Hostilities in the Gaza Strip and Israel | Flash Update #66

Key points

• Between the afternoons of 10 and 11 December, 208 Palestinians were killed and another 416 were injured, according to the Ministry of Health (MoH) in Gaza. Heavy Israeli bombardments from air, land, and sea across Gaza continued, especially in the central part, including Al Maghazi and An Nuseirat Refugee Camps, as well as in parts of northern Gaza. Meanwhile, intense ground operations and fighting between Israeli forces and Palestinian armed groups continued, especially in Khan Younis, Jabalya, and the northern parts of Gaza Strip. Additionally, air strikes have reportedly targeted residential homes in the western and central parts of Rafah, areas designated as safe for displaced Palestinians by the Israeli army. The firing of rockets by Palestinian armed groups into Israel also continued.
• On 11 December, the maternity department at Kamal Adwan hospital in Beit Lahiya, north of Gaza, was hit. As a result, two mothers were reportedly killed, and several people were injured. The hospital remains surrounded by Israeli troops and tanks, and fighting with armed groups has been reported in its vicinity for three consecutive days. The hospital is currently accommodating 65 patients, including 12 children in the intensive care unit (ICU) and six newborns in incubators. About 3,000 internally displaced persons (IDPs) remain trapped in the facility and are awaiting evacuation with extreme shortages of water, food and power reported.
• On 11 December, the Israeli military has again been calling and exerting pressure on Palestinian residents who have remained north of Wadi Gaza to leave southwards through a “corridor” along the main traffic artery, Salah Ad Deen Road, between 9:00 and 16:00. However, movement through the Salah Ad Deen areas located north and east of Khan Younis city, has reportedly experienced intense battles on the road.
• Tens of thousands of IDPs, who have arrived in Rafah (in the south) since 3 December, continue to face extremely overcrowded conditions both inside and outside shelters. Large crowds wait for hours around aid distribution centres, in desperate need of food, water, shelter, health, and protection. In the absence of an adequate number of latrines, open-air defecation is widespread, increasing concerns of the spread of disease, particularly during rains and related flooding.
• Limited aid distributions are taking place in Rafah governorate. In the rest of the Gaza Strip, aid distribution has largely stopped over the past few days, due to the intensity of hostilities and restrictions of movement along the main roads, except for limited fuel deliveries to key service providers and a one-off high-risk mission on 9 December to Al Ahli hospital.
• On 11 December, as of 22:00, 100 trucks carrying humanitarian supplies entered Gaza from Egypt, the same volume recorded on most days since the resumption of hostilities on 1 December. This is well below the daily average of 500 truckloads (including fuel) that entered every working day prior to 7 October. The ability of the UN to receive incoming aid has been significantly impaired over the past few days by several factors. These include a shortage of trucks within Gaza; the continuing lack of fuel; telecommunications blackouts; and the increasing number of staff who were unable to travel to the Rafah crossing due to the intensity of hostilities.
• On 11 December, some 120,600 litres of fuel entered Gaza from Egypt, up from a daily average of 67,000 litres on the previous three days. The increased amounts are the bare minimum needed to prevent the collapse of critical services, including hospitals and ambulances, water, and sanitation infrastructures, and IDP shelters. Additionally, on 11 December, 45 tonnes of commercial cooking gas entered from Egypt, the first such delivery since the resumption of hostilities on 1 December.
• On 11 December, 33 injured people and 461 dual nationals were evacuated from Gaza to Egypt, bringing the total number of wounded Palestinians and medical cases who have been evacuated since 7 October to 463 and 530 respectively.
• On 12 December, the World Health Organization (WHO) executive board unanimously adopted a resolution addressing the dire humanitarian crisis in the Gaza Strip, which emphasized health as a universal priority and called for immediate, unimpeded aid deliveries. In his opening remarks to the session, the WHO Director-General reported that “Gaza’s health system is on its knees and collapsing, with the risk expected to worsen with the deteriorating situation and approaching winter conditions.”
• On 9 and 10 December, in the north and Gaza city, Israeli forces reportedly detained hundreds of men and boys staying in public spaces, schools serving as shelters for internally displaced persons (IDPs) as well as private homes. Reportedly, detainees were stripped to their underwear, handcuffed, and were ordered to sit on their knees in open areas, subjected to beatings, harassment, harsh weather, and denial of basic necessities. They were filmed and the images were circulated over the media. According to the Israeli military, those suspected of affiliation with Hamas were transferred to Israel for interrogation, while others have been released.
• On 11 December, several Security Council envoys travelled to the Egyptian side of Rafah Crossing, the only open entry point into the Gaza Strip. They were briefed on the situation in Gaza and the humanitarian response. This visit, which was organized by the United Arab Emirates, comes days after the UN Secretary-General had invoked article 99 of the UN Charter, warning the Council of the deteriorating humanitarian situation in Gaza.

Hostilities and casualties (Gaza Strip)

• The following are among the deadliest incidents reported in the past 24 hours, involving the striking of residential buildings:
  • On 10 December, at about 15:40, a bicycle was reportedly hit, near Jalal Street, in the centre of Khan Yunis, killing 2 Palestinian children who were riding it.
  • On 10 December, at about 18:10, 22 people were reportedly killed when a house was hit in Al Maghazi Refugee Camp.
  • On 11 December, at about 02:15, ten people were reportedly killed when a residential apartment was hit, west of Rafah.
  • On 11 December, at about 11:00, ten people were reportedly killed when a house was hit in Deir Al Balah.
• According to the MoH in Gaza, between 7 October and 11 December afternoon, at least 18,205 Palestinians were killed in Gaza, about 70 per cent of whom are said to be women and children, and about 49,645 were reportedly injured.Many more people are missing, presumably under the rubble, waiting for rescue or recovery.
• UNRWA is verifying reports that IDPs, who were sheltering in its primary health clinic in Jabalya and in one of its schoosl in Gaza city, were forced to leave, with some subsequently shot or arrested while fleeing. Following the forced evictions, the two facilities were reportedly struck with munitions, resulting in damages. As of 7 October, 41 UNRWA installations have been directly hit and 60 installations sustained collateral damage, according to UNRWA. Some 284 IDPs sheltering in UNRWA shelters have been killed and another 976 injured.
• According to the Palestinian Journalist Syndicate in Gaza, 81 Palestinian journalists and media workers have been killed in Israeli airstrikes since 7 October. According to the Gaza Ministry of Health, 296 Palestinian medics have been killed. According to the Palestinian Civil Defense at least 32 Civil Defense members have been killed. According to UNRWA and WHO, 134 UNRWA staff and 1 WHO staff have been killed since 7 October.
• Overall, 104 Israeli soldiers have been killed in Gaza since the start of the Israeli ground operations, and another 582 have been injured, according to the Israeli military.

Displacement (Gaza Strip)

• On 1 December, the Israeli military issued a detailed online map, where the Gaza Strip is divided into hundreds of small areas. Reportedly, the map is intended to facilitate orders to evacuate people to specific areas ahead of their targeting. Since then, various areas, encompassing nearly 30 per cent of the Gaza Strip, have been marked for evacuation. The ability of residents to access this information is impaired by recurrent interruptions in telecommunications and the lack of electricity to charge electronic devices.
• Newly arrived IDPs in Rafah are facing extreme overcrowding in shelters. The two largest sites in the city, where thousands have relocated and erected makeshift structures and tents, are located in an under-construction hospital (‘the Qatari field hospital’) and the campus of the Al Quds Open University.
• As of 11 December, according to UNRWA, almost 1.9 million people in Gaza, or nearly 85 per cent of the population, are estimated to be internally displaced, some have been displaced multiple times. Families are very vulnerable as they are forced to move repeatedly in search of safety.
• As of 9 December, nearly 1.3 million of these IDPs were registered in 154 UNRWA facilities across Gaza, including more than 1.1 million in 97 UNRWA shelters in the Middle area, Khan Younis and Rafah governorates. Obtaining an accurate count is challenging, given the difficulties involved in tracking IDPs staying with host families, the movement of IDPs following evacuation orders since 1 December, and the evacuation of five UNRWA shelters on the orders of the Israeli military in eastern Khan Younis on 6 December.
• 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 diarrhea, acute respiratory infections, skin infections and hygiene-related conditions like lice.
• On average, UNRWA shelters located in the middle and southern areas are currently sheltering nine times the number of IDPs as was planned for.

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 were depleted. Depending on the availability of fuel, electricity is produced by generators, as well as by solar panels. For more information on electricity supply to the Gaza strip, please see this dashboard.

Health care, including attacks (Gaza Strip)

• For the sixth consecutive day, Al Awda Hospital, Jabalya (northern Gaza) remains surrounded by Israeli troops and tanks, and fighting with armed groups has been reported in its vicinity. Reportedly, 250 doctors, patients, and their family members are trapped inside the hospital. On 9 December, two medical staff were reportedly killed while on duty inside the hospital, during clashes between Israeli forces and Palestinian armed groups.
• Currently, only 13 out of 36 hospitals in the Gaza Strip are partially functional and able to admit new patients, although services are limited. Only one of these hospitals is in the north. The two major hospitals in southern Gaza are operating at three times above their bed capacity, while facing critical shortages of basic supplies and fuel. According to the MoH in Gaza, occupancy rates are now reaching 206 per cent in inpatient departments and 250 per cent in intensive care units. Additionally, these hospitals are providing shelter to thousands of IDPs.
• On 10 and 11 December, the vicinities of Al Aqsa Hospital in Deir Al-Balah and Al-Amal Hospital in Khan Younis were repeatedly bombarded, impeding the access of dozens of casualties. These two hospitals are among the 12 hospitals in the south which are still partially operational.
• The MoH in Gaza stated that only one percent of Palestinians injured in hostilities have been evacuated outside of Gaza for hospitalization through the Rafah border crossing. This corresponds to slightly over 400 people, while an additional 8,000 of the estimated 40,000 injured require urgent and immediate medical intervention. The process of obtaining security approvals for the injured individuals from the Israeli authorities takes one to three days. During this time the patient's condition can deteriorate, and some patients die waiting.
• On 11 December, the Palestine Red Crescent Society (PRCS) began initial ground preparations for establishing the Qatari field hospital in the Rafah governorate, in collaboration with the Qatari Red Crescent Society (QRCS). The hospital's capacity is 50 beds, including an operating room, intensive care unit, reception, and radiology.

Food security

• On 10 December, the World Food Programme (WFP), through its partner ‘Global Community,’ distributed 9,000 hot meals and 3,000 food parcels to IDPs outside of shelters and with host families in Rafah.
• During the humanitarian pause (24-30 November), WFP conducted a rapid food security assessment across the Gaza Strip involving a sample of 399 households. Severe hunger was found in 36 per cent of respondent households and moderate hunger in another 52 per cent. In 91 per cent of the households, respondents reported going to bed hungry, and 63 per cent reported enduring entire days without food. The situation is significantly worse in the north. The acute shortage of cooking gas has led to heavy dependence on less clean sources such as firewood, wood residues, and waste burning, raising the risk of respiratory diseases.

Water and sanitation (Gaza Strip)

• On 10 December, the Coastal Municipalities Water Utility (CMWU), together with UNICEF, installed several water and sanitation facilities at the ‘Qatari field hospital,’ an under-construction building in Rafah accommodating between 15,000 and 20,000 recently arrived IDPs. The facilities include two mobile bladders with 5 and 10 cubic metres capacities, regularly refilled with drinking water, and 24 toilet units, including showers.
• Grave concerns about waterborne diseases due to water consumption from unsafe sources persist, particularly in the north, where the water desalination plant and the pipeline from Israel was shut down. There has been almost no improvement in access to water for drinking and domestic purposes for residents of the north for weeks.
• UNRWA continues to operate nine water wells with a capacity to pump about 10,000 cubic metres a day to provide potable and domestic water supply for shelters across Gaza. Potable water trucking operations to the shelters in Rafah and Khan Younis areas continue despite the dangerous conditions. Additionally, shelters in Rafah have started to receive potable water through tankers from the Coastal Municipalities Water Utility.

Hostilities and casualties (Israel)

• The indiscriminate rocket fire by Palestinian armed groups from Gaza towards Israel continued on 11 December; one man was reportedly injured in central Israel. Over 1,200 Israelis and foreign nationals have been killed in Israel, including 36 children, according to the Israeli authorities, the vast majority on 7 October.
• During the humanitarian pause (24-30 November), 86 Israeli and 24 foreign national hostages were released. It is estimated that about 137 people remain captive in Gaza, including Israelis and foreign nationals, according to Israeli sources. Before the pause, four civilian hostages had been released by Hamas, one Israeli soldier had been rescued by Israeli forces, and bodies of three hostages had reportedly been retrieved by Israeli forces.

Violence and casualties (West Bank)

• No new fatalities or injuries were reported in the West Bank on 11 December.
• Since 7 October, 265 Palestinians, including 69 children, have been killed in the West Bank, including East Jerusalem. Additionally, two Palestinians from the West Bank were killed while carrying out an attack in Israel on 30 November. Of those killed in the West Bank, 255 have been killed by Israeli forces, eight by Israeli settlers and another two either by forces or settlers. The two-month 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.
• Since 7 October, four Israelis, including three members of Israeli forces, have been killed in attacks by Palestinians in the West Bank, including East Jerusalem. An additional four Israelis were killed in West Jerusalem in an attack by Palestinians (one of whom was killed by Israeli forces who misidentified him).
• 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 exchanges 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 3,472 Palestinians, including at least 535 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 84 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 9 per cent in the first nine months of 2023.

Settler Violence

• No new settler-related incidents were reported in the past 24 hours in the West Bank. Since 7 October, OCHA has recorded 331 settler attacks against Palestinians, resulting in Palestinian casualties (35 incidents), damage to Palestinian-owned property (251 incidents), or both casualties and damage to property (45 incidents).
• The weekly average of incidents since 7 October stands at 35, compared with 21 incidents between 1 January and 6 October 2023. The number of incidents since 7 October has gradually declined from 80 incidents in the first week (7-14 October) to 13 incidents in 2-7 December. One-third of these incidents included firearms, including shootings and threats of shootings. In nearly half of all recorded incidents, Israeli forces were either accompanying or reportedly seen as supporting the attackers.

Displacement (West Bank)

• Since 7 October, at least 143 Palestinian households comprising 1,026 people, including 396 children, have been displaced amid settler violence and access restrictions. The displaced households are from 15 herding/Bedouin communities. More than half of the displacements occurred on 12, 15, and 28 October, affecting seven communities.
• Also, since 7 October, 338 Palestinians, including 182 children, have been displaced following the demolition of their homes in Area C and East Jerusalem, due to lack of Israeli-issued building permits in Area C of the West Bank and East Jerusalem, which are almost impossible to obtain. The monthly average of displacement between 7 October and 7 December represents 27 per cent increase compared with the monthly average of displacement in the first nine months of the year.
• Another 68 Palestinians, including 34 children, have been displaced following the demolition of 16 homes on punitive grounds since 7 October, which is the same number of homes punitively demolished in the first nine months of the year. The Human Rights Committee, in its review of the fourth periodic report of Israel, in 2014, concluded that punitive demolitions are a form of collective punishment and as such are illegal under international law.
• Another 269 Palestinians, including 121 children, have been displaced since 7 October following the destruction of 42 residential structures during other operations carried out by Israeli forces across the West Bank; 61 per cent of the displacement was reported in Jenin Refugee Camp, and 29 per cent in Nur Shams and Tulkarm Refugee Camps (both in Tulkarm).

Funding

• As of 11 December, Member States have disbursed 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 nearly 37 per cent of the $1.2 billion requested. Private donations are collected through the Humanitarian Fund.

HUMANITARIAN NEEDS AND RESPONSES: 4 December – 10 December

Health

UNRWA carried out the following health activities across Gaza between 7 and 9 December:

• Some 97 medical teams attended about 30,000 IDPs in UNRWA shelters.
• Some 10,700 medical consultations were provided at health centres every day;
• Some 18,208 patients received healthcare in eight UNRWA health centres in the middle and south areas of Gaza;
• Mental health and psycho-social support services were delivered to about 2,000 people;

Protection

• Explosive Ordnance Risk Education (EORE) and Conflict Preparedness and Protection messages continue to be disseminated to people via available channels.
• UNMAS, Mines Advisory Group (MAG) and NPA continue with social media campaigns and HI and UNMAS are planning SMS campaigns to educate the public and mitigate Explosive Remnants of War (ERW) risks.
• A total of 35 Child Protection Case Management Actors attended remote training on Identification, Documentation, Tracing and Reunification of Unaccompanied and separated children.
• Child protection partners reached 35,290 boys and girls and 13,780 women and men in the past 15 days with awareness raising messages about protection issues, MHPSS support, case management and winter clothing kits.
• Temporary alternative care shelter in Rafah has been arranged for unaccompanied children who are identified and registered. Hosting capacity for children will be arranged in phases, with 15 children accommodated in the first phase.
• Despite extreme access challenges, GBV partners continue to provide support to women and girls in the south During the reporting period, partners distributed 17,000 menstrual health management kits and 9,500 dignity kits to 26,500 women and girls of reproductive age in the south. Further information is available here about MHM Strategy.

Food security

The majority of food distribution focused on IDPs in UNRWA shelters, public shelters and host families. Food security partners have undertaken the following responses during the reporting period:

• UNRWA distributed flour to about 160,000 people in the north of Gaza. In the south, flour distribution reached about 1,153,020 people.
• About 100,000 people received food parcels and about 130,000 people received hot meals in southern Gaza.

Nutrition

Nutrition partners have provided the following essential nutrition preventive and curative supplies during the reporting period to prevent malnutrition among children and mothers:

• UNICEF delivered Ready to Use Therapeutic Food (RUTF) for over high risk 4,850 children with severe and moderate acute malnutrition.
• UNICEF delivered additional quantities of High Energy Biscuits (HEB) to 11,760 children under the age of five. To date, 24,000 children have received HEB since the start of the response on 9 November.
• WFP delivered medium quantity lipid-based supplements to cover the needs of 57,500 pregnant-breastfeeding women and children under two years of age.
• Some 500 pregnant and breastfeeding women received iron-folate supplementation to prevent malnutrition.

Water, Sanitation and Hygiene (WASH)

No updates were given for the reporting period. Below are the updates for the period 27 November to 4 December:

• Some 3,896 cubic meters of water, and 690 cubic meters of bottled water were distributed to displaced people.
• Two desalination plants were installed in two IDP centres in Khan Younis. During the ceasefire period WASH actors increased activities in IDP locations. However, fewer WASH supplies entered Gaza, and there were no new deliveries of storage tanks, jerry cans, and cleaning kits to Rafah. No latrines were built. A consignment of pipes and generators was refused access over the ceasefire period. Fuel supply to WASH facilities, currently at 19,520L/day is at 35 per cent of the amount needed to operate water production, treatment and distribution, sewage treatment and storm water management.

Shelter and Non-Food Items (NFI)

During the reporting period, a significant shortage of basic shelter materials was reported, which includes supplying tents, tarpaulins, and plastic sheeting for protection during rainy days, particularly for people living outside the shelters. Shelter partners distributed the following items to IDPs:

• 470 mattresses.
• 420 water jerrycans.
• 250 sleeping mats.
• 150 kitchen sets.

There is still a major gap in shelter winterization materials and essential NFIs, including sealing off kits for damaged houses; a high shortage in bedding sets, including mattresses and blankets to cover the needs of the IDPs in various settings, including UNRWA shelters, as well as winterized tents to protect IDPs I in the open air from harsh weather.

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 ), psychosocial support (31,318 reached), and recreational activities (49,726 reached). The response has focused on Khan Younis, Rafah, and the Middle Area governorates, as North Gaza and Gaza governorates are inaccessible.

Multi-Purpose Cash assistance (MPCA)

Needs:

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

Respone:

• Since the beginning hostilities, 66,870 households (including roughly 449,000 people) received 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 has been 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 faciemajor challenges in re-stocking and operating. Therefore, informal markets, such as vendors, minimarts, carts and stalls are reportedly the main source for goods. Information is still unclear on whether shops and markets actors were able to restock during the pause.

Logistics

• The Logistics Cluster launched common storage services in Gaza and Egypt.
• In Gaza, three warehouses, managed by a Logistics Cluster partner, are available for partners’ storage in Deir al Balah (495 m2), Khan Yunis (170 m2), and Rafah (70 m2).
• The Logistics Cluster also facilitates the transport from Rafah to the three warehouse locations in Gaza Strip.
• In Port Said, Egypt, 800 pallet positions are available for common storage for the humanitarian community.
• Additionally, a cargo notification service in Rafah will support partners with the reception of their cargo entering Gaza. Partners wishing to access f these services should consult the details of the process in the Standard Operating Procedures (SOPs).
• The Logistics Cluster installed three Mobile Storage Units (MSUs) at the Rafah transshipment base to increase the partners’ offloading capacity in Rafah with an additional 960 m2. Three more MSUs have been installed at the UNRWA base in Rafah, in order to increase warehousing capacity.
• An additional 8 MSUs will be installed in Gaza by the Logistics Cluster, pending assessment with partners regarding key locations the IMPACCT Working Group (hosted at the Global Logistics Cluster) held a national workshop on the importation of humanitarian aid with relevant ministries, authorities, the Egyptian Red Crescent, UN and INGOs, with the Logistics Cluster intending to organize a meeting with partners r to present the main findings.

Emergency Telecommunications

• The Emergency Telecommunications Cluster (ETC) continues to coordinate a collective approach among partners for the importation of telecommunications equipment into Gaza.
• On 3 December, the ETC team, UNDSS, the NGO Help, and OCHA met with the Israeli Coordinator of Government Activities in the Territories (COGAT) to discuss the list of technical equipment and solutions submitted for importation into Gaza— to install an independent connectivity and security communications services for humanitarian responders.
• Following the feedback received from COGAT, the team is developing a revised detailed proposal containing the consolidated description of all equipment and solutions required to operate in Gaza.
• On 3 December, COGAT also authorized the team to purchase 20 satellite phones from a local service provider and import into Gaza for use by humanitarian responders.
• The ETC alerted COGAT of the ongoing limited internet connectivity for humanitarian responders, while UNOCHA raised the issue of limited fuel access for Mobile Network Operators—to power telecommunications towers.

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.