Humanitarian Needs and Response Update | 16–22 April 2024

Needs

• Expanded primary healthcare services in Khan Younis and Deir al Balah.  
• Medications for non-communicable diseases and psychotropic drugs. 
• Expanded Sexual and Reproductive Health (SRH) services to the community level. 
• Field hospitals in Deir al Balah, Khan Younis, and Gaza city. At present, six field hospitals (four in Rafah and two in Khan Younis) provide trauma care and other essential services.   
• Restore health services at Nasser Medical Complex. 
• Laboratory equipment and reagents. 
• Blood products for hospitals. 

Response

• UNFPA has set up SRH clinics to provide Comprehensive Emergency Obstetric and Newborn Care (CeMONC) services at the International Medical Corps field hospital in Rafah and the and the UK-Med field hospital in Rafah. 
• Two Emergency Medical Teams (EMTs) have been deployed to North Gaza to support Kamal Adwan and Al Awda hospitals. At present, there are 20 EMTs across Gaza, including two in northern Gaza.  
• Between 13 and 20 April, WHO and CADUS evacuated 13 cases from Kamal Adwan Hospital to the IMC field hospital and the European Government Hospital (EGH).
• Ongoing discussions on the restoration of health services at Nasser Medical Complex.

Challenges

• Shortages of fuel, food, medicine, and medical supplies in North Gaza and Gaza City governorates 
• Access to healthcare service points significantly affected by ongoing hostilities. 
• Lack of safe drinking water and poor sanitation conditions driving increase in cases of acute jaundice syndrome and bloody and acute watery diarrhoea (AWD).

Needs

• Ready-to-use therapeutic food (RUTF) and preventative nutrition commodities, including high-energy biscuits (HEB), lipid-based nutrient supplements (MQ-LNS), and micronutrient supplements. These supplies are essential for more than 160,000 pregnant and breastfeeding women (PBW) and 346,000 children under the age of five, who are at the greatest risk of malnutrition and preventable mortality, including about 135,000 children under the age of two who are highly vulnerable to acute malnutrition. Overall, 50,400 children under five are estimated to be acutely malnourished. 
• Immediate humanitarian access to address increasing acute malnutrition. The rate of malnutrition is particularly high in northern Gaza, where severe wasting is seen in 31 per cent of children under the age of two. 
• Continued active identification of nutrition cases to ensure timely detection, referral, and treatment of acutely malnourished children. 
• Preventive nutrition interventions, including infant and young child feeding (IYCF) and the provision of age-appropriate supplementary feeding products for people in need. 
• Expanded Outpatient Therapeutic Programme (OTP) targeting children with acute malnutrition to ensure greater proximity of nutrition treatment services to affected people. 
• Strengthen partners’ capacity to provide nutrition-in-emergency services, including community-based management of acute malnutrition (CMAM) and IYCF practices in emergencies. 
• Enhance the mapping of service coverage and monitoring and reporting systems to identify gaps and ensure effective coordination and a streamlined nutrition response.

Response

• Cluster partners continue to conduct Mid-Upper Arm Circumference (MUAC) screenings; to date, 51,679 children aged 6-59 months have been screened, of whom 3,513 have been diagnosed with acute malnutrition, including 2,559 with Moderate Acute Malnutrition (MAM) and 954 with Severe Acute Malnutrition (SAM).  
• Since 1 April, 37 children suffering from SAM with medical complications have required inpatient care at three Stabilization Centres (SCs) at Kamal Adwan Hospital, Tall as Sultan Hospital, and the IMC field hospital. Sixty-eight per cent of these admissions were at Kamal Adwan Hospital. WHO has provided supplies and technical support to the SCs while UNICEF has provided RUTF/nutrition commodities.  
• UNICEF has expanded outpatient treatment of acutely malnourished children to 95 OTP sites, providing services in North Gaza (36 sites), Deir al Balah (11 sites), Khan Younis (2 sites), and Rafah (46 sites) through 13 nutrition partners.  
• Since 1 April, WFP and seven organizations have distributed 15-day allocations of supplementary food (MQ-LNS) to 9,187 people, including 6,426 children under five and 2,761 PBW, in Deir al Balah, Khan Younis and Rafah.  
• Since 1 April, 9,970 caregivers of children under two, including PBW, received sensitization sessions on IYCF practices in emergencies (IYCF-E). Save the Children is supporting efforts to foster IYCF-E practices by setting up 10 mother-baby areas in Rafah, Deir Al-Balah, and Gaza city, together with UNRWA and Juzoor. As part of a wider IYCF programme, Save the Children facilitated a one-hour training in Rafah for Cluster partners on how to provide lifesaving support to infants under six months who have no option for breastmilk feeding; they plan to replicate the training in Arabic in Deir al Balah.  
• Nutrition interventions are being provided at 296 sites, including 21 health facilities, 238 formal and informal shelters, and 37 sites in the host communities. 

Challenges

• Limited humanitarian access throughout Gaza, particularly in the northern areas, continues to exacerbate the catastrophic levels of food insecurity already faced by people and to prevent the urgent delivery of life-saving nutrition commodities. Compounded by deteriorating health and WASH services, this is resulting in a higher number of acutely malnourished children.  
• Continued displacement undermines the effective provision of nutrition services.  
• Protracted hostilities and stress have resulted in an inability of mothers to breastfeed babies.

Needs

• Immediate, uninterrupted, and safe access across Gaza to address catastrophic levels of food insecurity, scale up the delivery of life-saving aid, and ward off famine. 
• A continuous supply of fuel and cooking gas to sustain humanitarian operations and keep essential services, such as mills and bakeries, operational.  
• Revitalizing agriculture, livestock and fishing activities to restore livelihoods and ensure a sustained supply of nutritious and diversified food.

Response

• During the reporting period, 16 partners were able to operate and provide food assistance across Gaza, including food parcels, hot meals, bread, and flour.  
• The distribution of fodder is ongoing in Rafah, with people each receiving a 50-kilogramme sack, sufficient to feed five sheep for five days. 
• Fifteen bakeries are currently operational in Rafah (5), Deir al Balah (6) and Gaza city (4), producing around 1.1 million bread parcels. Fuel availability will allow the expansion of the bakery network. 
• Since November, 1.9 million people have received flour in southern Gaza, of whom 1.2 million people received a second round and 172,000 people are now receiving a third round.

Challenges

• Humanitarian access throughout Gaza continues to be limited, particularly in the north, hindering the urgent delivery of life-saving food commodities. Failure to provide aid  could exacerbate displacement, increase vulnerability to exploitation, and perpetuate cycles of instability. 
•  Distribution efforts in the first half of April continued to face access challenges. In northern Gaza, there are significant gaps in the provision of humanitarian assistance, with only about 10 per cent of the population covered. In Deir al Balah and Khan Younis, food assistance reached 45 per cent of the population, while in Rafah, where more than a million people are concentrated, only 40 per cent of the population was reached. 
• The limited number of entry points into Gaza and sub-optimal operating hours at crossings and checkpoints continue to constrain the ability to expand supply routes. 
• Infrastructural and security hurdles continue to hinder mobility and safe humanitarian access within Gaza, with escorts necessary to safeguard convoys. 
• The lack of sufficient fuel for essential services and operations. 

Needs

• Maintain critical WASH infrastructure operational through increased provision of fuel and generators, including spare parts and maintenance equipment. 
• Collect the accumulated solid waste throughout Gaza and transfer it to landfills. 

Response

• Fuel continues to be distributed daily to water and sanitation facilities, albeit in insufficient and inconsistent quantities, including in northern Gaza.  
• Maintenance of the two damaged Mekorot water connection points and repair of the downstream transmission lines, is ongoing. 
• Emergency water distribution activities continue at scale in Rafah and Deir al Balah.  
• With support from UNICEF, the Coastal Municipalities Water Utility (CMWU) has installed four portable, solar-powered desalination plants in Rafah, generating 16 cubic meters of water per day.

Challenges

• Restricted access to sanitary landfills prevents the collection and safe disposal of accumulated solid waste.  
• Fuel shortages continue to hinder the effective operation of critical WASH infrastructure. 
• Limited access to northern Gaza continues to undermine the delivery of supplies and scaling up of WASH assistance. 

Needs

• Increase support for displaced households living in marginalized locations away from larger sites for internally displaced persons (IDP) sites. 
• Address deteriorating conditions of shelters and tents after months of usage, and upgrade shelters to ensure greater protection from extreme heat.  
• Scale-up support for families displaced multiple times and those attempting to return to their locations of origin.

Response

• Between 13 and 20 April, Shelter Cluster partners distributed 38,125 blankets, 15,875 mattresses, 5,100 tents, 625 sealing-off kits and 625 kitchen sets. 

Challenges

• Continued restrictions on the entry into Gaza of basic shelter and NFI materials. 
• Access constraints to many locations north of Rafah continue to hamper the activities of Shelter Cluster partners.  
• Limited availability of shelter materials in local markets, with cash shortages further hindering the ability of IDPs to access markets.  
• Lack of adequate space for shelters in makeshift sites.

Needs

• A tailored protection response, including provision of tents, clothing, and psycho-social support (PSS), for an increasing number of detainees released by Israel at Kerem Shalom Crossing.  
• Child Protection (CP): i) the provision of specialized counselling and PSS to address severe levels of trauma; ii) scaling up case management services, including for unaccompanied and separated children (UASC); and iii) clothing/shoes for hundreds of thousands of children. 
• Gender-Based Violence (GBV): i) scaling up GBV prevention and response services, including case management, MHPSS, legal support, and referrals; ii) conducting a safety audit/GBV assessment; Emergency GBV risk mitigation interventions, including provision of dignity kits, clothing kits, and Cash and Voucher Assistance (CVA); iii) strengthening life-saving specialized services in response to GBV, including the establishment of mobile safe spaces for women and girls, especially in hard-to-reach areas; iv) capacity support for GBV case workers and staff and self-care; and v) the development and updating of referral pathways.  
• Mine Action (MA): address the scale of Explosive Ordnance (EO) contamination in the immediate and long terms, including through: i) deployment of Explosive Ordnance Disposal (EOD) operators to conduct Explosive Threat Assessments (ETA) and the marking, removal, and destruction of UXOs; ii) Explosive Ordnance Risk Education (EORE) and Conflict Preparedness and Protection (CPP) messages tailored to different groups and needs; iii) Victim Assistance (VA) services for survivors of shelling and explosive ordnance related accidents; and iv) geographic information systems mapping and information management of UXO threats to inform effective mine action response. 

Response

• Between 2 and 8 April, protection partners provided support to more than 100 people released at Kerem Shalom Crossing. This included reception, case management, and referral. 
• Ongoing efforts to enhance protection monitoring, assessments, and coordination. 
• Child Protection: A range of child protection services have been provided to date to more than 370,000 children and 70,000 caregivers (see here for data on the response); and advocacy on programmatic priorities, such as the UASC advocacy note.  During the reporting period, CP partners coordinated with the Health Cluster to evacuate an injured child from North of Gaza and reunite her with extended family in southern Gaza, after both her parents were killed in the same incident that resulted in her injury. 
• GBV: Dignity kits, PSS, individual and group counselling, recreational activities, and CVA for women, girls and GBV survivors; and the operation of two safe spaces for GBV survivors in Al Mawasi/Rafah and Deir al Balah. GBV SC in coordination with Health Cluster, WHO and UNFPA finalized the concept note for Clinical Management of Rape (CMR) to ensure that healthcare professionals can provide health services for survivors of GBV. Mainstream GBV in other cluster plans and activities (mainly WASH and shelter clusters). 
• Mine Action: emergency risk education; continuously increasing the number of EOD officers to advise humanitarian actors on safe practices around UXOs and, where access permits, conduct ETA; delivering EORE-CPP sessions in Rafah and Deir al Balah, including for humanitarian workers, children, and local partners; developing standardized forms to coordinate requests for mine action support; mass media campaigns (radio/SMS/social media); a mapping tool to capture suspected UXO threats and high risk areas; and broadening MA integration through various clusters and working groups, such as the distribution of 20,000 stickers to local partners and 20,000 leaflets in food and NFI distributions.

Challenges

• Denial of entry of critical supplies with limited or no availability on the local market, such as MA supplies to properly equip EOD experts and recreational materials for children to support the implementation of PSS activities. Combined with soaring market prices of available items, the importation of materials from Egypt, Jordan, or Israel is critical.   
• Administrative hurdles, such as registration of organizational entities and delayed provision of visas, interrupt the deployment of EOD specialists, while the prohibited entry of some items (such as satellite phones, VHF radios, and armored vehicles) limits the number of experts able to deploy safely and the ability to bring in required EORE and CCP materials. 
• Continued denials of fuel requests and the interruption of internet and communications services as well as damage to key infrastructure curtail mobility and operations. 
• Migration of qualified frontline workers outside Gaza. 
• Logistic and security constraints make it difficult to establish spaces for confidential GBV case management activities, including safe house/sheltering for CMR and high-risk cases, and set up adolescent alternative care options for unaccompanied children.   
• Inability of beneficiaries to cash out their CVA.

Needs

• Establish Temporary Learning Spaces (TLSs) in shelters and provide emergency supplies and learning kits to school-age children to urgently commence non-formal learning, in light of the large-scale damage to education infrastructure. In April, there have been new reports of damage to several schools in Khan Younis, adding to the hundreds of schools that have already been assessed through the Satellite-derived Damage Assessment conducted by the Education Cluster.  
• Nearly 73 per cent of schools in Gaza will need full reconstruction or significant rehabilitation work to be functional again. More than 625,000 students, who have no access to education or a safe learning environment as a result of school closures and attacks on education, require a range of support services. Moreover, according to the Ministry of Education, as of 16 April, some 6,237 students and 296 educational staff have been killed, and 10,300 students and 973 teachers have been injured in the Gaza Strip since 7 October.   
• Provide tailored support for children with disabilities and other special needs to ensure continuity of their learning.

Response

• Since October 2023, 26 partners have reached more than 233,000 students and teachers, providing them with psychosocial support, emergency learning, recreational supplies and activities, and awareness-raising sessions (source: Education Cluster 5W dashboard). Most cluster response activities continue to be delivered by local partners, who, despite facing large-scale constraints, are doing everything possible to support students in need.  
• The Cluster continues to prioritise the provision of Education in Emergencies (EiE), recreational activities, and psychological support, including Social Emotional Learning (SEL) activities, to children in shelters and designated emergency shelters (DESs) to help children cope with trauma and build resilience so they can thrive in the long term.  
• Ongoing work to establish and/or expand existing TLS for school-aged children in and around IDP shelters.

Challenges

• The continued absence of schooling in the Gaza Strip, with eight out of every 10 schools destroyed, is depriving children of opportunities for their social, emotional and cognitive development. With limited humanitarian aid and education supplies, over 625,000 children are also at risk of permanently dropping out of school, rendering them vulnerable to exploitation, child labour, early marriage, and other forms of abuse. 
• The education response remains significantly underfunded, with less than 21 per cent of the required funds received as of 22 April. Unless funding is received, partners’ capacity to respond is constrained.  
• The continued lack of approvals of fuel requests submitted by cluster partners is undermining their capacity to implement planned activities.  
• Restrictions on the entry of recreational and psychosocial support kits, which are also unavailable on the local market, is hindering the implementation of critically needed response activities. 

Needs

• Urgently increase the storage and transport capacity inside Gaza, particularly in the northern areas, Deir al Balah and Khan Younis.

Response

• To date, the Logistics Cluster has facilitated storage services (with pick-up at the Rafah transshipment point) for over 15,036 cubic metres of humanitarian supplies at four warehouses in Rafah. 
• The Cluster-operated cargo notification system has so far benefited 24 organizations, informing them once their cargo arrives at the Rafah transshipment point and ready for pick up. 
• On 15 April, the third direct convoy, comprising 25 trucks carrying 308 metric tons of food, was dispatched from Amman to Kerem Shalom Crossing via the Jordan corridor, without any cross-loading of the trucks along the route. Between 15 and 17 April, another three convoys carrying 736 metric tons of food, shelter and health assistance were also dispatched on behalf of eight partners via the King Hussein/Allenby Bridge.  
• The pipeline forecast for the next three months stands at 348,448 metric tons of humanitarian aid, including 286,924 metric tons through the Egypt corridor, 35,367 metric tonnes through the Jordan corridor and an additional 26,157 metric tons, exclusively of flour, from the Ashdod port.

Challenges

• Infrastructural damage, access challenges, lengthy checkpoint clearance procedures and the lack of logistical supplies, assets and spare parts continue to limit storage and transport capacity within Gaza.   
• The Logistics Cluster has no presence on the Israeli side of the Kerem Shalom Crossing. 
• Access to northern Gaza continues to be extremely limited.  
• Uncertainty about the opening of additional entry points in the north, such as the Erez Crossing, continues to undermine the effective planning of cargo and international procurement. 

Needs

• Access to independent and reliable communication platforms to coordinate emergency response and deliver life-saving aid, amid ongoing communication challenges and intermittent access to telecommunications services. 
• Increase mainstreaming of PSEA messages and strengthen knowledge of safeguarding practices. 
• Under the new Flash Appeal released on 17 April, the ETC requires US$1.8 million to address urgent and lifesaving communication needs until 31 December 2024.

Response

• Briefed humanitarian partners on 16 April on technical recommendations for licensing and importing Frequency Modulation (FM) broadcasting equipment into Gaza, based on pre-requisites from Israeli authorities.  
• Planned deployment of ETC field coordinator to strengthen face-to-face engagements and support partners with technical advice and guidance on telecommunications services. 
• 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.  
• The import of telecommunications equipment into Gaza.