Hostilities in the Gaza Strip and Israel | Flash Update #75

Key points

• On 21 December, at about 20:40, the main telecommunication provider in Gaza announced that its services were gradually returning to the southern and central Gaza. This followed a shut down since 14 December, apart from 18 to 20 December, where there was a partial resumption at about ten per cent capacity in southern Gaza. Humanitarian agencies and first responders have warned that telecommunication blackouts jeopardize the already constrained provision of life-saving assistance. As a result of limited communication throughout the day, this Flash Update provides limited updated information about the humanitarian situation in Gaza over the past 24 hours. 
• On 21 December, heavy Israeli bombardments from air, land, and sea, continued across most of the Gaza Strip. Intense ground operations and fighting between Israeli forces and Palestinian armed groups continued, in most areas of Gaza, with the exception of Rafah. The firing of rockets by Palestinian armed groups into Israel continued. 
• Between 7 October and 19 December, 19,667 fatalities were reported by the Gaza Ministry of Health (MoH), which has not published updated tolls since then. The Gaza Government Media Office reported on the fatalities as of 21 December, although their methodology is unknown. Taken together, with the noted caveats, these figures amount to about 20,000. Of them, more than 8,000 are said to be children and more than 6,200 women. The Under-General Secretary stated: “That such a brutal conflict has been allowed to continue and for this long – despite the widespread condemnation, the physical and mental toll and the massive destruction – is an indelible stain on our collective conscience.” 
• Between 20 and 21 December, four Israeli soldiers were reportedly killed in Gaza. Since the start of the ground operations, 138 soldiers have been killed in Gaza, and 771 soldiers have been injured, according to the Israeli military. 
• The entire population in the Gaza Strip faces an imminent risk of famine, according to the latest estimates from the Integrated Food Security Phase Classification (IPC) global partnership on 21 December. Bombardment, ground operations, and the besiegement of the entire population, coupled with restricted humanitarian access, have resulted in catastrophic levels of acute food insecurity, intensifying the risk of famine each day, according to IPC.  
• Should the situation continue, it is precited that between 8 December 2023 and 7 February 2024, Gaza’s population will be the highest share of people facing high levels of acute food insecurity ever classified by the IPC initiative for any given area or country, since its establishment in 2004. (More details under the food security section). 
• On 20 December, Israeli forces raided the Palestine Red Crescent Society’s (PRCS) ambulance centre in Jabalya, north of Gaza, after a two-day siege. Reportedly, staff members and paramedics were arrested and taken to an unknown location. Some 127 people, including 22 injured patients who were being treated by staff, were inside the building. Contact was lost with the operations room and PRCS team in Gaza, due to the telecommunications blackout.  
• On 21 December, The World Health Organization (WHO) stated that northern Gaza had been left without a functional hospital due to the lack of fuel, staff, and supplies. Only nine out of 36 health facilities are partially functional in the whole of Gaza, with no functional hospital in the north. Al Ahli is still treating patients but not admitting new ones, along with Al-Shifa, Al Awda and Al Sahaba hospitals. These hospitals are still sheltering thousands of displaced people 
• Under such conditions, people are unable to avail of hospitals’ services. For example, 42 babies have been born within a school functioning as a shelter in Deir al Balah (Middle Area), according to UNRWA, instead of in health facilities.  
• On 20 December, the International Labour Organization and the Palestinian Central Bureau of Statistics assessed that at least 66 per cent of employment, the equivalent of 192,000 jobs, has been lost in Gaza since the escalation of hostilities on 7 October. The effects of the escalation are also felt in the West Bank, where 32 per cent of employment has been lost, the equivalent of 276,000 jobs, in the same time period, according to the two bodies. 
• On 21 December, 78 trucks carrying supplies and five ambulances entered Gaza through Rafah crossing and 22 trucks entered through Kerem Shalom crossing. This remains well below the daily average of 500 truckloads (including fuel and private sector goods) that entered every working day prior to 7 October.  

Hostilities and casualties (Gaza Strip)

• The following are among the deadliest incidents reported on 21 December: 
  • At about 19:00, 28 Palestinians, including children and women, were reportedly killed, and tens of others were injured, when two houses and agricultural land sheltering internally displaced persons (IDPs) were struck near the European Hospital, in Khan Yunis. 
  • At about 17:10, 13 Palestinians were reportedly killed, and ten others were reportedly injured when a house was struck in Al-Amal neighbourhood, west of Khan Yunis. 
• On 20 December, at about 17:20, Israeli forces reportedly forced Palestinian families out of their homes before setting those structures on fire at An Nazla area in Jabalya city, northern Gaza. 
• On 20 December, the UN Human Rights Office issued a statement on reports of an incident on 19 December between 20:00 and 23:00, whereby Israeli forces reportedly shot and killed at least 11 Palestinian men, and allegedly injured an unconfirmed number of women and children in the Al Awda residential building, also known as the “Annan building,” in Ar Remal neighbourhood, Gaza city. Three related families were sheltering inside this building during the incidents. Initial witness reports circulating through media allege that the men were separated from women and children and were then shot and killed in what may amount to a war crime. The details of this incident are yet to be verified. 

Displacement (Gaza Strip)

• Areas encompassing about 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. Access to this information is impaired by recurrent interruptions in telecommunications and the lack of electricity. 
• Inflow of IDPs to Rafah governorate continued on 20 December. As shelters in Rafah city have exceeded their capacity significantly, most newly arriving IDPs have settled in the streets and in empty spaces across the city. Rafah governorate has become the most densely populated area in the Gaza Strip, with hundreds of thousands of IDPs squeezed into extremely overcrowded spaces and in dire living conditions. Population density is assessed to now exceed 12,000 people per square kilometre, a fourfold increase prior to the escalation. Thousands of people line up before aid distribution centres in need of food, water, shelter, and protection, amid the absence of latrines and adequate water and sanitation facilities in informal displacement sites and makeshift shelters. This situation is compounded by the cold winter and rain over the last week, which have flooded tents and other makeshift shelters. 
• Obtaining an accurate figure of the total number of IDPs remains challenging. According to UNRWA, 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. 
• Lack of food, basic survival items, and poor hygiene, exacerbate the already dire living conditions, amplify protection and mental health issues, and increase the spread of disease.  

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)

• According to WHO, as of 19 December, nine out of Gaza’s 36 hospitals are partially functional, all located in the south. These hospitals are operating at three times their 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. 

Water, Sanitation and Hygiene

• On 20 December, UNICEF stated that children in Gaza are not able to access 90 per cent of their normal water use. The impact on children is severe, as they are more susceptible to dehydration, diarrhoea, disease, and malnutrition. Concerns of waterborne diseases such as cholera and chronic diarrhoea are particularly heightened given the lack of safe water, especially following the seasonal rains and flooding. Officials have recorded almost 20 times the monthly average of reported cases of diarrhoea among children under the age of 5, 160,000 cases of acute respiratory infection, and increases in other infectious conditions and illnesses, such as scabies, lice, chicken pox, and skin rashes. 
• On 20 December, the Director General of WHO echoed a concern for the rises in infectious disease stating that “Gaza is already experiencing soaring rates of infectious disease outbreaks. Diarrhoea cases among children aged under 5 are 25 times what they were before the conflict. Such illnesses can be lethal for malnourished children, more so in the absence of functioning health services.” 

Food security

• On 19 December, according to WFP’s Regional Director for the Middle East and North Africa, half of Gaza’s population is starving in a situation of extreme or severe hunger, and 90 per cent of the population regularly go without food for a whole day. Only ten per cent of the food currently required for 2.2 million people has entered Gaza in the last 70 days. On 17 December, media reported people jumping onto aid trucks, attempting to secure food and other supplies.
• The Inegrated Food Security Phase Classification (IPC), identify 5 Phases of classification for food security: Generally Food Secure (1), Borderline Food Insecure (2), Acute food and Livelihood Crisis (3), Humanitarian Emergency (4) and Famine/Humanitarian Catastrophe (5). The recent estimates from the IPC reveal an unprecedented level of acute food insecurity in the Gaza Strip. Over 90 percent of the population in the Gaza Strip (about 2.08 million people) was estimated to face high levels of acute food insecurity, classified in IPC Phase 3 or above (Crisis or worse). Among these, over 40 percent of the population (939,000 people) were in Emergency (IPC Phase 4) and over 15 percent (378,000 people) were in Catastrophe (IPC Phase 5). 
• Furthermore, in the projected period from the latest IPC findings, spanning from 8 December 2023 to 7 February 2024, the entire population in the Gaza Strip (approximately 2.2 million people) is anticipated to experience severe food insecurity, classified as IPC Phase 3 or higher (Crisis or worse).  The IPC Famine Review Committee has been activated amid evidence exceeding acute food insecurity Phase 5 threshold. Among these, over half a million people are facing catastrophic conditions—IPC Phase 5 (Catastrophe), characterized by households experiencing an extreme lack of food, starvation, and exhaustion of coping capacities. 
• On 20 December, WFP delivered hot meals to 2,000 people in Gaza city communities. These were done in addition to the distribution of food parcels to 2,500 people in Rafah communities. 

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.  
• During the humanitarian pause (24-30 November), 86 Israeli and 24 foreign national hostages were released. The Israeli authorities estimate that about 129 Israelis and foreign nationals remain captive in Gaza. On 21 December, UN Special Representative of the Secretary-General on Sexual Violence in Conflict, called for the immediate, safe, and unconditional release of remaining hostages. 

Violence and casualties (West Bank)

• On 20 December, Israeli forces shot and killed a 16-year-old Palestinian child and injured seven others with live ammunition in Husan (Bethlehem), during confrontations between Israeli forces and Palestinians which erupted during a search-and-arrest operation. On the same day, Israeli forces shot and killed one Palestinian man while inside his vehicle on Road 60 next to a military checkpoint near Beit ‘Einoun (Hebron). According to Israeli authorities, the man tried to run over soldiers; no Israeli injuries were reported. Ambulances were prevented from accessing the body as Israeli authorities withheld it. 
• Since 7 October, 293 Palestinians, including 76 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, 283 were 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 493 Palestinians killed in the West Bank, 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. Another 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).  
• Seventy-one per cent 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. Half of the fatalities were reported in operations that did not involve armed clashes. 
• Since 7 October, Israeli forces have injured 3,801 Palestinians, including at least 575 children; 51 per cent in the context of search-and-arrest and other operations and 41 per cent of them in the context of demonstrations. Another 88 Palestinians have been injured by settlers and 18 other Palestinians injured 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 353 Israeli settler attacks against Palestinians, resulting in Palestinian casualties (35 incidents), damage to Palestinian-owned property (27 incidents), or both casualties and damage to property (46 incidents).  
• The weekly average of incidents since 7 October stands at 33, 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 198 Palestinian households comprising 1,208 people, including 586 children, have been displaced amid settler violence and access restrictions. The displaced households are from at least 15 herding/Bedouin communities. More than half of the displacements occurred on 12, 15, and 28 October, affecting seven communities. 
• Also, since 7 October, 378 Palestinians, including 198 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.  
• A total of 19 homes have been demolished on punitive grounds since 7 October, resulting in the displacement of 95 Palestinians, including 42 children. This figure is higher than the 16 homes punitively demolished in the first nine months of the year, resulting in the displacement of 78 Palestinians. 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 451 Palestinians, including 207 children, have been displaced since 7 October following the destruction of 69 residential structures during other operations carried out by Israeli forces across the West Bank; 55 per cent of the displacement was reported in Jenin Refugee Camp, and 39 per cent in Nur Shams and Tulkarm Refugee Camps (both in Tulkarm). 

Funding

• As of 20 December, Member States have disbursed US$609.5 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 50 per cent of the $1.2 billion requested. Private donations are collected through the Humanitarian Fund.

HUMANITARIAN NEEDS AND RESPONSES: 11-17 December

Health

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

• Eight out of 22 UNRWA health centres are still operational in the middle and southern areas of Gaza. On 13 December, 8,265 refugees and non-refugees received health services.
• Midwives are providing care for post-natal and high-risk pregnant women at the eight operational health centres. There are an estimated 50,000 pregnant women in Gaza, with more than 180 giving birth every day. A total of 124 post-natal and high-risk pregnancy cases were attended to at health centres.
• UNRWA continued providing health care to IDPs at shelters through 97 medical teams. Each team is composed of one or two doctors and a nurse. Some 591 health workers in health centres and shelters provided support to 12,305 patients.

Protection

• The situation in Gaza has deteriorated to the extent whereby protection actors are largely unable to operate, due to communication outages, safety and security risks and the lack of access to northern Gaza, and severe constraints on the activities of service providers and frontline actors.
• There are major and mounting protection concerns for vulnerable groups, including children separated from their families, pregnant and lactating women (PLWs), newborns, persons with disabilities (PwDs), and the elderly.
• The following activities were undertaken during past week included:
  • The Palestine Medical Relief Society distributed 1,616 dignity kits to PwDs and vulnerable women/girls in UNRWA shelters in Khan Younis
  • The Treatment and Rehabilitation Centre for Victims of Torture provided 25 people with remote psychological first aid support.

Food security

• Between 7 October to 10 December, UNRWA distributed flour to about 160,000 people north of Gaza. In the south, flour distribution reached about 1,153,020 people, including 75,000 families outside shelters.
• Since the beginning of December, WFP distributed high energy biscuits (HEB) to about 600,000 internally displaced people (IDPs) in designated shelters. WFP has also distributed food parcels or wheat flour to about 110,000 IDPs during the past two week.
• Some 11,385 IDPs residing in host communities received food parcels to support their food needs for 15 days.
• Throughout the reporting week, only two partners—UAWC and Taawon—managed to implement operations in the northern area of Gaza; they distributed food parcels to approximately 46,250 IDPs in public shelters.
• In the southern area, 11 partners have provided ready-to-eat (RTE) food, food parcels, flour, and hot meals to about 2.5 million people over the past week.
• World Central Kitchen (WCK), in partnership with ANERA and MECA, provided hot meals and RTE to a variety of family sizes. WCK plans to provide community kitchen kits, wood pellets or charcoal, and food products for 28,000 meals.
• The Food Security Cluster (FSS) has set a primary objective to meet the daily food needs of 2.2 million people, for a weekly cumulative target of 15.4 million people. In the current reporting week, FSS partners achieved a coverage of only 18 per cent of the cumulative weekly target.

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) quantities to its partners, Juzour and UNRWA, to launch the implementation of the simplified approached for the management of wasting, for children under five with severe acute malnutrition (SAM) and moderate acute malnutrition (MAM).
• UNICEF managed to deliver Lipid-based supplements (SQ-LNS) covering the need of 61,600 children (6-24 months) inside shelters for one month; micronutrient supplements for 1,660 pregnant and breastfeeding women; and Vitamin A supplements for 3,370 infants (6-11 months).
• UNRWA distributed HEBs to 320,000 people and 27,184 date bars to people in shelters, as an immediate urgent food response in emergency.

Water, Sanitation and Hygiene (WASH)

• A total of 20 WASH partners are currently active and operating across the Gaza Strip. Several organizations are trying to reactivate their operations in Rafah (15), Khan Younis (15), Gaza City (10), and northern Gaza (7).
• The constraints on the import of dual-use items inhibits an adequate WASH response. A consignment of piping and generators were not allowed into Gaza during the humanitarian pause. During the pause, few WASH supplies entered Gaza, despite the use of the prioritization list for entry. No new storage tanks, jerry cans, or cleaning kits entered through Rafah crossing. No latrines were built.
• Water quality and access standards remain unachieved. Access is a key challenge. Water networks are fractured, production points are reduced, power for pumping and distribution is restricted, and storage and outlets are minimized. Many communities are isolated across Gaza, particularly north of Wadi Gaza.
• The CMWU and WASH agencies have produced on average 41,068 cubic metres of water, and have distributed around 80,000 litres of fuel, approximately 11,430 litres daily.

Shelter and Non-Food Items (NFI)

• During the reporting period, despite some progress in delivering and distributing basic NFIs, including bedding, there remains significant shortages of shelter winterization materials, including tents, tarpaulins, and plastic sheeting.
• IDPs are increasingly seeking shelter in large ad hoc sites.
• Shelter Cluster partners distributed the following items inside and outside collective centres in the southern governorates:
  • 2,300 kitchen kits
  • 56,800 blankets and 27,450 mattresses
  • 2,000 mats
  • 7,300 tarpaulin sheets

Logistics

• The Logistics Cluster, together with HELP Logistics and JSI, coordinated an assessment of the Gaza public health capacity for warehousing and logistics between November-December 2023, available here.
• The Cluster has handed over and installed a total of 14 Mobile Storage Units (MSUs) that have augmented the offloading capacity in the Rafah handover point and the storage capacity of four UN Agencies and International NGOs.
• In Al Arish, Egypt, the Logistics Cluster augmented the ERC storage capacity with the installation of 10 MSUs with a dedicated set-up for the temperature-controlled cargo through four inflatable cold rooms, in addition to eight prefabs and four ablution units.
• Prevention of Sexual Exploitation and Abuse
• To enhance communication with communities, the PSEA network adopted a new visual identity named 'Sanad,’ which regularly disseminates safeguarding messages through various mediums, including printed brochures, stickers, and radio spots tailored to the emergency context.
• Given communication challenges in Gaza and limited internet access, the network predominantly relies on printed brochures and stickers to reach the population. UNICEF sent 500,000 Sanad brochures to Gaza for distribution, alongside hygiene kits.
• Sanad initiated social media channels to convey safeguarding messages. In the initial two weeks, messages on these platforms reached about 150,000 users, with over 90 per cent from the West Bank. There are further plans to increase the reach of these channels to a broader audience in the weeks ahead.

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.