Humanitarian Needs and Response Update | 12-18 March 2024

Needs

• Expand primary healthcare services to cover shelters with no medical service points, including offering reproductive health services, routine immunization, and management of non-communicable diseases.
• Address congestion and diminished bed capacity at the few remaining partially functional hospitals, and to restore health services at Nasser hospital and primary health care facilities in Khan Younis and Deir al Balah.
• Ensure the availability of laboratory equipment and reagents, which are vital for accurate diagnostics and testing.

Response

• Between 5 and 11 March, 79,600 patients were reached with primary and secondary health care through health partners, including Emergency Medical Teams (EMT) partners.
• On 11 March, WHO led a mission with MSF France and UNMAS to Al Shifa and Al Helou hospitals in Gaza city to deliver 24,000 litres of fuel, medical supplies for 42,000 patients at Al Shifa, and food parcels. They also conducted assessments to inform the resumption of services. 
• On 13 March, a WHO led a mission to Al Aqsa Hospital in Deir al Balah to deliver medical supplies for 80,000 patients, assess the need to expand bed capacity, conduct quality assurance visits to two Emergency Medical Technicians, and evaluate the hospital's water, sanitation, and hygiene (WASH) capacity.
• On 16 March, a WHO team visited the European Gaza Hospital in Khan Younis to deliver medical supplies for 80,000 patients, assess the WASH capacity and other hospital conditions, and conduct quality assurance visits. 
• On 17 March, WHO, UNRWA, and UNMAS conducted a joint mission to Nasser Hospital to deliver 10,500 litres of fuel, assess conditions for the resumption of essential services, and evaluate safety concerns.
• The Rehabilitation Taskforce has established a referral pathway for post-operation trauma cases in collaboration with EMTs. The taskforce comprises eight rehabilitation professionals providing care for trauma patients at hospitals and post-discharge services at the community level, including at IDP shelters. 

Challenges

• Hospitals in northern Gaza remain in dire need of fuel, medical supplies, and food parcels for medical staff. Currently, hospitals are operating with limited resources, facing electricity shortages, and witnessing an increase in trauma and malnutrition cases. 
• Continued hostilities and insecurity pose significant barriers to accessing healthcare service points.
• Lack of access to safe drinking water and poor sanitation facilities continues to pose significant public health risks.
• The absence of segregated sanitation facilities and electricity within shelters presents a considerable health risk for women and girls.

Needs

• Immediate access to northern Gaza to enable humanitarian partners to provide a comprehensive package of nutrition services.
• Expand nutritional assessments across all Gaza governorates to assess the nutrition status of people in need, identify cases of acute malnutrition, and deliver treatment through simplified approaches for the management of wasting.
• Establish additional service points for the Outpatient Therapeutic Programme (OTP) and three additional stabilization centers, in addition to enhancing partners' capacities to manage the rising number of acute malnutrition cases.
• Position adequate quantities of key nutrition supplies for both preventive interventions (High Energy Biscuits (HEB), Lipid-Based Supplements (LNS), and micronutrient supplements (MNs)) as well as curative interventions such as Ready to Use Therapeutic Food (RUTF).

Response

• Partners continue to carry out Mid-Upper Arm Circumference (MUAC) screenings, alongside vaccination campaigns, targeting children aged 6 to 59 months in shelters and health care facilities to detect and refer for treatment cases of acute malnourishment. Between mid-January and mid-March, 1,1717 out of 23,611 children aged 6-59 months who underwent MUAC screenings were found to have moderate (1,371) or severe (346) levels of acute malnutrition. These children are currently receiving treatment according to the simplified treatment protocols. 
• The International Medical Corps (IMC), with support from WHO, has established a second stabilization center in northern Rafah for the provision of quality treatment for children suffering from severe acute malnutrition (SAM) with medical complications. 
• Nutritional supplies have been distributed to partners for both the prevention and treatment of malnutrition.
• Some 11 MoH service providers were trained on the simplified approaches for the management of wasting.

Needs

• Enhancing sanitation coverage, focusing on latrine and waste management access. 
• Ensuring safe drinking water access, especially for displaced populations and northern Gaza areas. 
• Addressing the shortage of WASH supplies and fuel for water and wastewater facilities

Response

• Water trucking for IDPs: Only 4,745 cubic metres of water is being trucked, given limited fuel supplies and water trucking capacity.
• Some 76,722 m3 of fuel has been distributed to water and wastewater facilities this week. 

Challenges

• Safe drinking water provision. Water production remains very low as only one out of three Mekorot connections (Bani Saeed pipeline) is functioning at 83  per cent of its full capacity, two out of three desalination plans are only partially operating, the UAE's small desalination plant is producing 2300 cubic metres per day, and 34 wells are producing 31,992 cubic metres per day.
• In addition to limited fuel supplies and water trucking capacity, there is also limited water quality monitoring due to the non-availability of water testing kits and water treatment chemicals.

Needs

• Strengthening identification of cases of unaccompanied, previously detained and separated children (UASC), in addition to tracing, reunification, and interim and alternative care arrangements.
• Assistance to children injured by the conflict, including Explosive Remnants of War (ERWs), and provision of MHPSS (including recreational kits, psychological first aid and specialized counselling) for children who face neglect and exploitation. As humanitarian access remains limited, the risks of neglect, exploitation and violence against children are dramatically escalating.
• Scaling up of life-saving services for survivors of Gender-Based Violence (GBV), including the need for prefabricated structures to serve as safe spaces for women.
• Ensuring a continued pipeline of dignity kits and menstrual hygiene supplies for women as well as winter clothing and blankets for children. 
• Victim Assistance (VA) services for survivors of shelling and explosive ordnance related accidents.
• Immediate action to enable large-scale assessments of the scale of Explosive Ordnance (EO) contamination, including through the deployment of Explosive Ordnance Disposal (EOD) operator, Explosive Ordnance Risk Education (EORE), and Conflict Preparedness and Protection (CPP) messages tailored to different groups and needs. EORE and CPP training for humanitarian workers is also needed.

Response

• Child protection partners continue to deliver specialized child protection services, including MHPSS, winter clothes and awareness raising messages on EORE and Child Rights. Also see data on the response. 
• GBV partners continue to provide lifesaving GBV services, including referrals in line with the developed emergency referral pathways, cash for protection and PSS services, and the provision of menstrual health management items. As part of these efforts, UNFPA delivered an orientation session on clinical management of rape targeting frontline health service providers as part of efforts to strengthen the availability and capacity of health response to GBV. 
• Mine Action partners are delivering EORE and CPP sessions in Rafah and central Gaza, delivering dedicated sessions for humanitarian workers, conducting EORE-CPP Training of Trainers for local partners, and executing mass radio and SMS outreach campaigns. There has been an increase in the number of EOD officers to conduct Explosive Threat Assessments and advise humanitarian actors on safe practices around unexploded ordnance (UXO). Mine Action sub-cluster has also finalized the rollout of an open-source mapping tool that captures suspected UXO threats and high-risk areas and continues to broaden the integration of mine action through various clusters and working groups.

Challenges

• Fuel shortages limit staff transportation, preventing the implementation of a comprehensive case management response, and putting at risk the operation of the temporary shelter for unaccompanied children. 
• Partners are also facing difficulty in bringing psychosocial support kits into Gaza to support the implementation of activities.
• Mine Action partners report facing administrative hurdles, such as registration challenges for organizational entities and the delayed provision of visas interrupting the deployment of some EOD specialists. Other challenges that continue to hinder mine action response include restrictions on the import of essential humanitarian mine action supplies and unreliable communication systems.

Needs

• The storage and transport capacity inside Gaza remains challenging due to infrastructural damages, access challenges and the unavailability of certain logistical supplies, assets and spare parts.

Response

• In support of the limited storage resources available in Gaza, the Logistics Cluster facilitates access to four warehouses through three partner organizations in Rafah. A total of 10,463 cubic metres of cargo have been received as of 17 March.
• On 12 March, the Logistics Cluster dispatched a 24-truck convoy through the Jordan corridor via King Hussein/Allenby Bridge. This brings to 339 the number of trucks supported through this route. The Logistics Cluster has also supported the coordination of 233 trucks through the Aqaba-Nueibaa route.
• On 14 March, the Logistics Cluster, in collaboration with ECHO and UNHRD, airlifted an additional 12 Mobile Storage Units (MSUs) from Dubai to Al Arish. These are prefabricated storage tents that will expand the Egyptian Red Crescent (ERC) storage capacity in Arish by 3,840 square metres, augmenting the capacity to support cargo consolidation in the Gaza response. The Logistics Cluster has already deployed and installed multiple assets that have augmented ERC logistics and infrastructure capacity to 8,230 square metres.
• The Logistics Cluster is mapping humanitarian partners’ storage capacity in Gaza. So far, 15 organizations have provided information on 43 warehouses, of which only 28 warehouses with a storage capacity of 22,634 square metres are reported operational. Most of this storage capacity (88.8 per cent) is in Rafah governorate, with only 3,400 square metres of storage capacity reported in Gaza and North Gaza Governorates.  
• A total of 241,183 metric tons are expected over the next three months, including 17,845 metric tons through the Jordan corridor and 223,338 metric tons through the Egypt corridor. The Food Security Sector accounts for 89.9 per cent of the expected pipeline tonnage. 

Challenges

• Fluidity of the situation and uncertainty around access make logistics planning for all humanitarian organizations extremely challenging, thus affecting the efficiency of the overall response. 
• The deployment of the Temperature-Controlled Units (mobile storage units for health cargo) in Gaza is pending approval.
• The limited number of operational storage spaces, with the majority concentrated in Rafah governorate, pose significant challenges for making available safe and accessible storage capacity across the Gaza Strip.

Needs

• Independent and reliable communication platforms for humanitarian responders in Gaza to coordinate emergency response and deliver lifesaving aid.
• Restoration and repair of connectivity infrastructure to enable community engagement activities and people’s access to services.

Response

• Between 6 and 14 March, the ETC conducted a Security Communications Systems (SCS) needs assessment survey targeting UN agencies in Gaza to inform the distribution of 30 approved digital Very High Frequency (VHF) handheld radios upon arrival and collect focal point contact details. 
• The ETC is seeking approval to bring additional solar power solutions into Gaza to facilitate the provision of a continuous 24/7 power supply at the VHF radio repeater sites in Khan Younis and Deir al Balah. 
• For more information on ETC activities, please visit: Palestine: Conflict | Emergency Telecommunications Cluster (ETC) (etcluster.org).

Challenges

• Limited access to electricity, fuel, and telecommunications services continues to impede the humanitarian response in Gaza. 
• Import of telecommunications equipment is challenging.

Needs

• The restoration of telecommunications infrastructure to enable adequate and consistent community engagement activities, including risk communications, communication regarding where to receive services and reach first responders, and collate feedback and complaints on needs and received assistance. 
• An inter-agency community feedback mechanism, including an AAP hotline, to systematically capture feedback, enable referrals, and facilitate analysis on needs and gaps. 
• A service directory to enable service providers and humanitarian staff to have comprehensive, real-time information on available services and channel it to affected people.

Response

• The AAP Technical Group has updated and circulated to clusters and partners the inter-cluster joint message on available helplines, hotlines and complaint channels. The group also continues to share with clusters identified trends based on received calls to inform operational planning. 
• An AAP Technical Group has agreed with the national Palestinian telecommunications service providers on a protocol to enable the delivery of emergency text messages. 
• Ground Truth Solutions and Awrad have completed a perception report on community priorities and perceptions of aid in Gaza. The findings aim to inform operational response activities by partners in the face of growing needs.  
• Protection risk mitigation messages have been finalized and circulated among humanitarian aid workers. These messages will be disseminated among affected people via various available channels, including face-to-face communications and telecommunication companies.

 Challenges

• The extensive damage to telecommunication infrastructure in Gaza, compounded by the lack of electricity to charge batteries, has adversely impacted connectivity in Gaza which continues to limit community engagement activities and outreach. There is zero landline and internet coverage in Noth Gaza, Gaza city and Khan Younis, and 28 per cent coverage in Deir Al Balah. Moreover, cellular coverage stands at 2 per cent in Khan Younis, and at roughly 77 per cent on average in Deir Al Balah. Both landline/internet and cellular coverage is the strongest in Rafah, at 80 per cent and 90 per cent respectively. Where available, the speed and quality of coverage have been compromised by congestion.  
• Limited connectivity and access to cellular devices has disproportionally impacted the most vulnerable groups, including women, youth and the elderly, with most calls received on the humanitarian hotlines emanating from Rafah and made by men.

Response

• Between 6 and 18 March, 3,226 households received one round of emergency MPCA. Cash out operations are concentrated in the governorates south of Wadi Gaza, with the majority in Rafah. 
• As of 18 March, one round of emergency MPCA was delivered to some 170,493 households, a top-up was delivered to 34,000 people, including people with disabilities and nursing mothers, and over 21,267 households have received a second round. 
• Since 7 October, some 122,289 out of the 170,493 households have cashed out their assistance, and about 5,400 payments have been cancelled after not being cashed out for months mainly due to the lack of connectivity and available agents (especially north of Wadi Gaza). 
• Based on the last post-distribution monitoring (PDM) data collected between mid-January and mid-February, food remains the most purchased item with humanitarian cash (80 per cent), followed by medicines (39 per cent), water (23 per cent), hygiene bedding (10 per cent), and transportation. PDM data show that cash remains a relevant modality of assistance which can be used by recipients to access goods and services that remain available.

 Challenges

• Poor electricity supply and connectivity is affecting the ability of financial service providers to make cash accessible, compromising the encashment of the MPCA package.
• Provided assistance falls well short of needs, given market collapse and price volatility. 
• Since late December, commercial trucks have entered Gaza, with 923 trucks recorded as of 2 March. Informal markets are the primary source of accessible goods, which complicates efforts to track distributions and gather market data.

Needs

• Increase awareness about, and sensitisation to, PSEA messages.
• Strengthen knowledge of safeguarding practices. 
• Enhance trust-building and access to community reporting mechanisms.
• Ensure services are available for people at risk of sexual exploitation and abuse.

Response

• Between 12 and 18 March, the helpline received around 1,500 calls, and more than 350 cases have been referred by the helpline to protection services. Since October 2023, around 2,500 callers have been referred by specialized counsellors for specialised services.
• Since October 2023, more than 800 at-risk people in Gaza were referred to cash-for-protection schemes. 
• Through “Sanad” platforms, PSEA network partners are continuously co-producing Risk Communication materials in Arabic to raise community awareness and promote safeguarding practices. Since the platform’s launch on Facebook and Instagram in late December 2023, the network has produced and published a total of 143 stories, 22 Reels/videos, and 10 informative posts and carousels. Through these Meta platforms we are consistently reaching an average of 1.4 million people per month, 98 per cent of whom reside in the occupied Palestinian territory. Audience reach figures in Gaza are estimated at around 200,000. As of 18 March, the total number of followers on Instagram and Facebook has increased to 4,727, 70 per cent of whom are women. 
• New rounds of PSEA training sessions for humanitarian and development aid staff and service providers have been conducted in the West Bank. 
• The PSEA Network has made available MHPSS support and remote counselling sessions for PSEA focal points on the ground in Gaza, who are documenting complaints and feedback. 

 Challenges

• Online reach remains extremely restricted, with 99 per cent of audience reach achieved through paid promotions. 
• Communications cuts are limiting reporting and access.