Hostilities in the Gaza Strip and Israel | Flash Update #81

ⓘ The next Flash Update will cover 31 December 2023 - 2 January 2024

Key points

• On 30 December, heavy Israeli bombardment from air, land, and sea, continued across most of the Gaza Strip, especially in the refugee camps in central Gaza. The firing of rockets by Palestinian armed groups into Israel also continued. Ground operations and intense fighting between Israeli forces and Palestinian armed groups, with airstrikes and missiles striking housing units and infrastructure, reportedly resulted in high numbers of fatalities. This occurred in areas where Palestinians have relocated following orders from Israeli forces to move from northern Gaza. 
• Between the afternoons of 29 and 30 December, 165 Palestinians were killed, and another 250 people were injured, according to the Ministry of Health (MoH) in Gaza. Overall, between 7 October and 7:00 on 30 December, at least 21,672 Palestinians were killed in Gaza, according to the MoH in Gaza. About 70 per cent of those killed are said to be women and children. As of then, 56,165 Palestinians have reportedly been injured. Many people are missing, presumably buried under the rubble, waiting for rescue or recovery.  
• On 30 December, the Israeli military announced that one additional soldier had been killed in Gaza and one had succumbed to injuries sustained last week. Overall, since the start of the ground operation, 168 soldiers have been killed, and 955 soldiers injured in Gaza, according to the Israeli military. 
• On 30 December, the MoH in Gaza declared that it had succeeded in resuming some services, increasing thereby the capacity of a number of hospitals in the north of Gaza, including Al Ahli Arab Hospital, the Patients Friends charity hospital, Al Helou International hospital, and Al Awda hospital, in addition to a number of other primary care centres. This occurred amidst great risks surrounding the movement and work of medical teams due to the continuous bombing of residential neighborhoods and the vicinity of health facilities. Furthermore, the MoH in Gaza, UNRWA and WHO are coordinating on a plan for the reactivation of health centres to meet the needs of displaced people in all places of displacement. 
• On 30 December, the MoH in Gaza emphasized the need to prioritize the evacuation of more than 5,300 wounded and sick people who are facing serious and complex medical conditions in Gaza. The objective is to facilitate getting them adequate care. The MoH and WHO are attempting to find effective mechanisms with all parties to facilitate the exit of the wounded and sick for treatment abroad.  
• On 30 December, 103 trucks with food and medical supplies entered Gaza. The volume of aid remains woefully inadequate. The Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator declared “that this is an impossible situation for the people of Gaza and for those trying to help them. The fighting must stop.”  
• On the morning of 29 December, the Director of UNRWA’s Gaza Field Office announced that Israeli forces had fired at an aid convoy that was returning from northern Gaza and had been taking a route which was designated by the Israeli army. While no one was injured, one vehicle sustained damage. The UNRWA director reiterated that aid workers should never be a target. The Under Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator condemned this attack by stating: “The convoy was clearly marked and its movements were coordinated with the parties. Attacks on humanitarian workers are unlawful. The conflict must stop.” 

Hostilities and casualties (Gaza Strip)

• The following are examples of incidents resulting in fatalities reported between 29 December and 30 December: 
  • On 29 December, at about 23:20, the house of journalist Jaber Abu Hadrous was reportedly hit in An Nuseirat Camp, Middle Gaza. The journalist was reportedly killed along with six members of his family, including children. An unconfirmed number of the injured were reportedly transferred to Al Aqsa Hospital. 
  • On 29 December, at about 14:30, two internally displaced people (IDPs) were reportedly killed and another one injured when UNRWA elementary school for boys in Al Bureij camp, Middle Gaza, was reportedly hit. 
• As of 27 December, 144 UN staff members have been killed in hosilities, including 142 UNRWA staff , one UNDP staff member and one WHO staff member.

Displacement (Gaza Strip)

• Obtaining an accurate figure of the total number of IDPs remains challenging. By the end 2023,  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, as families are forced to move repeatedly in search of safety. Lack of food, basic survival items, and poor hygiene, further exacerbate the already dire living conditions of IDPs, amplify protection and mental health issues, and increase the spread of disease.  
• Preliminary estimates by humanitarian actors on the ground continue to witness a high influx of internally displaced persons (IDPs) have arrived in Rafah, the most southernly city in Gaza in recent days, following the intensification of hostilities in Khan Younis and Deir al Balah, and the Israeli army’s evacuation orders. Already on 20 December, Rafah was estimated to be the most densely populated area in Gaza, exceeding 12,000 people per square kilometre. The new influx of IDPs has further exacerbated conditions related to the already overcrowded space and limited resources. 
• The spread of diseases in Gaza has reportedly intensified, particularly due to the recent mass displacements across the south of Gaza. Some families have been forced to move multiple times. This situation adds strain to an already overwhelmed health system, which is struggling to meet the immense needs of the population. On 29 December, the head of the WHO in the occupied Palestinian territory announced that people living in shelters in Gaza have continued to fall ill. Close to 180,000 people are suffering from upper respiratory infections; there are 136,400 cases of diarrhea (half of these among children under five years old); 55,400 cases of lice and scabies; 5,330 cases of chickenpox; 42,700 cases of skin rash (including 4,722 cases of impetigo); 4,683 cases of Acute Jaundice Syndrome; and 126 cases of meningitis. 

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. The communications and fuel shutdown continues to significantly hinder the aid community’s efforts to assess the full extent of needs in Gaza and to adequately respond to the deepening humanitarian crisis. For more information on electricity supply to the Gaza Strip, please see this dashboard.

Health care, including attacks (Gaza Strip)

• On 30 December, media reported an air raid in the vicinity of the European Hospital injuring an unconfirmed number of civilians and killing five people. 
• On 29 December, the vicinity of several hospitals continued being struck. A house near An Nasser Hospital in Khan Younis was hit, injuring ten people. On the same day, a house near the Jordanian Field Hospital, west of Khan Younis was struck, killing three Palestinians, and injuring five others. 
• On 30 December, the MoH in Gaza raised concerns for children and women highlighting that they are exposed to multiple psychological disorders due to heavy bombardment and serious physical injuries, including the loss of body parts, ailments compounded by death of family members and loss of homes and dignity.   
• On 29 December, 600,000 vaccines were delivered to the Gaza Strip by UNICEF, as part of the routine immunization programme. In 2024, the vaccines will be administered to over 292,000 eligible infants and children under five by the MoH, in cooperation with humanitarian partners, including UNRWA and local NGOs in operating health centres and in shelters. Since the start of hostilities, over 16,854 infants missed one or more routine vaccines. 
• According to WHO, as of 27 December, 13 out of Gaza’s 36 hospitals are partially functional; nine in the south and four in the north. Those in the north have been offering maternity, trauma, and emergency care services. However, they face challenges such as a shortage of medical staff, including specialized surgeons, neurosurgeons, and intensive care staff, as well as a lack of medical supplies such as anesthesia, antibiotics, pain relief medicines, and external fixators. Additionally, they have an urgent need for fuel, food, and drinking water. The situation of hospitals and the level of functionality depend on fluctuating capacity and minimum level of supplies being able to reach the facilities. 
• The nine partially functional hospitals in the south are operating at three times their capacity, while facing critical shortages of basic supplies and fuel. MoH in Gaza, occupancy rates are reaching 206 per cent in inpatient departments and 250 per cent in intensive care units.  

Food security

• The Famine Review Committee (FRC), activated due to evidence surpassing the acute food insecurity Phase 5 (Catastrophic threshold) in the Gaza Strip, warns that the risk of famine increases daily amid intense conflict and restricted humanitarian access. The committee added that, to eliminate the famine risk, it is imperative to halt the deterioration of health, nutrition, food security, and mortality situation through the restoration of health, water, sanitation, and hygiene (WASH) services. In addition, the FRC call for the cessation of hostilities and the restoration of humanitarian space for delivering multisectoral assistance are vital first steps to eliminate any risk of famine.  

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 128 Israelis and foreign nationals remain captive in Gaza.  

Violence and casualties (West Bank)

• Since 7 October and as of 30 December, 307 Palestinians, including 79 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, 298 were killed by Israeli forces, eight by Israeli settlers and another one either by forces or settlers, which is in the process of being verified. This toll represents over 60 per cent of all Palestinians killed in the West Bank in 2023. With a total of 506 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 and as of 30 December, 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). The number of Israelis killed in the West Bank and Israel so far in 2023 (36) marks the highest number of Israelis killed in the West Bank since OCHA started recording casualties in 2005. 
• Among the 506 Palestinians killed, some 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. So far, since the beginning of the year, 75 per cent of the Palestinians killed across the West Bank occurred during Israeli forces operations, which in some cases led to exchanges of fire. The number of Palestinians killed in Israeli forces operations is more than four times higher than those reported in 2022. 
•  Since 7 October and as of 30 December, Israeli forces have injured 3,822 Palestinians, including at least 582 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 91 Palestinians have been injured by settlers and 12 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 and as of 30 December, OCHA has recorded 370 Israeli settler attacks against Palestinians, resulting in Palestinian casualties (36 incidents), damage to Palestinian-owned property (287 incidents), or both casualties and damage to property (47 incidents). The number of such incidents represents almost one third of all settler attacks against Palestinians in the West Bank in 2023. In a new report on the situation of human rights in the occupied West Bank, including East Jerusalem, the UN Human Rights Office called on the Government of Israel to “ensure that all incidents of violence by settlers and Israeli security forces against Palestinians, including violence against women, and damage to their property, are promptly, effectively, thoroughly and transparently investigated; that perpetrators are prosecuted and, if convicted, punished with appropriate sanctions, and that victims are provided with effective remedies, including adequate compensation, in accordance with international standards.” 
• Since the beginning of the year, 1,225 incidents involving settlers (with or without Israeli forces) resulted in Palestinian casualties and/or property damage in the West Bank, including East Jerusalem. Some 909 of these incidents resulted in damage, 163 resulted in casualties and 153 resulted in both. This is the highest number since OCHA started recording incidents involving settlers in 2006.  
• The weekly average of such incidents since 7 October stands at 32, 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 11 incidents between 16 and 22 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 and as of 30 December, 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. They represent 78 per cent of all displacement reported due to settler violence and access restrictions since the beginning of the year (1,539 people, including 756 children).  
• Additionally, Since 7 October and as of 30 December, a total of 429 Palestinians, including 220 children, were displaced following the demolition of their homes due to lack of Israeli-issued permits in Area C and East Jerusalem. This represents 37 per cent of all displacement reported due to the lack of building permit since the beginning of the year (1,160 people). The monthly average of displacement in this context between 7 October and 7 December represents a 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. Between January and September 2023, 16 homes were punitively demolished, resulting in the displacement of 78 Palestinians. Punitive demolitions are a form of collective punishment and as such are illegal under international law.  
• Another 483 Palestinians, including 222 children, have been displaced since 7 October following the destruction of 73 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). This represents 57 per cent of all displacement reported due to the destruction of homes during Israeli military operations since the beginning of the year (854 people)

Funding

• As of 30 December, Member States have disbursed US$633 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 52 per cent of the $1.2 billion requested. Private donations are collected through the Humanitarian Fund.

HUMANITARIAN NEEDS AND RESPONSES: 18-25 December

Health

• Eight out of 22 UNRWA health centres are still operational south of Wadi Gaza, recording 10,095 patient visits on 21 December, including refugees and non-refugees.
• Midwives are providing care for post-natal and high-risk pregnant women at the eight operational health centres. On 21 December, 221 post-natal and high-risk pregnancy cases were attended to.
• UNRWA continues to provide health care to IDPs at shelters through 97 medical teams. Each team comprises one or two doctors and a nurse. On 21-22 December, UNRWA medical teams attended to 21,004 IDPs.
• On 20-21 December, mental health, and psychosocial support (MHPSS) services were resumed in the Middle Area and Khan Younis governorates, with a team of two psychiatrists and 16 counsellors and supervisors to assist special cases referred from health centres and shelters.

Food security

• Between 18 and 24 December, the Food Security Sector reached 1,783,565 people. Given that it aims at reaching Gaza’s 2.2 million people daily, this represents 12 per cent of the target.
• Amid immense access challenges, 800 people in the north, including IDPs residing in public shelters and those with host families, received food parcels. Additionally, 780 hot meals were provided in northern Gaza.
• In southern Gaza, food parcels reached 268,333 people in UNRWA shelters, 2,800 in public shelters, 23,841 staying with host families, and 1,000 who are not displaced. In addition, 53,000 hot meals were distributed to people in public shelters and host families; ready-to-eat rations were provided to 3,500 people in similar circumstances; and flour distribution benefited 1,722,792 people.
• Additionally, between 23-26 December, the World Food Programme (WFP) provided 18,822 people outside shelters with food parcels through partner distribution points. It also provided about 500,000 IDPs in UN shelters south of Wadi Gaza with food parcels, wheat flour, high-energy biscuits and lipid-based nutrient supplements. Additionally, it provided 16,420 hot meals in Rafah, the Middle Area, and Gaza city through five community-led kitchens. Finally, 50 metric tons of wheat flour are scheduled for dispatch to 14 bakeries.

Education

• The Education Cluster reported that 352 schools have sustained damage across the Gaza Strip, affecting the education of 400,700 students (52.1 per cent girls). Three governorates (Gaza, Khan Younis and North Gaza) are highly affected, accounting for 74 per cent of the total damage. About 90 per cent of school buildings are being utilized as shelters by IDPs and/or sustained damage, with the severity of damage varying from minor (128 schools), moderate (110 schools), major (96 schools) and destruction (8 schools).
• The Education Cluster’s 10 partners currently active in Gaza have reached 84,262 students and teachers since 7 October, with the provision of emergency learning and recreational supplies (52,653 reached), psychosocial support (64,854 reached), and recreational activities (83,262 reached), south of Wadi Gaza.

Nutrition

Nutrition partners provided the following essential to prevent and or cure malnutrition among children and mothers:

• Juzoor reached 21,000 pregnant and breastfeeding women with iron-foliate and multiple micronutrients supplementation in Rafah and the Middle Area.
• UNICEF delivered lipid-based supplements covering the needs of 11,200 children (ages 6-24 months) inside shelters for one month.
• UNICEF delivered ready-to-use infant formulas to address the needs of 400 non-breastfed infants (ages up to 5 months) for one month.

Multi-purpose Cash Assistance (MCPA)

• Since the beginning of hostilities, nearly 110,000 households (comprising almost 750,000 people) have received emergency MPCA. With about 80,000 households having already cashed out their assistance, cash out rates stand at 73 per cent, and are declining slightly.
• While distribution has been delivered across the Gaza Strip, the vast majority is now concentrated in the southern governorates.
• While formal markets are largely depleted, informal markets are now the key sources of basics goods and services. This includes trades of personal belongings, small household-based production (bread, vegetables), humanitarian assistance, and other items.
• Post distribution monitoring data from recipients of cash assistance point to food, medicines, debt repayment, drinking water, and transportation as the top expenditures reported. The percentage of expenditures on food has further decreased over the past weeks, while the percentage of expenditures on medicines has doubled. Some 70 per cent of respondents report that unrestricted cash has helped them access needed goods and services, either fully or partially, while 87 per cent report unrestricted cash as their preference for future assistance.

Logistics

• The results of the rapid , conducted by the Global Logistics Cluster, HELP Logistics, JSI, and partners, have been shared with partners. The assessment was conducted during November and December through field visits to 23 locations in Khan Yunis and Rafah governorates.
• The IMPACCT Working Group continues to engage with various ministries for clarifications on customs procedures for the importation of humanitarian aid. The Standard Operating Procedures on the importation processes are under development.
• The Logistics Cluster continues to facilitate access to common services in the Gaza Strip and Egypt through common storage services, road transport to the storage location, and cargo notification transshipment services. In Gaza, two warehouses in Rafah are currently available for partners’ storage, one managed by ACTED (70 square metres) and one by WFP (1,000 square metres). The common warehouses in Deir al Balah and Khan Yunis are currently on hold until further notice. The Logistics Cluster also facilitates transport services from Rafah to the Logistics Cluster common warehouses in Gaza. Additionally, a cargo notification service is available to inform partners once their cargo has arrived at the Rafah handover point. In Egypt, the Logistics Cluster facilitates common storage services in Port Said with 800 pallet positions.

Emergency Telecommunications

• The Emergency Telecommunications Cluster (ETC) and its partners continue to engage with the Israeli Coordinator of Government Activities in the Territories (COGAT) for authorization to import telecommunications equipment and set up an independent, efficient, and reliable communications platform for humanitarian responders.
• The ETC met for a technical engagement with UNDSS in Jerusalem on 18 December and discussed the status of the Very High Frequency (VHF) radio network security communications system (SCS) in Gaza, which has four repeaters in Jabalya, Gaza city, Khan Yunis, and Rafah. Only Khan Yunis and Rafah were functional when the system was reactivated on 3 December, and the Khan Yunis repeater broke down on 13 December and is currently inaccessible because of the prevailing insecurity.
• On 18 December, ETC partner, REACH, completed a communications and information needs assessment for the population in Gaza using the secondary data review methodology of all available data from sources on the ground. The report was shared with all ETC global partners on 22 December to inform and guide humanitarian responders on their current and planned activities in Gaza.

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.