Humanitarian Needs and Response Update | 19-25 March 2024

Needs

• Expand primary healthcare services to cover shelters with no medical services, including offering reproductive health services, routine immunization, and management of non-communicable diseases. 
• Address congestion and diminished bed capacity at the 10 remaining partially functional hospitals, and to restore health services at Nasser hospital and primary health care facilities in Khan Younis and Deir al Balah. 
• Hospitals in northern Gaza are in dire need of medical supplies, specialized medical staff, continued multi-sectoral support and fuel and electricity, to address the increases in trauma and malnutrition cases.
• Ensure the availability of laboratory equipment and reagents, which are vital for accurate diagnostics and testing.

Response

• There are currently 55 health partners responding to the humanitarian health crisis in Gaza through direct and indirect programming.
• On 23 March, WHO led a mission, with MSF and MedGlobal, to Kamal Adwan and Al Awda hospitals in the north of Gaza to deliver 15,000 litres of fuel, in-patient therapeutic supplies, food parcels for medical staff and patients, and technical support for the setup of a stabilization center for children suffering from acute malnutrition with medical complications. During the same mission, WHO, Cadus and the Palestine Children’s Relief Fund (PCRF) transferred two pediatric cases (one cystic fibrosis case and one leukemia case) from Kamal Adwan Hospital to the IMC field hospital, and there are ongoing efforts to medically evacuate these cases outside Gaza. To date, about 3,400 cases, out of some 9,200 patients in need of medical evacuation outside Gaza, have been evacuated.
• On 22 March, WHO installed tents and 21 beds in Al-Aqsa hospital, in Deir al Balah, to expand bed capacity at the hospital.

Challenges

• Hostilities across the Gaza Strip pose significant barriers to accessing healthcare service points.
• Hostilities and siege on hospitals continue to hinder response efforts, including restoration of service delivery at Nasser Hospital in Khan Younis, and endangering health workers and internally displaced persons (IDPs) seeking safety and shelter at Al Shifa Hospital in Gaza governorate and Al Amal Hospital in Khan Younis. At Al Amal Hospital, one PRCS staff was killed, and another was critically injured, on 24 March. A proposed WHO medevac mission to Al Shifa Hospital, where about 103 patients urgently need medicines and supplies, was denied on 20 March.
• The remaining functional hospitals in the northern governorates are struggling to operate due to military operations and access constraints. 
• The continued lack of safe drinking water and poor sanitation facilities remain a major public health concern.

Needs

• The delivery of foods and supplements to address the urgent nutritional needs, particularly among children and over 160,000 pregnant and breastfeeding women (PBWs). Some 346,000 children under the age of 5 are at greatest risk of malnutrition and preventable mortality, of whom about 50,400 children are estimated to be acutely malnourished at present (compared to 7,685 prior to the onset of hostilities). The condition is especially dire for an estimated 135,000 children under 2 years of age, who are the most vulnerable to severe acute malnutrition. Infant and young child feeding (IYCF) practices and care practices often deteriorate rapidly in conflict situations and among displaced populations on the move, placing vulnerable babies at high risk of malnutrition. 
• An intact supply pipeline of both preventative (High Energy Biscuits (HEB), Lipid-Based Supplements (LNS), and micronutrient supplements (MNs)) and therapeutic (Ready to Use Therapeutic Food (RUTF)) nutrition commodities is critical to ensure there is an uninterpreted nutrition response in the Gaza Strip.
• Immediate access to northern Gaza to deliver comprehensive nutrition services, including both preventative and treatment services, to avoid the serious consequences of acute malnutrition. Reflecting a sharp deterioration in malnutrition, the recent Gaza Nutrition Vulnerability Analysis (NVA) has found that 1 in 3 children under the age of two in northern Gaza are now estimated to be suffering from wasting, the most severe form of malnutrition, compared to 1 in 6 children in January. The assessment summarizes the current nutrition status of the vulnerable population across all governorates in Gaza and highlights the impact of the various drivers of malnutrition.
• Continued active case identification throughout Gaza to ensure timely detection, referral, and treatment of acute malnourishment cases, including the management of wasting, through simplified approaches. 
• Expand the Outpatient Therapeutic Programme (OTP) and partners’ capacities to ensure the proximity of nutrition treatment services to the rising number of children with acute malnutrition. 
• Ensure continued mapping of service coverage and enhanced monitoring and reporting systems.

Response

• Partners continue to conduct Mid-Upper Arm Circumference (MUAC) screenings, targeting children aged 6 to 59 months at shelters and healthcare facilities, to detect acute malnutrition cases and refer them for treatment using simplified protocols. UNRWA is extending its MUAC screening at shelters in Deir al Balah, with plans underway to further expand into Al Mawasi area and at shelters in Khan Younis.
• Between mid-January and mid-March 2024, a total of 28,180 children aged 6-59 months underwent MUAC screening, of which 1,947 children were diagnosed with acute malnutrition (1,554 with Moderate Acute Malnutrition (MAM) and 393 with Severe Acute Malnutrition (SAM)). These children are currently receiving the required treatment.
• An OTP is currently being established at Kamal Adwan Hospital. Moreover, on 23 March, WHO delivered SAM kits and therapeutic milk to the stabilization center at the hospital to support inpatient management of children suffering from SAM with medical complications. The hospital has a capacity of 10 beds, and six children are now being treated at the center. 
• An INGO referred 64 malnourished children to Tall as Sultan stabilization center in Rafah, where 45 children were diagnosed with MAM (20 girls and 25 boys) and 19 with SAM (9 girls and 10 boys). Two children were referred for advanced care, one was referred to the European Gaza Hospital and the second was referred outside Gaza.
• WFP delivered a 15-day-allocation comprising 110,295 packs of LNS for 7,353 PBWs and children under five years of age at informal, public shelters, makeshift shelters, and host communities in Deir Al Balah, Khan Younis, and Rafah. Moreover, 3,608 caregivers, including PBWs, received sensitization sessions on Infant and young children feeding practices in emergencies (IYCF-E) 
• Efforts are underway to establish 10 Mother and Baby Areas (MBAs) in Rafah for IYCF-E services.
• UNICEF distributed preventative and curative commodities, including Small-Quality Lipid-based supplements (SQ-LNS), HEB and RUTF. Ready to Use Infant Formula (RUIF) was also provided to 171 non-breastfed infants (including 76 in Rafah, 86 in Khan Younis, and nine in Deir al Balah). In addition, 190 caregivers, including PBWs, received IYCF-E counseling, with an emphasis on breastfeeding, proper feeding, and hygiene practices; these include 47 in Rafah, 78 in Khan Younis, 17 in Deir al Balah, and 48 in An Nuseirat Refugee Camp. 
• UNICEF has facilitated the procurement of specialized milk for children suffering from various medical conditions, which is currently in the pipeline for distribution. 
• Gaza Nutrition Cluster continues to enhance the capacity of partners; between 19 and 25 March, a training was provided to 11 staff members from the Ministry of Health (MOH) on the early identification and treatment of acutely malnourished cases through simplified approaches, bringing the total number of trained health workers to date to 57, including 18 who have received training on the management of SAM cases with medical complications. Furthermore, 32 community volunteers/community engagement workers were trained in IYCF practices and MUAC screening.

Needs

• Enhancing access to safe drinking water, especially among displaced populations and northern Gaza governorates.
• Addressing shortages of hygiene kits, disinfection materials, and other WASH supplies, including menstrual hygiene management supplies, as well as fuel for WASH service operations.
• Increase access to sanitation facilities, such as emergency latrines, showers, and drainage/liquid waste management.
• Expanding sanitation coverage across IDP sites, mainly latrines, bathing space and waste management facilities.

Response

• Between 19 and 25 March, humanitarian partners provided WASH assistance to 164,383 people, primarily focusing on distributing 938t cubic metres of trucked water. In addition, six latrine units were constructed, and 102 tons of solid waste were collected and safely disposed. From 7 October 2003 to 5 March, the WASH cluster installed a total of 1,692 latrines in the Gaza Strip, achieving 96 per cent of its initial target (1,750 latrines).
• The WASH-Infection Prevention and Control (IPC) Working Group, an inter-cluster forum aimed at preventing and controlling the spread of WASH-related diseases such as acute watery diarrhea and jaundice syndrome, continues to collect data, assess gaps, and implement interventions to strengthen IPC and WASH services. This includes cleaning healthcare facilities and distributing hygiene kits at medical points.

Challenges

• Water production remains very low, amounting to approximately 61,832 cubic metres per day. Only one out of three water pipelines coming from Israel is operational at 70 per cent of its full capacity; two out of the three main desalination plants are partially functional, while the UAE’s small desalination plant generates 2,300 cubic metres of water per day, and 34 wells are producing 31,992 cubic metres per day.
• Combined with limited fuel supply and water trucking capacity, the unavailability of water testing kits and water treatment chemicals hampers water quality monitoring.
• Limited access to the northern and central areas of the Gaza Strip continues to hamper the scaling up of sanitation services.
• Limitations on the entry of construction material into Gaza have resulted in a fourfold increase in construction costs of WASH facilities.

Needs

• Unimpeded, safe, and sustained access throughout Gaza is urgently required to provide immediate food assistance at scale. Half of the population is experiencing catastrophic levels of food insecurity (IPC Phase 5), according to the most recent Integrated Food Security Phase Classification analysis issued on 18 March 2024; catastrophic levels of food insecurity refer to extreme lack of food and/or the inability of households to meet other basic needs even after full employment of coping strategies.  
• The functioning of mills and bakeries and other basic services requires a steady supply of fuel, cooking gas and other essential items. 
• Rehabilitate livelihoods in the agricultural, livestock and fishing sectors to revive production and ensure a sustained supply of essential nutritious food.
• Establish additional entry points and supply routes into Gaza to scale up life-saving food assistance and ensure its delivery across all governorates.

Response

• Between 18 and 24 March, a total of 15 partners provided food assistance, including food parcels and hot meals, reaching a daily average of 550,000 people (around 27 per cent of the population). Fifty-two per cent of food assistance was distributed in Rafah governorate, 36 per cent in Deir al Balah, 14 per cent in Khan Younis, one per cent in Gaza, and three per cent in North Gaza. 
• Since 21 November, 1.8 million people have received flour in the southern governorates, of whom 44 per cent have received two rounds of flour.

Challenges

• A very limited number of trucks has so far been authorized to gain access to northern Gaza.  
• Expanding supply routes is challenging given the limited number of entry points into Gaza and non-optimal operating hours at crossings and checkpoints.   
• 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

• Provide specialized counselling and psychosocial support (PSS) for children, to address severe levels of trauma. 
• Identify mechanisms tailored to the current operating environment for scaling-up case management services, including for unaccompanied and separated children, children injured by the conflict and those at risk of neglect, exploitation and violence. 
• Scale up life-saving services for survivors of Gender-Based Violence (GBV), including the need for prefabricated structures to serve as safe spaces for women.
• Ensure a continued pipeline of dignity kits and menstrual hygiene supplies for women as well as winter clothing, blankets, and shoes for hundreds of thousands of 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

• In the first two weeks of March, child protection partners reached over 35,000 people (26,359 children and 9,292 caregivers) across the Gaza Strip with 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 GBV services, including referrals in line with the developed emergency referral pathways, cash for protection, PSS services, and menstrual health management items. In addition, as part of ongoing efforts to strengthen the availability and capacity of health response to GBV, UNFPA delivered an orientation session to frontline service providers on the clinical management of rape. 
• Mine Action (MA) partners have gradually scaled-up the range of activities aimed at addressing EO challenges in Gaza:
  • The number of EOD Officers in Gaza that conduct Explosive Threat Assessments (ETA) and advise humanitarian aid actors on safe practices around unexploded ordnance (UXO) is continuously increasing. 
  • MA partners continue to deliver EORE-CPP sessions in Rafah and Deir al Balah, with dedicated sessions for humanitarian workers and specific messaging for children.
  • MA partners are conducting EORE-CPP Training of Trainers for local partners with previous experience in mine action and/or humanitarian work as well as executing mass media campaigns over radio and SMS.
  • MA Area of Responsibility (AOR) has created an open-source mapping tool that captures suspected UXO threats and high-risk areas and is setting up mechanisms to systematically collect and coordinate requests for MA support.
  • MA AOR continues to broaden the streamlining and integration of mine action in the work of various clusters and working groups, such as the inclusion of EORE messaging stickers on distributed food and non-food items.

Challenges

• Fuel shortages limit staff transportation, prevent the implementation of a comprehensive case management response, and put at risk the operation of temporary shelters for unaccompanied children. Protection partners have been denied requests for fuel for months, severely impacting the implementation of services. 
• Partners are facing difficulty in bringing psychosocial support kits into Gaza to support the implementation of activities.
• MA 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 MA response include restrictions on the import of essential humanitarian mine action supplies and unreliable communication systems. 
• Damage to key civilian infrastructure has led to widespread communication blackouts and connectivity challenges in Gaza, hampering coordination of the overall protection response.

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

• On 24 March, the ETC conducted a follow-up assessment at the Very High Frequency (VHF) repeater site at Al Shaboura Clinic and is following up to address the issue and ensure that the communications system in Rafah can function effectively. Since 9 January, when ETC personnel arrived in Gaza, the ETC has conducted 20 Information and Communications Technology (ICT) assessments in 15 locations and supported 18 humanitarian agencies with repairs, technical advice, and guidance on the use of ICT equipment and services.
• The ETC is engaging with the Israeli authorities through OCHA to facilitate the swift release of 30 digital VHF radios upon their arrival at Tel Aviv Airport.
• 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

• There is a pressing humanitarian need for improved storage and transport capacity, particularly in the North Gaza, Gaza, Deir al Balah and Khan Younis governorates. This is due to infrastructure damage, access challenges, and the lack of logistical supplies, assets and spare parts.

Response

• The Logistics Cluster facilitated access to an additional warehouse in Rafah, bringing to five the total number of warehouses currently available in the governorate, amounting to 3,470 square metres of common storage capacity.  
• A total of 9,538 cubic metres of humanitarian cargo have been received as of 25 March. 
• Between 18 and 24 March the Logistics Cluster dispatched two 24-truck convoys carrying food items and dignity kits through the Jordan corridor via King Hussein/Allenby Bridge. So far, a total of 387 trucks have been supported through this route. Efforts are currently ongoing to increase the number of convoys to three per week.  
• The Logistics Cluster continued the mapping of humanitarian partners’ storage capacity in Gaza. A total of 18 organizations have provided information on 48 warehouses, of which only 30 are reported operational. Most of this storage capacity (81 per cent, corresponding to 20,516 square metres) is in Rafah governorate, with critical gaps throughout all the other governorates. 
• A total of 260,885 metric tons of humanitarian aid are expected over the next three months, of which 25,453 metric tons through the Jordan corridor and 235,432 metric tons through the Egypt corridor. The Food Security Sector accounts for 87.8 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.  
• Constraints on access to northern Gaza and the need to organize joint convoys.  
• Safe and accessible storage capacity across the Gaza Strip remains extremely limited, with few available operational storage spaces mainly concentrated in Rafah governorate.

Response

• Between 19 and 25 March, 2,163 households received one round of emergency MPCA. Cash out operations are concentrated in the governorates south of Wadi Gaza, with the majority in Rafah. Overall, as of 25 March, one round of emergency MPCA was delivered to some 168,907 households, a top-up was delivered to 34,000 people, including persons with disabilities (PwD) and nursing mothers, and over 21,267 households have received a second round.  
• Since 7 October, some 120,400 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).

Challenges

• Poor electricity supply and connectivity continue to affect 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.  
• Informal markets are the primary source of accessing goods, which complicates efforts to track distributions and gather market data.