Hostilities in the Gaza Strip and Israel | Flash Update #69

Key points

• On 14 December, heavy Israeli bombardments from air, land, and sea across Gaza continued, especially in Jabalya, Beit Hanoun and Beit Lahiya, in the northern Gaza Strip. Between the afternoons of 13 and 14 December, at least 179 Palestinians were killed and another 303 were injured, according to the Ministry of Health (MoH) in Gaza. Overall, according to MoH, between 7 October and 14 December afternoon, at least 18,787 Palestinians have been  killed in Gaza. About 70 per cent are said to be women and children, and about 50,589 were reportedly injured. Many  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 Khan Younis, in southern Gaza. According to the Israeli military, one Israeli soldier was killed in Gaza on 14 December, bringing the total number of Israeli soldiers who have been killed in Gaza since the start of the ground operations to 116, with 648 injured, according to the Israeli military. The firing of rockets by Palestinian armed groups into Israel has also continued.   
• On 14 December, for the third consecutive day, Israeli troops, accompanied by tanks, raided Kamal Adwan Hospital, in Beit Lahiya, north of Gaza city, with reports of Palestinians being subjected to mass arrests and ill-treatment. The MoH in Gaza claimed that Israeli troops forced all the 2,500 internally displaced persons (IDPs) taking refuge inside the hospitals to leave, and evacuated the remaining wounded people and medical staff to the hospital grounds. The MoH also claims that the Israeli military prevented medical staff from providing support to 12 babies in intensive care and to ten injured people in the emergency department, leading to the death of two patients. 
• On 13 December, following the release of some of the detainees, Israeli forces allegedly shot and injured five people while they were on their way back to the hospital. Over 70 medical staff, including the director of the hospital, remain detained at an unknown location. According to the Israeli military, tens of Hamas operatives have been detained in this operation. That day, the World Health Organization (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 already only minimally functional due to acute shortages of fuel, water, food and medical supplies even before the hospital was sieged. WHO called for the protection of all people inside the hospital.   
• On 14 December, as of 22:00, there are initial reports that at least 100 trucks carrying humanitarian supplies and four tankers of fuel have entered the Gaza Strip. 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. At a press conference on 14 December, UNRWA Commissioner-General, Philippe Lazzarini, declared: “What we need today is not just 100 trucks, or 200 trucks. We need meaningful, at scale, uninterrupted and unconditional flow of basic commodities into the Gaza Strip.” The Humanitarian Coordinator Lynn Hasting has said that the Israeli authorities “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 14 December, there were no reports of injured or dual nationals evacuating Gaza to Egypt. The total number of wounded Palestinians and other medical cases evacuated since October 7 represents one per cent of the reported injury toll. This corresponds to slightly over 400 people, while an additional 8,000 of the estimated 40,000 injured are said to require immediate medical intervention. 
• On 14 December at about 17:45, the main Palestinian telecommunication group in Gaza announced that all services had been cut; the shutdown of communications is having severe impact on the ability of emergency services and humanitarian partners to reach the vulnerable. 
• On 14 December 2023, in the West Bank, Israeli forces withdrew from Jenin City and Jenin refugee camp, after a large-scale operation, during which they had imposed a curfew for about 60 hours. Over this period, eleven Palestinians, including three children, were killed and dozens injured by Israeli force. An additional fatality was a boy who died while being impeded from accessing a hospital in an unrelated medical emergency. Of the eleven fatalities, one was a boy who, according to eyewitness accounts by  Médecins Sans Frontières (MSF) and the MoH in the West Bank, was shot by Israeli forces within the Khalil Suliman hospital compound. Two of the overall fatalities in Jenin, including the aforementioned boy who was impeded from reaching a hospital, died while Israeli forces surrounded the Jenin Governmental Hospital and impeded their access. 
• The military operation in Jenin involved air and ground strikes, and exchange of fire with Palestinians. The operation also resulted in the displacement of people and severe infrastructure damage, including to roads, especially in the refugee camp. Hundreds of Palestinians were arrested, including some who were released outside of the city after having been interrogated; they were not allowed to return to Jenin and were forced to take shelter in nearby communities. 

Hostilities and casualties (Gaza Strip)

• The following are among the deadliest incidents reported between 14:00 on 13 and 14 December: 
  • On 13 December, at about 18:20, at least 27 Palestinians were reportedly killed and at least ten others were injured when two residential buildings were hit in Ash Shabora area of Rafah, southern Gaza. 
  • On 13 December, at about 22:00, at least 26 Palestinians were reportedly killed when a house was struck in Ad Daraj neighbourhood of Gaza city. The bodies were reportedly extracted from the rubble. 
• On 13 December, at about 21:00, a school that was being used as a shelter by IDPs, was struck in Ash Sheikh Radwan in Gaza city. Six Palestinians were reportedly killed, and tens were injured. UNRWA reports that, since 7 October, 222 IDPs sheltering in UNRWA premises have been killed and 911 injured. A total of 342 school buildings have sustained damage (over 69% of all school buildings in Gaza). Of the 70 UNRWA-damaged schools, at least 56 serve as shelters for IDPs. Several schools, including UNRWA schools, have been directly hit by Israeli strikes or tank shells.   
• On 13 December, at about 12:30, an Israeli military drone reportedly killed a Palestinian girl in an UNRWA school sheltering IDPs in Ad Dahra area, western Khan Yunis. According to Ministry of Education (MoE), as of 5 December, more than 3,477 students and 203 educational staff have been killed. MoE further notes that more than 5,429 students and 507 teachers have been injured in the Gaza Strip since 7 October.  

Displacement (Gaza Strip)

• 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 that was launched on 1 December. Access to this information is impaired by recurrent interruptions in telecommunications and the lack of electricity. 
• Obtaining an accurate total of the displaced remains challenging, but 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, including people who have been displaced multiple times. As of 13 December, nearly 1.3 million of these IDPs were registered in 155 UNRWA facilities across Gaza, including more than 1.2 million in 98 UNRWA shelters in the Middle Area, Khan Younis and Rafah. governorates. Tens of thousands of IDPs, who have arrived in Rafah since 3 December, continue to face extremely overcrowded conditions both inside and outside shelters. Without enough latrines, open-air defecation is prevalent, increasing concerns of further spread of disease, particularly during winter weather. 

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 14 December, WHO announced that it had delivered 4,200 body bags with support from the Contingency Fund for Emergencies (CFE), underscoring the critical need to safeguard civilians from the risk of infection. 
• For the ninth consecutive day, Al Awda Hospital, Jabaliya (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 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 14 December, Jabalya Health Centre was reportedly hit, with severe damage caused to the centre and the vicinity. No casualties have been reported. 
• There have been significant increases or increased risk of outbreak 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 and scabies. The heavy rains and flooding which affected large parts of Gaza on 13 December compounded human misery and added to the risk of waterborne diseases. 

Water, sanitation and hygiene (WASH)

• On 13 December, WASH partners reported an urgent need for pipes and construction material. Stockpiles of material for the repairing of pipe systems are running low, and many of the pipe systems have been damaged and need of repair. Inability to provide repairs could result in water being cut off from certain areas. 
• On 13 December, heavy rains fell on Gaza, flooding multiple areas, worsening the living conditions of IDPs amid lack, or limited capacity, to manage sewage, particularly in IDP shelters, and the accumulation of solid waste in various locations.  
• Due to the lack or limited capacity of latrines especially in IDP shelters, people are adopting unhealthy coping mechanisms, such as open defecation. In shelters, people wait for hours to access toilets, and in some other locations where IDPs are located, no toilets are available at all. Children reportedly defecate in the open, while adults resort to buckets and dispose of the waste in improvised areas or solid wate dumps. 
• In many locations, solid waste is piling up with no effective waste management mechanism for collection or disposal. Reportedly, rats and insects, including mosquitos, congregate in these areas, contributing to the risk of spreading disease. 

Hostilities and casualties (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. The indiscriminate rocket fire by Palestinian armed groups from Gaza towards Israel continued on 14 December. 
• During the humanitarian pause (24-30 November), 86 Israeli and 24 foreign national hostages were released. The Israeli authorities estimate that about 133 people remain captive in Gaza, including Israelis and foreign nationals.  

Violence and casualties (West Bank)

• Since 7 October, 276 Palestinians, including 70 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, 266 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. With a total of 475 Palestinian fatalities, 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 3,502 Palestinians, including at least 549 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. Another 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

• 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 35, compared with 21 incidents per week between 1 January and 6 October 2023. The number of incidents since 7 October has 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 189 Palestinian households comprising 1,257 people, including 582 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 14 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

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.