Humanitarian Needs and Response Update | 2–8 April 2024

Needs

• Urgently establish field hospitals in northern Gaza to relieve the pressure on the four remaining partially functioning hospitals.  
• Expand the capacity of the ten remaining partially functional hospitals across the Gaza Strip. 
• Enhance preparedness in the western coastal areas of Rafah as part of contingency planning. 
• Increase access to essential healthcare services for internally displaced persons (IDPs) and host communities, particularly the most vulnerable, such as children, pregnant and breastfeeding women (PBW), and people with chronic illnesses. 
• Expand routine immunization, disease surveillance, and laboratory and diagnostic capacity.  

Response

• Between 31 March and 6 April, 17 health partners provided primary and secondary health services to 245,000 people. In the western coastal areas of Rafah and in Deir al Balah, partners continue to expand their medical service points. 
• International Medical Corps (IMC) has relocated its 162-bed field hospital to western Rafah. The UK-Med field hospital in Rafah is operating with an initial capacity of 36 beds, which is set to increase to 70 beds. 
• The Norwegian Aid Committee (NORWAC) has deployed an emergency medical team (EMT) to Al Awda Hospital in northern Gaza. This is the second EMT to be deployed to the north.  
• On 4 April, fuel, medical supplies and food were delivered to Al Ahli and Sahaba hospitals.  
• On 5 April, a preliminary assessment mission to Al Shifa Hospital found the hospital severely damaged and destroyed, rendering it completely non-functional. 

Challenges

• Limited access to fuel continues to pose major challenges to partner operations, especially local NGOs. 
• Poor living conditions and scarce or no access to proper water, sanitation, and hygiene (WASH) facilities continue to fuel a high risk of disease outbreak.

Needs

• An intact supply pipeline of both preventative nutrition commodities (high-energy biscuits, lipid-based nutrient supplements, and micronutrient supplements) and ready-to-eat therapeutic food (RUTF). These supplies are essential for over 160,000 PBW and some 346,000 children under the age of five, who are at greatest risk of malnutrition and preventable mortality and this total includes about 135,000 children under the age of two who are highly vulnerable to acute malnutrition. Some 50,400 children under the age of five are estimated to be acutely malnourished. 
• Immediate humanitarian access to address increasing acute malnutrition. The rate of malnutrition is high in the north, with an alarming 31 per cent of children under the age of two suffering from severe wasting.  
• Continued active identification of nutrition cases to ensure timely detection, referral, and treatment of acutely malnourished children. 
• Scaling up preventive nutrition interventions including infant and young child feeding (IYCF) and the provision of age-appropriate supplementary feeding products for people in need.  
• Expand the 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 as well as monitoring and reporting systems to identify gaps and ensure effective coordination and a streamlined nutritional response.

Response

• Since mid-January, a total of 36,218 children aged 6-59 months have undergone Mid-Upper Arm Circumference (MUAC) screenings at shelters and healthcare facilities. A total of 2,505 have been diagnosed with acute malnutrition, including 1,876 with Moderate Acute Malnutrition (MAM) and 629 with Severe Acute Malnutrition (SAM). These children are currently receiving treatment in accordance with the simplified protocols. Nutrition interventions are provided at 18 health facilities, 191 formal and informal shelters, and 18 sites in host communities.  
• UNRWA has extended its MUAC screening at shelters in Deir al Balah, and work continues to expand the screening also to the Al Mawasi area and at shelters in Khan Younis. Moreover, International Medical Corps (IMC) has deployed 15 community nutrition volunteers to provide screening and referral services.  
• During the first week of April, the Gaza nutrition cluster coordinator trained 12 UNRWA staff on the early identification and treatment of acutely malnourished cases, bringing the total number of trained health workers to 77.  
• UNICEF has scaled up the outpatient treatment of acutely malnourished children to 58 OTP sites across the Gaza Strip, and it is prioritizing stabilization centres in IYCF interventions. Over the past month, a total of 44,168 caregivers, including PBW, and children under two have received sensitization sessions on IYCF practices in emergencies (IYCF-E).  
• WHO is providing the needed supplies and technical support for the stabilization centre at Kamal Adwan hospital. With UNICEF’s support, MedGlobal is also scaling up the screening and treatment services for children at the hospital's emergency and outpatient departments. 
• The stabilization centre established at the IMC field hospital in Rafah is now operational with a six-bed capacity. One child has already been admitted into the facility. IMC has also trained staff at the hospital to manage SAM cases with complications.  
• Between 31 March and 4 April, a total of 2,631 PBW and 5,767 children under five received a 15-day allocation of 125,970 lipid-base supplements (MQ-LNS), across informal, public and makeshift shelters and in host communities in Deir al Balah, Khan Younis, and Rafah.

Challenges

• Limited humanitarian access throughout Gaza, particularly in the northern areas, continues to exacerbate the catastrophic levels of food insecurity already faced by the population and to prevent the urgent delivery of life-saving nutrition commodities. This dynamic, compounded by deteriorating health and water, sanitation and hygiene (WASH) services, is resulting in an increasing number of acutely malnourished children.  
• Continued displacement undermines the effective provision of nutrition services.  
• Extreme fear and stress, malnutrition, and complex living conditions due to the protracted hostilities have resulted in mothers being unable to breastfeed their newborn 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, including the need for a secure humanitarian corridor.  
• 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 food.

Response

• Between 25 March and 7 April, a total of 19 partners provided food assistance across Gaza, including food parcels, hot meals, bread and flour.  
• Out of 150 tons of fodder that were successfully loaded on nine trucks, six have already entered Gaza and three are expected to enter in the upcoming days. Distribution is ongoing in Rafah, with 2,500 people each receiving a 50-kilogramme sack that would allow them to feed five sheep for five days. 
• 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

• Limited humanitarian access throughout Gaza, particularly in the northern areas, continues to exacerbate the catastrophic levels of food insecurity already faced by the population and to prevent the urgent delivery of life-saving food commodities. Failure to provide assistance could exacerbate displacement, increase vulnerability to exploitation, and perpetuate cycles of instability. 
• Distribution efforts between 25 March and 7 April faced numerous access challenges. In northern Gaza, food distribution by humanitarian actors reached only 16 per cent of the population. 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 30 per cent of the population was reached. 
• The limited number of entry points into Gaza and sub-optimal operating hours at crossings and checkpoints continues 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

• Enhance access to safe drinking water, especially in northern Gaza, and improve the functioning of water supply systems amid reduced water production capacities. 
• Increase access to sanitation facilities for IDPs, particularly emergency latrines, showers, as well as solid and liquid waste management. 
• Address shortages of hygiene kits, disinfection materials and other essential WASH supplies, particularly among displaced populations. 

Response

• Between 26 March and 7 April, six humanitarian partners provided WASH assistance to 130,983 people. In total, partners distributed 10,099 cubic metres of trucked water, provided over 5,000 family hygiene kits and child packet diapers, constructed 13 latrine units, and collected and safely disposed 52.1 tons of solid waste. 
• Several fuel delivery missions have been conducted to maintain critical WASH infrastructure operational, especially in light of reduced water production capacities in northern Gaza. 
• WASH Cluster has analyzed and shared the results of a rapid WASH assessment with all partners. This initiative aims to ensure a comprehensive understanding of prevailing needs and enable partners to prioritize their interventions based on accurate and up-to-date information, thereby enhancing overall response effectiveness.

Challenges

• Water production remains very low, amounting to approximately 48,000 cubic meters 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 is working at full capacity and only 34 water wells are operational.  
• Combined with limited fuel supply and water trucking capacity, the unavailability of water testing kits and water treatment chemicals hampers water accessibility and water quality control. 
• Limited access to northern Gaza continues to severely undermine the scaling-up of WASH services. 
• Limitations on the entry of construction material and other WASH-related material and supplies into Gaza are hindering the response and have triggered a rapid increase in market prices of construction and other WASH-related items. 

Response

• As of 8 April, Shelter Cluster partners have distributed 47,500 blankets, 16,800 tents, 11,875 kitchen sets, 10, 375 family mattress kits and 4,375 sealing-off kits. 
• A technical working group on prefabricated shelters was established and there are plans to establish other working groups to facilitate technical coordination on other priorities.  
• A partner survey has been launched to identify key gaps and inform strategic decision-making.  
• Ongoing discussions to expand the range of shelter items currently distributed, to include emergency shelter options as well as facilitate the voluntary return of displaced people and the repair of damaged dwellings. 
• For more information on Shelter Cluster activities, please visit: Shelter Cluster: Response Palestine. The site has been updated to include a number of Arabic-language resources, including the 2018 edition of the Sphere Handbook, which provides one of the most widely known and internationally recognized sets of common principles and universal minimum standards in humanitarian response.

Needs

• The integration of protection risk mitigation and response across all humanitarian work plans. 
• A tailored protection response, 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 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

• Support for over 100 people released at Kerem Shalom Crossing between 2 and 8 April, including reception, case management, and referral. 
• Ongoing efforts to enhance protection monitoring, assessments, and coordination. 
• CP: A range of child protection services have been provided to date to more than 329,000 children and 56,000 caregivers (see here for data on the response); and advocacy on programmatic priorities, such as the UASC advocacy note.   
• 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. 
• MA: 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 armoured vehicles) limits the number of experts able to deploy safely. 
• Protracted denials of fuel requests.     
• Logistical constraints, including the lack of spaces for confidential GBV case management activities.

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, confirmed also by a recent Satellite-derived Damage Assessment conducted by the Education Cluster.  conducted by the Education Cluster.  
• More than 625,000 students have no access to education or safe learning spaces and need psychosocial support that can be provided through Education in Emergencies (EiE) recreational activities and Social Emotional Learning. Moreover, according to the Ministry of Health, as of 2 April, over 5,994 students and 266 educational staff have been killed, and more than 9,890 students and 973 teachers have been injured in the Gaza Strip since 7 October.  
• Provide assistive devices to, and identify other needs for, children with disabilities to ensure continuity of learning

Response

• Since the onset of the hostilities, 26 partners have reached more than 233,254 students and teachers 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.  
• One local Education Cluster partner has piloted the establishment of TLS in and around IDP shelters and has been delivering learning support sessions for school-aged children at TLS and still accessible schools. This is the first learning continuity intervention by a cluster partner.

Challenges

• The education response remains significantly underfunded, with less than 17 per cent of the required funds received as of 7 April. This is hindering the capacity of partners to establish TLSs and provide necessary support to school-age children. Urgent funding is therefore required to address this gap and meet immediate learning needs.

Needs

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

Response

• In total, some 5,440 square metres of additional storage space has been created in Egypt through the installation of 17 Mobile Storage Units (MSUs) at several locations between El Arish and Rafah. This recently included the installation of two MSUs at El Arish Sea Port and one MSU at the Egypt Red Crescent Society (ERCS) Humanitarian Kitchen. 
• The Cluster-operated cargo notification system has so far benefited 25 organizations, informing them once their cargo arrives at the Rafah transshipment point and is ready for pick up. 
• Through the Jordan Corridor, between 1 and 7 April, two convoys carrying 639.2 metric tons of food, shelter, WASH, and protection assistance were dispatched on behalf of nine partners via the King Hussein/Allenby Bridge. On 8 April, the first direct 50-truck convoy was dispatched, carrying food supplies provided by three partners from Amman directly to Kerem Shalom Crossing, without any cross-loading of the trucks along the route.  
• To date, the storage of 11,754.8 cubic metres of humanitarian supplies at four warehouses in Rafah was facilitated. Storage assessments in Deir al Balah also continue to be conducted to increase storage space for humanitarian partners.  
• The pipeline forecast over the next three months is 280,254 metric tons of humanitarian aid, including 251,746 metric tons through the Egypt corridor and 28,778 metric tons through the Jordan corridor.

Challenges

• Infrastructural damage, access challenges and the lack of logistical supplies, assets and spare parts continue to limit storage and transport capacity within Gaza.  
• Uncertainty regarding the opening of additional entry points into Gaza, such as Erez Crossing, undermines the effective prepositioning of cargo and international procurement plans. In general, the highly volatile access conditions hamper logistical planning and negatively affect the efficiency of the overall response.   
• Access to northern Gaza continues to be extremely limited, impacting the ability of humanitarian actors to organize joint convoys.

Needs

• Provide humanitarian responders with access to independent and reliable communication platforms to coordinate emergency response and deliver lifesaving aid, amid ongoing communication challenges and intermittent access to telecommunications services. 
• Increase mainstreaming of PSEA messages and strengthen knowledge of safeguarding practices. 

Response

• On 31 March, the Emergency Telecommunications Cluster (ETC) confirmed the successful internet connection of the VHF radio repeater site in Rafah with the UNDSS server in Jerusalem, following the resolution of a configuration issue by Paltel. With the installation of internet connectivity and a solar-powered solution on 25 February, the repeater site is now fully functioning, ensuring uninterrupted 24/7 operations.  
• On 2 April, 30 pre-approved Very High Frequency (VHF) digital radios arrived at Tel Aviv airport. The radios have been shipped by WFP’s Fast IT and Telecommunications Emergency and Support Team (FITTEST) in Dubai and will be received by UNDSS in Jerusalem for configuration and further distribution to UN agencies in Gaza. 
• On 2 April, the ETC received confirmation by OCHA that the Israeli Coordination of Government Activities in the Territories (COGAT) has approved the importation of 20 additional satellite phones into Gaza. 
• 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.

Needs

• Increase mainstreaming of PSEA messages and strengthen knowledge of safeguarding practices. 
• Ensure safe and accessible community reporting mechanisms, which are trusted by at risk people and victims of sexual exploitation and abuse (SEA).  
• Enhance support services for individuals at risk of SEA.

Response

• During the reporting period, 308 at-risk people in Gaza were referred to Cash for Protections schemes.  
• In-person awareness sessions on PSEA continue to be regularly conducted for humanitarian responders and service providers. Between 6 and 27 March, 37 aid workers attended sessions in Gaza. 
• Some 200,000 people in Gaza accessed online Arabic-language communication materials on PSEA. The materials were developed with support from one NGO and shared mainly via social media and messaging apps. As of 8 April, Sanad's Instagram, Facebook, and Telegram accounts had a total of 6,229 followers, 70 per cent being women.

Challenges

• Internet and telecommunication blackouts continue to hinder awareness raising on SEA at community level as well as effective reporting of potential SEA cases.