation systems. He noted that more than 111,000 cases of acute respiratory infection, 36,000 cases of diarrhoea in children below five, and 24,000 cases of skin rash had been recorded since the start of the crisis.  
• On 30 November, eight Israelis held as hostages in Gaza, and 30 Palestinian detainees, held in Israeli prisons, were released. The freed hostages comprised six women, one girl and one man. Among the Palestinian detainees were seven women and 23 children. Since the start of the pause, 240 Palestinians, 86 Israelis, and 24 foreign nationals have reportedly been released. 

Hostilities and casualties (Gaza Strip)

• While the humanitarian pause that started on 24 November has largely held, sporadic incidents have been reported. On 29 November, at about 18:00, Israeli troops reportedly opened fire at Palestinians in northern Gaza city, killing two of them; the circumstances remain unclear. On 30 November, additional shooting incidents were reported in Gaza city, as well as shelling by the Israeli navy towards the Gaza shore in the south, none of which resulted in casualties. 
• According to the Government Media Office (GMO) in Gaza, since the start of hostilities, more than 15,000 Palestinians have been killed in Gaza, including about 6,150 children and 4,000 women. The GMO, which is under the de facto authorities in Gaza, has been reporting casualties since the Ministry of Health (MoH) in Gaza stopped doing so on 11 November, following the collapse of services and communications at hospitals in the north. 
• The fatality toll since 7 October includes at least 198 Palestinian medics, according to the Gaza Ministry of Health; 112 UN staff; 70 journalists and media workers, according to the Palestinian Journalist Syndicate; and at least 15 Civil Defense staff, according to the Palestinian Civil Defense. 
• Overall, 75 Israeli soldiers have been killed in Gaza since the start of the Israeli ground operations, according to official Israeli sources. 

Displacement (Gaza Strip)

• Movement of people from the north to the south has been declining since the start of the pause on 24 November and almost halted on 29 and 30 November. In previous weeks, the Israeli military has been calling and exerting pressure on residents of the north to leave southwards through a “corridor” along the main traffic artery, Salah Ad Deen Road. 
• Up to 1.8 million people in Gaza, or nearly 80 per cent of the population, are estimated to be internally displaced. However, obtaining an accurate count is challenging; including because of difficulties in tracking IDPs staying with host families and accounting for those who returned to their homes during the pause but remain registered in UNRWA and other shelters.    
• Nearly 1.1 million IDPs are registered in 156 UNRWA facilities across Gaza, of whom about 86 per cent (946,000) are registered in 99 UNRWA shelters in the south. Another 191,000 IDPs are estimated to be staying in 124 public schools and hospitals, as well as in other venues such as wedding halls, offices, and community centres. The rest are hosted by families. 
• Due to the overcrowding and poor sanitary conditions at UNRWA shelters in the south, 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. There are also initial reports of disease outbreaks, including hepatitis.  
• Concerns have been raised about vulnerable groups of people who are struggling with difficult shelter conditions. This includes people with disabilities; women who are pregnant, have recently given birth, or are breastfeeding; people who are recovering from injuries or surgeries; and those with compromised immune systems. 

Humanitarian Access (Gaza Strip)

• On 30 November, as in previous days, significantly larger convoys than prior to the pause, carrying a variety of humanitarian supplies, fuel and cooking gas entered Gaza from Egypt. The Egyptian border crossing also opened for the evacuation of wounded and sick people, and the entry of Gaza residents who had been stranded outside; figures are not available at the time of writing. 

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. Depending on the availability of fuel, electricity is produced by generators, as well as by solar panels. 

Health care, including attacks (Gaza Strip)

• According to media reports, the decomposed bodies of five premature babies were discovered on 29 November in An Nasr Paediatric Hospital in Gaza city. This facility was reportedly forcefully evacuated on 10 November by Israeli forces. The circumstances of the case remain unclear. 
• On 29 November, a Jordanian field hospital recently established next to the Nasser Hospital, in Khan Younis, has started operating. Surgeries and maternal services are ongoing. Both hospitals have established a mechanism for mutual referrals.  
• Since the start of the pause, the number of hospitals operating in the north, and admitting patients, has risen to six (out of 24), although they are only providing limited services. On 29 November, UN agencies delivered to two hospitals in Gaza city, Al Ahli and As Sahaba, lifesaving medicines and surgical supplies (in addition to fuel) estimated to be sufficient to meet the urgent health needs of 100 patients at each facility.  

Water and sanitation (Gaza Strip)

• Despite the pause, there has been almost no improvement in the access of residents in the north to water for  drinking and domestic purposes, as most of the main water production facilities remain shut, due to the lack of fuel and some also due to damages. Water is primarily available from small private and UNRWA wells. Concerns about waterborne diseases due to water consumption from unsafe sources persist. 
• On 30 November, UNRWA and UNICEF continued delivering fuel to Gaza’s main water utility, which in turn distribute 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. 
• Also in the south, UNRWA continues to operate eight water wells that provide potable and domestic water to IDP shelters, alongside water trucking operations. Solid waste collection from the camps, and emergency shelters and transfer to landfills also continues, reducing the level of health and environmental riks.  

Food security

• On 29 November, UNICEF and the World Food Programme (WFP) delivered nutritious biscuits, bottled water, and other essential supplies to IDPs in 13 shelters in the north. 
• On 28 November, the Palestinian Central Bureau of Statistics (PCBS) stated that Gaza suffers a US$1.6 million daily loss in farm production. The institution assesses the losses are likely higher considering the destruction of farm equipment and farmland, and damage caused to thousands of trees, especially olive trees. The economic impact is also significant, considering that 55 per cent of Gaza’s agricultural products used to be sold outside the coastal enclave, PCBS stated. 
• The amount of cooking gas that has reportedly entered Gaza from Egypt since the start of the pause (about 85 tons per day) is a third of the equivalent daily average that entered between January and August 2023. Queues at a filling station in Khan Younis have reportedly extended for about 2 kilometres, with people waiting at them overnight.  

Hostilities and casualties (Israel)

• On 28 November, for the seventh consecutive day, 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.  
• Following the release of 102 hostages since 24 November, 137 people remain captive in Gaza, including Israelis and foreign nationals, according to Israeli official sources. Furthermore, on 28 November, one Israeli civilian and three soldiers, initially missing, were declared killed. 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.

Violence and casualties (in and around the West Bank)

• On 30 November, two Palestinian men from East Jerusalem opened fire at a bus stop in West Jerusalem, killing three Israelis, including an elderly man and two women, one of whom was reportedly pregnant. The assailants were shot and killed by an Israeli civilian and two off-duty soldiers. Additionally, Israeli media reports that a fourth Israeli was also killed after being mistakenly identified as one of the assailants. Hamas reportedly claimed responsibility for the attack. 
• On 30 November, two Palestinian men were shot and killed by Israeli forces. One was killed during confrontations with Palestinians who gathered to welcome released detainees near the Israeli prison of Ofer in Ramallah. The second Palestinian was killed after he rammed and injured two Israeli soldiers near Tubas.  
• Monitoring by the UN Human Rights Office indicates that the 8- and 15-year-old Palestinian boys shot and killed by Israeli forces on 29 November during an operation in the Jenin Camp (see Flash Update #54), did not seem to pose any concrete threat to the Israeli forces when shot at. 
• Between 7 October and 30 November, 241 Palestinians, including 63 children, were killed in the West Bank, including East Jerusalem. Additionally, two Palestinians from the West Bank were killed in Israel, one by Israeli forces and another by an Israeli civilian (see above). Of those killed in the West Bank, 231 were killed by Israeli forces, eight by Israeli settlers and two either by forces or settlers. The seven-week toll represents more than half of all Palestinians killed in the West Bank this year. Already, 2023 is the deadliest year for Palestinians in the West Bank since OCHA began recording casualties in 2005. 
• Two-thirds of the Palestinian fatalities in the West Bank since 7 October have occurred during search-and-arrest and other operations carried out by Israeli forces, including some – mainly in Jenin and Tulkarm governorates – involving exchange of fire with Palestinians. More than half of the fatalities were reported in operations that did not involve armed clashes. 
• Since 7 October, Israeli forces have injured 3,187 Palestinians, including at least 509 children; 45 per cent of them in the context of demonstrations and 46 per cent in the context of search- and- arrest and other operations. An additional 78 Palestinians have been injured by settlers and 18 others either by Israeli forces or settlers. Some 33 per cent of those injuries have been caused with live ammunition, compared with nine per cent in the first nine months of 2023. 
• On 30 November, Israeli settlers and Israeli forces opened fire, and shot teargas canisters and sound grenades at Palestinian farmers who were harvesting olive trees in their land in Kafr Ad Dik village, west of Salfit; ten olive trees were vandalized.  
• Since 7 October, OCHA has recorded 299 settler attacks against Palestinians, resulting in Palestinian casualties (33 incidents), damage to Palestinian-owned property (226 incidents), or both casualties and damage to property (40 incidents). This reflects a daily average of five incidents, compared with three since the beginning of the year. 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, 220 Palestinians, including 114 children, have been displaced since 7 October following demolitions in Area C and East Jerusalem, due to lack of permits; and 63 Palestinians, including 31 children, have been displaced following punitive demolitions. 

Funding

• As of 29 November, Member States have disbursed USD$352.6 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 29 per cent of the $1.2 billion requested. Private donations are collected through the Humanitarian Fund.

HUMANITARIAN NEEDS AND RESPONSES: 20-26 November

Health

During the reporting period, Cluster partners have delivered the following items across Gaza:

• Various medical supplies to six hospitals and the ambulances; 
• 300 Interagency Emergency Health Kits (IEHK);  
• 15 Acute Watery Diarrhoea (AWD) community kit and 50 midwifery kit and 15 obstetric surgical kit; 16 Inter-Agency Emergency Health Kits (IARH)  
• 72 rehabilitation and nursing sessions, and 3,177 post-natal care consultations. 
• 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 30,000 primary healthcare consultations per day through fixed and mobile clinic services; 10,156 children were vaccinated after this service resumed in November. Mental health and psychosocial services are being provided by partners, mainly in shelters, to 20,000.  

An Emergency Medical Team (EMT) Coordination Cell is now operational in Cairo and will soon be active in Gaza. The strategy involves providing a surge in supplies, infrastructure, and staffing to support existing health facilities. Médecins Sans Frontières (MSF) and The International Committee of the Red Cross (ICRC) surge teams are already on the ground, offering healthcare services. The Jordanian field hospital is being set up, and 31 teams are ready to deploy with support from WHO. 

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 the funding required to respond has been committed. 

Protection

Mine risk education remains a top priority right now in protection for people in Gaza. Despite challenges, during the reporting period, 21 Explosive Ordnance Risk Education (EORE) focal points were deployed in 11 UNRWA shelters in the south benefiting 4,768 people. The UN Mine Action Service is planning to send 1 million people EORE messages. Planning for the expansion of risk education outreach in non-UNRWA shelters is underway. One of the biggest challenges is reaching everyone in Gaza, both physically reaching them particularly in the north, in non UNRWA locations as well as challenges with patchy communication and electricity shortages.   

A registration tool for unaccompanied and separated children is ongoing. Temporary care arrangements are being confirmed as well as coordination with Ministry of Social Development (MOSD) and WHO on children who are evacuated for medical reasons. Child protection actors in Gaza are being identified and mapping of available services is ongoing. Access challenges, including fuel shortages, and limited children related supplies in Gaza such as suitable winter clothes, recreational kits and activities continue to affect the scale of immediate child protection responses. Important also is identifying/mapping available child protection actors and services 

Providing crucial support for women and girls involves addressing the depletion of local hygiene supplies, particularly dignity and menstrual hygiene kits. Despite efforts to procure these supplies, the demand exceeds the available resources, necessitating increased supplies, improved access, and additional funding. Ensuring the safety of women in shelters is paramount, prompting the GBV sub-cluster to develop an observation tool. A team of volunteers will collect observations in nearby sites, contributing valuable information on gender-related issues and needs. Challenges include reaching GBV partners, comprehensive mapping of services, and the significant impact on GBV services. Out of over 20 partners, only nine were reached, and six can assist with voluntary observational work. Re-establishing referral pathways for survivors, crucial in GBV response, requires rebuilding and coordination with UNRWA is deemed essential. 

Beyond mine risk efforts, disability and inclusion initiatives concentrate on psychosocial support (PSS) recreational activities in UNRWA southern shelters. In the past week, 46 sessions were conducted across 46 shelters, benefitting 10,649 children and 316 adults (parents and caregivers participating in the activities with their children). Additionally, 108 assistive devices were distributed. More supplies, including assistive devices, hygiene kits, and wound dressing kits, are expected to arrive in Gaza in the coming days. Ongoing challenges and constraints hampering the much-needed scale-up of response efforts include insufficient fuel for movements and communication issues. 

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 November 24th, WFP has supported 121,161 people in shelters and host communities by distributing bread, food parcels, and e-vouchers. Additionally, one WFP bakery operates ad-hoc, reaching approximately 90,000 people in shelters with bread on Fridays. 

On November 26, UNRWA extended its flour distribution to areas outside shelters in the southern governorates, reaching 20,720 families thus far. 

During the current humanitarian pause, the prioritised flour distribution continued in the North and Gaza City as part of ongoing humanitarian convoys in the North of Wadi Gaza. 

On November 26, at UNRWA shelters in Jabalia in the north, approximately 7.6 metric tons of high-energy biscuits provided by the World Food Programme (WFP), were distributed as ready-to-eat food. This allocation is sufficient to meet the minimal daily food intake for 23,616 people for one day. 

Partners are encountering difficulties in operating, given the situation on the ground. Despite the 4-day truce, they reported difficulties in fuelling their vehicles to implement/monitor the food assistance.  

• Anera, PARC, together with United Palestinian Appeal, Taawon, and Middle East Children Alliance, covered around 55,000 people with food parcels in host communities this week. 
• ACF targeted host families by giving fresh vegetable parcels to 3,200 people to host families. 
• OXFAM distributed 1000 Food parcels to IDPs in non-UN shelters in Rafah and Khan Younis and reached 1133 families in Rafah and Khan Younis with food vouchers. 
• Beit Lahia Development Association distributed bread for host families, targeting around 6,000 beneficiaries. 
• Other partners are mobilizing resources in the coming days, targeting the three governorates of the Middle Area, Khan Younis and Rafah. 

Shelter and Non-Food Items (NFI)

During the reporting period, including since the humanitarian pause, Shelter Cluster partners conducted field assessments at numerous collective centres and makeshift shelters in the south, revealing a shortage of basic bedding sets (mattresses and blankets) for the majority of IDPs. There is also an urgent need for firewood as an alternative fuel source for preparing food due to a lack of other options. 

Due to limited supplies, cluster partners coverage of Shelter and NFIs needs not more than 3 per cent of needs, and not more than 17 per cent if the items in the pipeline that have not arrived are considered.  

Severe shortages in shelter winterization materials and essential NFIs persist, including sealing off kits for damaged houses and creating additional living spaces; there is a significant lack of bedding sets, including mattresses and blankets, to meet the needs of IDPs in various settings. 

Education

Since 7 October, nine Education Cluster partners have reached 50,726 students and teachers. The main deliverables included emergency learning and recreational supplies (26,833 people reached), psychosocial support (31,318 reached), and recreational activities (49,726 reached). The response has been focusing on Khan Younis, Rafah, and Middle governorates, as North Gaza and Gaza governorates are inaccessible. 

Multi-Purpose Cash assistance (MPCA)

Since the beginning of the hostilities, 66,870 households (including roughly 449,000 people) were delivered Emergency MPCA. Cash out rates across the response stand at 70-75 per cent but have been declining slightly over the past few days. While distribution is delivered across the Gaza strip, the vast majority is now concentrated in the south. 

Formal market actors, such as supermarkets and retailers are largely depleted and facing major challenges in re-stocking and operating; however, informal markets, such as vendors, minimarts, carts and stalls, reportedly turned into the main source for goods. Information is still unclear on whether shops and markets actors were able to restock during the pause. 

Post distribution monitoring data from recipients of cash assistance point to food, water, medicines, hygiene products, and clothing as the top expenditures reported. About 81 per cent of respondents reported that unrestricted cash helped them accessing needed goods and services, either fully or partially. Over 95 per cent reported unrestricted cash as their preference for future assistance. 

Logistics

The Logistics Cluster developed and disseminated a new online reporting form to collect information regarding incoming supplies as well as the current stock levels in Egypt and other countries. The form was shared with 34 organisations that are part of the Logistics Cluster and other Clusters and is an ongoing project to be updated on a weekly basis. 

On 22 November, 21 mobile storage units (MSUs) arrived in Al Arish, Egypt. The MSUs will be installed, in Egypt to augment the Egyptian Red Crescent’s (ERC) warehousing capacity, and 11 will be delivered to Gaza to expand the storage capacity in key locations. An additional three MSUs were already delivered to Gaza and are in the process of being installed. The latter MSUs will provide an additional 960 m2 of storage capacity. To further support partners inside Gaza, an International NGO will support with providing access to their storage capacity through the Logistics Cluster to receive I/NGOs’ cargo on behalf of the wider humanitarian community.  

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, 11 partners have submitted their ICT equipment needs through a survey which is currently ongoing. The ETC urgently requires an initial US$250,000 out of the total requested US$800,000 in the Flash Appeal to continue its ongoing activities and address the immediate needs in Gaza. 

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. 

Water, Sanitation and Hygiene (WASH)

The standards for emergency water supply include aspects for water quantity, water quality and access to water.  The minimum daily water needs for the population of Gaza has been agreed at 15 liters/person/day (L/D/P), whereas the pre-crisis water use was approximately 100 L/P/D.   

During the reporting period, the Coastal Municipalities Water Utility and WASH agencies have produced on average over 50,327 cubic meters of water, which is the equivalent of approximately 22.6 L/P/D. Water quality and access standards, however, remain unachieved.  Access is a particular challenge as the water networks are fractured, production points are reduced, power for pumping and distribution restricted and storage and outlets minimized.  Many communities are isolated across Gaza but particularly north of Wadi Gaza. 

WASH partners activities included the trucking of 316 cubic meters of water, the distribution of 522 cubic meters of bottled water, and 10,280 family hygiene kites, all in the south. In addition, 260 Solid Waste Containers were distributed in 13 shelters in the north.  

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.