Hostilities in the Gaza Strip and Israel | Flash Update #68

Key points

• Heavy Israeli bombardments from air, land, and sea across Gaza continued on 13 December, especially in Jabalya, in the northern Gaza Strip. According to the Ministry of Health (MoH) in Gaza, between the afternoons of 12 and 13 December, at least 196 Palestinians were killed and another 499 were injured in Gaza. Since 7 October, MoH has reported on at least 18,608 fatalities and about 50,594 injuries. About 70 per cent of the total fatalities are said to be women and children. Many more people are missing, presumably buried under the rubble, waiting for rescue or recovery.
• Additionally, intense ground operations and fighting between Israeli forces and Palestinian armed groups continued, especially in An Nuseirat Refugee Camp in the Middle Area. According to the Israeli military, ten Israeli soldiers, including several senior officers were killed overnight, bringing the total number of Israeli soldiers who have been killed in Gaza since the start of the ground operations to 115, with 619 injured. The firing of rockets by Palestinian armed groups into Israel has also continued.
• On 13 December, for the second consecutive day, Israeli troops, accompanied by tanks, raided Kamal Adwan Hospital, in Beit Lahiya, north of Gaza city, with reports of mass arrests and ill-treatment of people who they have detained. On 13 December, Israeli forces released five doctors and all the female staff from custody detained the previous day. The director of the hospital and about 70 other medical staff remain detained in an unknown location outside of the hospital. Reports from those released indicate that they were interrogated, beaten and exposed to the harsh weather, before they eventually returned to the hospital.
• WHO expressed its concern about the raid on Kamal Adwan Hospital. According to the MoH in Gaza, there are 65 patients including several needing intensive care, and 45 medical staff in the hospital. The hospital was operating at a minimal level due to acute shortages of fuel, water, food and medical supplies even before the raid. WHO called “for the protection of all people inside the hospital”.
• On 13 December, an UNRWA school which was sheltering internally displaced persons (IDPs) in Jabalya Refugee Camp was hit, with casualties reported. The same school had been hit several times previously. On the same day, another school in Jabalya, which was also sheltering IDPs, was raided by Israeli forces with initial media reports and footage indicating IDP casualties.
• UNRWA is verifying recent reports of incidents at UNRWA facilities. Since 7 October, 156 incidents affecting UNRWA premises have been reported, including at least 12 cases of military use and/or interference at UNRWA premises.
• On 13 December, the Israeli military designated an additional area southwest of Khan Younis city, encompassing about 1.4 square kilometres, for immediate evacuation. This area was home to about 37,000 residents and an estimated 5,000 IDPs who took shelter in three designated emergency shelters in October 2023. Similar evacuations orders were issued in previous days for a large area east of Khan Younis. Collectively, these areas in the Khan Younis governorate encompass about 22 per cent of the Gaza Strip.
• Limited aid distributions continue to take place in Rafah governorate, where almost half of Gaza’s population is now estimated to be residing. 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 high-risk mission on 9 December to Al Ahli hospital in Gaza city.
• On 13 December, for the second consecutive day, aid trucks were screened at the Israeli-controlled Kerem Shalom crossing, before being 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 insufficient; they have been advocating for 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. In a press briefing in Geneva on 13 December, the Humanitarian Coordinator reiterated that “without Kerem Shalom, we will never be able to properly deliver humanitarian assistance in Gaza.” She further noted: “Israel, as the occupying power, is responsible to protect the Palestinian civilian population. This means they have to provide for basic needs. Allowing trucks to get to the border between Egypt and Gaza is insufficient. They need to ensure that the conditions inside of Gaza are also such that we will be able to provide assistance to everybody who is in need.”
• On 13 December, as of 22:00, 152 trucks carrying humanitarian supplies, and four tankers of fuel entered Gaza from Egypt. This is above the daily volume recorded since the resumption of hostilities on 1 December but remains 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 and fuel are needed to enter Gaza, but equally, more capacity is needed in Gaza to handle incoming aid.
• On 13 December, 268 dual nationals were evacuated from Gaza to Egypt; no injured people evacuated. The total number of wounded Palestinians and other medical cases evacuated since October 7 represents only one per cent of the total Palestinians injured in hostilities. Over 400 evacuated, while more than 20 times more injured – some 8,000 of the estimated 50,000 - urgently need medical intervention.
• A new World Bank report warned of the severe impact that the current crisis is having on the Palestinian economy, stating that” the loss of life, speed and extent of damages to fixed assets and reduction in income flows across the Palestinian territories are unparalleled.” The Gaza Strip operated at only 16 per cent of its productive capacity in October, while prices have increased on average by 12 per cent, due to demand for products that are increasingly difficult to find on the local market. Approximately 85 per cent of workers in Gaza have been unemployed since the hostilities started, with most of Gaza’s 56,000 formal business establishments suspending operations, according to the World Bank. The West Bank economy has also been significantly affected, following Israel’s decision to prohibit access to 200,000 workers who previously worked in Israel and the settlements. Prior to the conflict, the World Bank forecast 3.2 per cent real GDP growth for the Palestinian economy in 2023, which has now been revised to -3.7 per cent.

Hostilities and casualties (Gaza Strip)

• The following are among the deadliest incidents reported between 14:00 on 12 December and 14:00 on 13 December:
  • At least eight Palestinians were reportedly killed, and several others were injured in a residential building that was hit in Ash Shabora area in Rafah.
  • At least nine Palestinians were reportedly killed in a residential building that was hit in Al Amal project, western Khan Younis.
• Additionally, on 11 December, an IDP sheltering in an UNRWA installation in Khan Younis was reportedly shot and killed. Since 7 October, 43 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 Ministry of Education, as of 5 December, more than 3,477 students and 203 educational staff have been killed, more than 5,429 students and 507 teachers have been injured in the Gaza Strip. Some 342 school buildings sustained damage (over 69 per cent of all school buildings in Gaza). Of the 70 UNRWA-damaged schools, including at least 56 currently serving as shelters for IDPs during these hostilities. Several schools, including UNRWA schools, in the Gaza Stirp were directly hit by Israeli strikes or tank shell.

Displacement (Gaza Strip)

• To date, 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 that was 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 presently sheltering in southern Gaza. The two largest sites in the Rafah governorate, 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.
• 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. The heavy rains and flooding which affected large parts of Gaza on 13 December are compounding human misery and adding to the risk of waterborne diseases.
• As of 12 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, many of them have been displaced multiple times.
• As of 11 December, nearly 1.3 million of these IDPs were registered in 155 UNRWA facilities across Gaza, including more than 1.1 million in 98 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, chicken pox, meningitis, jaundice, impetigo acute respiratory infections, skin infections and hygiene-related conditions like lice.
• On average, UNRWA shelters south of Wadi Gaza 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)

• The Ministry of Health (MoH) in Gaza has announced that it has run out of vaccinations, leading to catastrophic health repercussions for children and the spread of diseases, especially among displaced people in overcrowded shelters. 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.
• For the eighth consecutive day, Al Awda Hospital in Jabalya, northern Gaza, remains surrounded by Israeli troops and tanks, and fighting with armed Palestinian groups is 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 13 December, the vicinity of Nasser hospital in Khan Younis was repeatedly bombarded, impeding the access of dozens of casualties. This hospital is among the ten hospitals in the south which are still partially operational and are sheltering thousands of IDPs.

Water, sanitation and hygiene (WASH)

• On 13 December, water, sanitation, and hygiene (WASH) partners reported an urgent need for pipelines and construction material. Stockpiles of material for the repairing of water pipelines systems are running low, and many of the pipelines have been damaged and are in need of repair. Inability to provide repairs could result in water being cut off from certain areas in the south of Gaza.
• On 13 December, heavy rains fell on Gaza, flooding many of the areas, worsening the struggle of displaced Palestinians amid the lack or limited capacity to manage sewage, particularly in IDP shelters, and the accumulation of solid waste in various locations. These factors, coupled with the absence of effective waste management, which have been attracting insects, mosquitoes, and rats, are significantly elevating the risk of spreading of disease, threatening both physical and mental wellbeing.
• On 13 December, WASH partners have also highlighted that due to overcrowded conditions, lack of toilets and sanitation services in shelters, people are forced to wait in line for hours to access toilets, and in other locations where IDPs are located and where no toilets are available at all have forced people to implement open air defecation, increasing concerns of disease spreading.

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 13 December, reportedly, two additional hostages were declared as dead. It is estimated that about 133 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 13 December, no Palestinian fatalities were reported in the West Bank.
• 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. 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 the 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 3,488 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 12 and 13 December, three settler attacks resulting in damage to Palestinian-owned property were reported. In two of the incidents, armed assailants who are known by Palestinians to be settlers but were wearing Israeli military uniforms, broke into the Palestinian community of Susiya in Hebron, where they reportedly stole agricultural equipment and water tanks. In another incident, Israeli settlers, reportedly from the newly established Israeli settlement outpost near Havat Ma'on, broke into Mantiqat Shi'b al Butum community in Masafer Yatta in southern Hebron Hills and stole water tanks and broke the windows of a Palestinian-owned vehicle.
• Since 7 October, OCHA has recorded 343 settler attacks against Palestinians, resulting in Palestinian casualties (35 incidents), damage to Palestinian-owned property (263 incidents), or both casualties and damage to property (45 incidents).
• The weekly average of incidents since 7 October stands at 38, compared with 21 incidents per week prior to 7 October (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 21 incidents between 9 and 14 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.
• On 13 December, Israeli forces demolished a residential building comprising four apartments, for lacking an Israeli-issued building permit, in Ras Al A’mud, East Jerusalem. As a result, five Palestinian households, including two refugee families, comprising 29 people, including 14 children, were displaced.
• Also, since 7 October, 367 Palestinians, including 196 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 13 December, Member States have disbursed US$479 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

Education Cluster’s 10 partners currently active in the Gaza strip have reached 84,262 individual students and teachers since 7 October with provision of emergency learning and recreational supplies (52,653 reached), psychosocial support (64,854 reached), and recreational activities (83,262 reached), in Khan Younis, Rafah and Middle governorates.

The Gaza Education Cluster conducted an Observation Assessment between 25 to 27 November in the three Southern governorates to assess the level of damage of 41 schools and conduct a preliminary mapping of available space for setting up temporary learning spaces as well as the presence of teachers and personnel trained to carry out recreational activities at shelters. All assessed schools sustained some level of damage. The assessment report includes recommendations to the Ministry of Education and UNRWA, Education cluster partners, and for the education cluster coordination team itself. Two task forces for the Gaza response were activated following this exercise, one on MHPSS and recreational activities and one on Continuity of Education. The assessment of school damage will continue if/when security allows.

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.

Response:

• 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.