Humanitarian Needs and Response Update | 27 February – 4 March 2024

Needs

• Expanding essential healthcare services is critical to safeguard public health and mitigate the spread of infectious diseases especially amongst the IDPs. These essentials encompass medication supplies, enhanced immunization rates, access to reproductive and maternal health services, the availability of laboratory equipment and reagents critical for precise diagnostics and testing, and the provision of blood products in hospitals.
• Military operations at hospitals have resulted in a reduction in their capacity, which necessitates the establishment of field hospitals across the Gaza Strip.
• Reports of death and threat of death among children who suffer from Severe Acute Malnutrition (SAM) due to inadequate food and nutrition supplies necessitate urgent access to the northern regions of Gaza to supply food and establish SAM stabilization centres, along with outpatient therapeutic feeding programs.
• There is a need to improve access to safe drinking water and proper sanitation facilities.

Response

• Between 26 February and 3 March, 19 health cluster partners delivered health services to 80,000 patients.
• As part of the WHO Emergency Medical Teams (EMTs) program, 16 EMTs treated 13,000 patients in Deir Al Balah, Khan Younis and Rafah, providing primary and secondary healthcare services at 5 MoH hospitals.
• A WHO-led mission, in partnership with UNICEF and OCHA, delivered medicine, medical supplies, and 10,000 liters of fuel to Al-Shifa hospital on 1 March. These supplies included medication for SAM management and therapeutic milk formula.
• A WHO-led mission, in partnership with OCHA, UNICEF, UNFPA and UNMAS visited Al-Awda and Kamal Adwan hospitals in northern Gaza on 3 March. The mission delivered medicine, medical supplies, and 9,500 litres of fuel to each of the two hospitals. The supplies to Kamal Adwan Hospital included medication for treating SAM and therapeutic milk formula for children. WHO also discussed with the Director of Kamal Adwan Hospital the potential establishment of a stabilization centre for the management of SAM cases with medical complications.
• WHO has prepositioned psychotropic medication in Rafah.

Challenges

• Hospitals in the northern regions of Gaza have been largely inaccessible and are experiencing fuel, food, medicine, and medical supplies shortages.
• Continuous hostilities in Khan Younis pose significant barriers to accessing healthcare service points.
• The increase in bloody and watery diarrhoea is attributed to the unavailability of safe drinking water, posing a significant public health challenge.
• The absence of segregated sanitation facilities and electricity within shelters presents a considerable safety risk, depriving women and girls of secure environments and thereby increasing their vulnerability to sexual violence.

Needs

• The food security situation continues to be extremely severe, particularly in northern Gaza:
  • People reportedly feed their children animal fodder and native plants, leading to potential health consequences, such as malnutrition and nutritional deficiencies. 
  • Consuming improperly prepared native plants carries risks of toxicity or food-borne illness. The reliance on wild food during extreme food shortages is a stark indicator of highly severe food insecurity. 
  • There is an urgent need for humanitarian assistance and intervention to address the underlying causes of famine and ensure access to adequate food supplies. 
  • Vulnerable segments of the population, including children, the elderly and people with underlying health conditions, are particularly exposed to the risk of malnutrition and famine.
• In the middle and southern governorates, the food security situation is also critical, with most of the population queuing for hours to receive hot meals when trucks manage to enter. 
• In Rafah, the situation is increasingly concerning, with growing reports of people stopping aid trucks to take food and eat it immediately.
• It is critically important to increase the fleet of delivery trucks, together with the need to import the agricultural inputs necessary for reactivating domestic production of essential fresh foods, such as eggs, vegetables, meat, fish and milk, in order to ensure the availability of a balanced nutrition. 
• There is a need to establish secure and uninterrupted humanitarian corridors, with the support of the private sector, and focus on critical resources like fuel and cooking gas.

Response

• Between 26 February and 3 March, a total of 17 partners engaged in providing food assistance, including food parcels and hot meals, across the Gaza Strip, reaching a daily average of 245,000 people (around 10% of the population) with food assistance at least once. Rafah Governorate received about 42 per cent of the total food distributed, 33 per cent in Deir al Balah, 18 per cent in Khan Younis, five per cent in Gaza (but did not include hot meals), and two per cent in North Gaza (mainly hot meals but very few food parcels).

Challenges

• Operating partners are reporting a lack of food to distribute, as what is entering into Gaza is very limited compared to the needs. The number of hot meals provided to people remains insufficient to meet daily nutritional requirements. 
• Ongoing airstrikes and heavy fighting in Gaza continue to affect the flow of food supply, posing challenges for the conduct of safe and efficient humanitarian operations. Frequent border closures, restrictions, and security concerns hinder the delivery of a consistent and dependable food supply.

Needs

• There is a continued need to assess and enhance partners' capacities to handle cases of acute malnutrition and address the rapidly growing needs for both preventative and curative care. This includes carrying out Mid-Upper Arm Circumference (MUAC) screening over a larger area, identifying cases of SAM and Moderate Acute Malnutrition (MAM) especially among children, and providing appropriate treatment, including nutrition supplies, until recovery.
• There is a need to improve access to all governorates in Gaza, including in the north, to rapidly scale up MUAC screening and treatment and ensure continuous outpatient treatment (8-12 weeks) until recovery is achieved.
• There is a need to establish at least five stabilization (inpatient care) centers across the Gaza Strip to treat SAM cases with medical complications.

Response

• Implementing partners are consistently conducting MUAC screenings for malnutrition among children aged 6 to 59 months in shelters and health facilities. Children diagnosed with acute malnutrition are promptly referred for treatment. Between mid-January and 4 February 2024, a total of 13,963 children aged 6-59 months underwent MUAC screening. Among them, 961 cases of children suffering from acute malnutrition were identified and are receiving treatment using the simplified protocol. In Rafah, a stabilization center has been established.

Challenges

• Ongoing access restrictions to northern Gaza continue to heighten concern about rising levels of food insecurity, the risk of widespread starvation, high rates of malnutrition, and the risk of death from hunger.

Needs

• About 1.7 million people across the Gaza Strip are still in need of shelter and NFI assistance.
• Approximately 22,930,000 metric tons of debris has been generated by the destruction of properties, mainly residential units, across the Strip. Cluster partners estimate that it would take around eight years to clear the debris, given existing capacities in the Strip.
• Preliminary findings from a rapid shelter assessment that has been piloted at 33 UNRWA sites, predominantly schools, show that covered living space is as low as 1 m² per person, significantly falling below the Sphere standard of 3.5 m² per person.

Response

• Between 27 February and 4 March, shelter partners have distributed approximately 1,820 tarpaulins, 2,520 bedding sets, 1,360 Sealing-off Kits (SoKs), and 2,550 blankets.

Challenges

• Challenges persist as a result of the scarcity of shelter materials entering the Gaza strip (both humanitarian and commercial). Upon entry of aid, obstacles to distributing it safely persist.
• Recurrent displacement creates the need to re-distribute assistance, while the movement of IDPs has been challenging to track.
• For further details, please see the Cluster response strategy and Shelter Cluster website.

Needs

• Key findings from a rapid WASH assessment carried out between 4 and 18 February 2024 at 41 IDP sites in Rafah governorate include: 
  • Across all assessed sites, people had access to only 2 litres of water per person daily (a median value) for drinking, cooking, washing and other domestic purposes.
  • Most sites relied mainly on water trucking to access water. Makeshift sites had a higher reliance on water trucking and piped water, while there was a higher availability of water from wells at collective centres.
  • The higher population density at collective centers compared to makeshift sites (on average 20,470 vs. 4,005) might explain the lower volume of water accessible to the population living in collective centers compared to people living in makeshift sites (on average, 8 vs. 2 litres per person per day). 
  • Across all assessed sites, one toilet is available for 341 people (a median value). Moreover, only 24 per cent of assessed sites had latrines that offered safe and private access, and only 20 per cent of sites had latrines accessible for persons with physical disabilities.
  • In 61 per cent of assessed sites, there were no showers. For assessed sites where showers were available, there was one shower available for 1,292 persons (median value). Furthermore, only 24 per cent of sites had separate showers for men and women and only 12 per cent of sites had showers accessible for pregnant women, the elderly, and persons with physical disabilities.
  • In 93 per cent of assessed sites, there was some type of visible waste, including solid waste, human feces or stagnant water, and 68 per cent of sites had informal or uncontrolled dumping areas.
  • Most assessed sites did not have access to sufficient WASH and NFIs, including soap, cleaning supplies, and menstrual hygiene materials.
• WASH needs of IDPs remain a priority, including a major gap in sanitation coverage and WASH and NFI provision.  None of the wastewater treatment systems are currently working.
• Safe drinking water provision: water production remains very low as only one out of three Mekorot connections (Bani Saeed pipeline) is functioning at 42% of its full capacity, two out of three desalination plans are 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 water. 
• Water trucking needs are significantly high among IDPs. Only 4,745 cubic metres of water is being trucked, given 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. 
• A significant amount of temporary latrine construction materials is required to improve sanitation coverage at IDP sites. The local market is almost empty. Despite significant efforts by UNICEF through its partners to construct 80 family latrines this week, the sanitation coverage remains very low.
• Solid waste continues to pile up especially at IDP sites, including fecal waste and personal hygiene items, posing further public health risks and environmental hazards.

Needs

• More than 625,000 students and nearly 23,000 teachers in the Gaza Strip have been affected by school closures and attacks on education, with no access to education or a safe place.
• According to the Ministry of Education, as of 27 February, more than 5,379 students and 255 educational staff have been killed and more than 8,888 students and 891 teachers have been injured in the Gaza Strip since 7 October.
• Some 92 per cent of all school buildings in Gaza are being used as shelters for IDPs and/or have sustained varying levels of damage (source: Education Cluster Damaged School Dashboard). A Satellite-derived Damage Assessment conducted by the Education Cluster finds that at least 55 per cent of schools in Gaza will either need full reconstruction or major rehabilitation work to be functional again, and 45 per cent of school buildings that have been used by IDPs as shelters have been either directly hit or damaged.
• Education partners are concerned about satellite imagery, reports, videos and pictures depicting schools being used for military operations by Israeli forces, including their use as detention and interrogation centres, or as military bases.
• Key priorities include the provision of Education in Emergencies recreational activities and psychological support, including Social Emotional Learning activities to children in informal shelters and designated emergency shelters (DESs); establishing Temporary Learning Spaces (TLS) in shelters/DESs to start non-formal learning activities for children; and provision of emergency supplies and learning kits. In addition, a key need is the identification and support of children with disabilities and other needs, with assistive devices for continuity of learning.

Response

• Since October 2023, eleven partners have reached more than 164,032 students and teachers (source:Education Cluster 5W dashboard) with psychosocial support, emergency learning, recreational supplies and activities, and awareness sessions in the Deir al Balah, Khan Younis, and Rafah governorates. Most cluster responses are delivered by local partners.
• UNICEF and its partners are working on establishing TLS to start non-formal education activities for displaced children in shelters/DESs.

Challenges

• No activities have been undertaken in the North Gaza and Gaza governorates due to ongoing hostilities and access challenges.
• As of 2 March, the education response remains significantly underfunded, receiving less than 15 per cent of its requirements. Urgent funding is required to meet immediate response requirements.

Response

• As of 3 March 2024, the Logistics Cluster has received for storage 6,854 cubic metres of cargo on behalf of 19 organisations in Gaza, and so far has supported 23 organisations with cargo notification services at the Rafah transshipment point.
• Of the relief items transported, cargo was consolidated, and transport facilitated for an inter-agency convoy that departed on 28 February from Jordan through Amman – King Hussein Bridge – Gaza route, delivering 356 metric tons of relief items on behalf of four partners through 24 trucks.
• The Logistics Cluster is collecting the pipeline for incoming cargo through the Egypt and Jordan corridors for the coming three months. As of 4 March, 228,451 metric tons of cargo is expected through Jordan and Egypt corridors. Data is based on inputs from 29 organizations that contributed to the exercise, therefore, does not represent the entire pipeline and should be interpreted accordingly.
• The Cluster has publicly launched the inter-active dashboard to display detailed information on the inter-agency convoys dispatched from Jordan through both King Hussein and Aqaba-Nuweibaa routes in support of the Gaza response.
• IMPACCT Working Group is actively engaging with UN agencies and INGOs on customs and aid importation/exportation procedures to support clarification of processes and requirements for the Jordan Corridor. Partners are invited to submit their questions through the dedicated form.
• The Logistics Cluster is working with partners and WFP to facilitate access of humanitarian organisations to the WFP-led convoys inside Gaza as and if the situation permits. Partners` needs can be provided through the online form.
• The Palestine Logistics Cluster has updated its Concept of Operations (ConOps) and ConOps map, which are published on the operation webpage.

Challenges

• The storage and transport capacity inside Gaza remains challenging. The Logistics Cluster continues to facilitate access to temporary storage, transport, and cargo notification transshipment services.
• As of 3 March, a backlog of approximately 1,300 UN/INGOs trucks are reported in Al Arish, Egypt.

Needs

• There is an urgent need for independent communication platforms for humanitarian responders in Gaza to coordinate emergency response and deliver aid, amid ongoing communication blackouts and unreliable and/or intermittent access to telecommunication services.

Response

• On 27 February, the Emergency Telecommunications Cluster (ETC) engaged with the British Broadcasting Corporation (BBC) Arabic edition media team to support the finalization of equipment required for the delivery of broadcast content for communities. The ETC recommended the use of battery-operated portable speakers for content broadcast in the shelters in Rafah and Khan Younis for wider dissemination.
• On 25 February, the ETC successfully installed and commissioned a solar power solution to provide continuous 24/7 operation of the Very High Frequency (VHF) radio repeater located in Al Shaboura Clinic in Rafah. The repeater had been down since 8 February due to power issues. The 30 recently approved digital VHF handheld radios will be usable on this network for UN staff in Rafah, once received, despite anticipated continued challenges with internet connectivity.
• The ETC is supporting humanitarian agencies in Gaza with Information and Communication Technology (ICT) assessments, technical advice and information, repairs, and guidance on the use of ICT equipment. Since 09 January, the ETC has conducted 17 ICT assessments in 14 locations in Rafah and supported 17 humanitarian agencies to maximize the available telecommunications resources on the ground.
• 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.
• Importation of telecommunications equipment into Gaza is lengthy and extremely challenging.

 Response

• Between 26 February and 3 March, 2,054 households received one round of emergency MPCA. Cash out operations are concentrated in the governorates south of Wadi Gaza, with the majority being reported in Rafah. As of 3 March, one round of emergency MPCA was delivered to some 162,000 households, a top-up was delivered to 34,000 people, including people with disabilities and nursing mothers, and over 16,000 households have received a second round.
• Since 7 October, some 116,000 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 sporadically entered Gaza, with 923 trucks recorded as of 02 March. Informal markets are the primary source of accessible goods, which complicates efforts to track distributions and gather market data.