Hostilities in the Gaza Strip and Israel | Flash Update #67

Key points

• Between the afternoons of 11 and 12 December, 217 Palestinians were killed and another 455 were injured, according to the Ministry of Health (MoH) in Gaza. Overall, according to the MoH in Gaza, between 7 October and 12 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 50,100 were reportedly injured. Many more people are missing, presumably buried under the rubble, waiting for rescue or recovery.  
• On 12 December, heavy Israeli bombardments from air, land, and sea across Gaza continued, especially in the city of Rafah, in the southern Gaza Strip. Intense ground operations and fighting between Israeli forces and Palestinian armed groups continued, especially in Khan Younis (also in the south) and the northern parts of Gaza Strip. The firing of rockets by Palestinian armed groups into Israel also continued. 
• One Israeli soldier died from wounds sustained two weeks ago, bringing the total number of Israeli soldeirs that have been killed in Gaza since the start of the ground operations to 105, with 600 injured, according to the Israeli military.   
• On 12 December, initial reports and footage emerged of Israeli forces blowing up  an UNRWA school in Beit Hanoun, in northern Gaza. 
• The spread of diseases in Gaza has reportedly intensified, especially due to overcrowded living conditions; which adds to the strain on an increasingly overwhelmed health system and an increased risk of people dying. On 12 December, the MoH’s spokesperson in Gaza said that the ministry had documented 360,000 cases of infectious diseases in shelters, noting that the actual number is believed to be higher.  
• On the same day, the head of the World Health Organisation (WHO) in the occupied Palestinian territory announced that cases of meningitis, jaundice, impetigo, chickenpox and other upper respiratory tract infections had been recorded. Additionally, the director of the Abu Youssef An Najjar Hospital in Rafah announced that diarrhoea* and influenza were spreading amongst internally displaced persons (IDPs) in Rafah; including 1,500 cases of intestinal disease reported daily due to food shortages. 
• On 12 December, Israeli forces raided Kamal Adwan hospital in Beit Lahiya, north of Gaza city, arrested the director and transported some 70 medical staff to an unknown location. The remaining staff were ordered to collect all patients and carers into one building and evacuate the other buildings; where they remain without electricity, water, or food. The hospital had already been under siege for three days, according to the MoH in Gaza. 
• Limited aid distributions are taking place in Rafah governorate. In the rest of the Gaza Strip, aid distribution has largely stopped, due to the intensity of hostilities and restrictions on 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, Gaza city. 
• On 12 December, for the first time since the escalation of hostilities on 7 October, aid trucks were screened at the Israeli-controlled Kerem Shalom crossing, and then allowed to enter Gaza through the Rafah crossing. While this measure should help alleviate the delays in aid trucks entering Gaza, as screening is now conducted in two locations, humanitarian agencies report this is not sufficient and have been requesting the complete re-opening of the Kerem Shalom crossing, which prior to 7 October was the main access point for goods entering and exiting the Gaza Strip. The humanitarian community has stressed that the crossing must open for both humanitarian and commercial commodities. 
• On 12 December, as of 22:00, 107 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 and private sector goods) that entered every working day prior to 7 October. The ability of the UN to receive incoming aid is being significantly undermined by a shortage of trucks within Gaza; the continuing lack of fuel; telecommunications blackouts; and the increasing number of staff unable to reach the Rafah crossing safely, due to the intensity of hostilities. More aid is needed to enter Gaza, but equally, more capacity is needed in Gaza to handle incoming aid 
• On 12 December, some 129,000 litres of fuel and 45,020 kilogramms of gas entered Gaza from Egypt. 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. Fuel has been prioritized to hospitals in the south of Gaza.  
• On 12 December, one injured person and 399 dual nationals were evacuated from Gaza to Egypt, bringing the total number of wounded Palestinians and other medical cases who have been evacuated since 7 October to 464 and 530, respectively. 
• On 9 and 10 December, in Gaza North governorate and in Gaza city, Israeli forces reportedly detained hundreds of men and boys sheltering in public spaces, schools serving as IDP shelters as well as private homes. Reportedly from the same period, detainees were stripped to their underwear, handcuffed, and ordered to kneel in open areas, while subjected to beatings, harassment, harsh weather, and denial of basic necessities. Images have been circulating over the media, drawing widespread condemnation. According to the Israeli military, those suspected of affiliation with Hamas were transferred to Israel for interrogation, while others have been released. 

Hostilities and casualties (Gaza Strip)

• The following are among the deadliest incidents reported between 14:00 on 11 and 12 December, involving the striking of residential buildings: 
  • A residential building was hit in Musabbah area, Northern Rafah, reportedly killing at least 12 Palestinians including at least 6 children and injuring 10 others. 
  • A residential building was hit in Al-Nuseirat, Middle Gaza, reportedly killing 17 Palestinians. 
  • A residential house was hit in Sheikh Radwan neighborhood, Gaza City, reportedly killing tens of Palestinians. 
• UNRWA is verifying reports that IDPs sheltering in its primary health clinic in Jabaliya and in one of its schools in Gaza city were forced to evacuate, with some subsequently shot or arrested while fleeing. Following the forced evacuations, the two facilities were reportedly struck with munitions, resulting in damages. Since 7 October, 41 UNRWA installations have been directly hit and 60 installations have sustained collateral damage, according to UNRWA. Some 284 IDPs sheltering in UNRWA facilities have been killed and another 976 injured. 
• According to the Palestinian Journalist Syndicate in Gaza, 81 Palestinian journalists and media workers have been killed 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. 

Displacement (Gaza Strip)

• On 11 December, the Israeli military was again calling and exerting pressure on Palestinian residents remaining 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, people moving through that road north and east of Khan Younis city reportedly experienced intense battles. 
• So far, areas encompassing nearly 30 per cent of the Gaza Strip (excluding the orders to evacuate the areas north of Wadi Gaza) have been marked for evacuation on the Israeli military’s online map launched on 1 December. Residents’ access to this information is impaired by recurrent interruptions in telecommunications and the lack of electricity. 
• Following multiple orders by Israeli forces for Palestinians to evacuate, many IDPs are now in southern Gaza. The two largest sites in the Rafah where thousands have relocated and erected makeshift structures and tents, are in an under-construction hospital (‘the Qatari field hospital’) and the campus of the Al Quds Open University. Tens of thousands of IDPs, who have arrived in Rafah 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. Without enough latrines, open-air defecation is prevalent, increasing concerns of further spread of disease, particularly during rains and related flooding.
• 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, including people who have been displaced multiple times.  
• 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 total is challenging, given the difficulties involved in tracking IDPs staying with host families, the renewed 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, influenza*, meningites, jaundice, impetigo acute respiratory infections, skin infections and hygiene-related conditions like lice.  
• On average, UNRWA shelters in the middle area and south are sheltering nine times their intended IDP capacity. 

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. For more information on electricity supply to the Gaza strip, please see this dashboard.

Health care, including attacks (Gaza Strip)

• On 12 December, WHO reiterated its call for the protection of health care and humanitarian assistance in Gaza, following military checkpoint delays and detention of health partners during a mission to transfer critically ill patients and deliver supplies to a hospital in northern Gaza (see Flash Update 65). During that mission, a patient reportedly died, and staff were obstructed and subject to ill-treatment. Since 7 October, WHO has recorded 231 attacks in the Gaza Strip, affecting 60 health facilities and 76 ambulances in the Gaza Strip. 
• For the seventh consecutive day, Al Awda Hospital, Jabaliya (northern Gaza), remains surrounded by Israeli troops and tanks, and fighting with armed Palestinian 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 11 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, according to WHO. The two major hospitals in southern Gaza are operating at three times 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 11 and 12 December, the vicinities of Nasser and Al Amal hospitals 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 and are sheltering thousands of IDPs. 

Hostilities and casualties (Israel)

• The indiscriminate rocket fire by Palestinian armed groups from Gaza towards Israel continued on 12 December. 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. On 12 December, reportedly, two additional bodies were retrieved. 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)

• On 12 December, Israeli forces killed five Palestinian men and injured several others during a large-scale operation that they carried out in Jenin city and Jenin Refugee Camp. The operation included a drone strike that killed four of the five people. A six and a seventh Palestinian, including a 13-year-old child, died after their access to medical care and hospitalization was impeded during the incident. During the operation, Israeli forces surrounded the three main hospitals in the city, and obstructed the movement of ambulances, including those transporting the injured. Additionally, Israeli forces caused extensive damage to infrastructure and private property. 
• Since 7 October, 271 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, 261 have been killed by Israeli forces, eight by Israeli settlers and another two either by forces or settlers. This toll represents more than half of all Palestinians killed in the West Bank this year. 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 an attack by Palestinians from the West Bank in West Jerusalem (one of the four 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 3,481 Palestinians, including at least 541 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 85 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 by live ammunition, compared with 9 per cent in the first nine months of 2023.  

Settler Violence

• Between 11 and 12 December, four settler attacks resulting in damage to Palestinian-owned property were reported. In one of the incidents, armed assailants who are known by Palestinians to be settlers but were wearing Israeli military uniforms, physically assaulted a Palestinian family while they were picking olives near their house in Turmus'ayya, Ramallah. In another incident, Palestinian landowners in Awarta village, southeast of Nablus, accessed their lands through a special permission granted by the Israeli authorities, only to find settlers harvesting their trees. Israeli forces then removed the family from their agricultural land. In the two remaining incidents, armed Israeli settlers raided the Palestinian communities of Al Farisiya-Khallet Khader and Ein al Hilwa (both in Tubas), physically assaulted residents and took livestock.  
• Since 7 October, OCHA has recorded 336 settler attacks against Palestinians, resulting in Palestinian casualties (35 incidents), damage to Palestinian-owned property (256 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 between 2 and 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. The same number of homes were 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 12 December, Member States have disbursed US$479.2 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 nearly 39 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 daily. 
• Some 18,208 patients received health care in eight UNRWA health centres in the middle and south areas of Gaza. 
• Mental health and psycho-social support services (MHPSS) were delivered to about 2,000 people. 

Protection

• Explosive Ordnance Risk Education and Conflict Preparedness and Protection messages continue to be disseminated via available channels. 
• UNMAS, Mines Advisory Group and NPA continue with social media campaigns and HI and UNMAS are planning SMS campaigns to educate the public and to mitigate Explosive Remnants of War 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 regarding 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. 
• Partners specializing in addressing gender-based violence continue to provide support to women and girls in the south. During the reporting period, partners distributed 17,000 menstrual health management (MHM) kits and 9,500 dignity kits to 26,500 women and girls of reproductive age in the south.  

Food security

Most food distribution focused on IDPs in UNRWA shelters, public shelters, and host families. Food security partners have provided 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 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 4,850 high-risk 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 provided for the reporting period. Below are the updates for the period, 27 November to 4 December: 

• Some 3,896 cubic metres of water, and 690 cubic metres 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 their activities in IDP locations. However, fewer WASH supplies entered Gaza, and there were no new deliveries of storage tanks, jerry cans, or cleaning kits to Rafah. No latrines were built. A consignment of pipes and generators was refused entry over the ceasefire period. Fuel supply to WASH facilities, currently at 19,520 litres per 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 tents, tarpaulins, and plastic sheeting for protection during rainy days, particularly for people living outside 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 in the open air. 

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 people), and recreational activities (49,726 people). 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 of 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. 
• While distribution has been provided 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 face major challenges in re-stocking and operating. Therefore, informal markets, such as vendors, minimarts, carts, and stalls are reportedly the main source for goods. 

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 storage in Deir al Balah (495 square metres), Khan Yunis (170 square metres), and Rafah (70 square metres). 
• The Logistics Cluster also facilitates transport from Rafah to the three warehouse locations in the 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 the access of partners’ cargo into Gaza: details of the process in Standard Operating Procedures.
• The Logistics Cluster installed three Mobile Storage Units (MSUs) at the Rafah transshipment base to increase partners’ offloading capacity in Rafah with an additional 960 square metres. Three more MSUs have been installed at the UNRWA base in Rafah to increase warehousing capacity. 
• An additional eight 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. 

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 submitted for importation into Gaza and install an independent connectivity and security communications services for humanitarian responders. 
• On 3 December, COGAT authorized the team to import 20 satellite phones into Gaza for humanitarian responders. 

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.