Humanitarian Situation Update #231 | Gaza Strip

The Humanitarian Situation Update is issued by OCHA Occupied Palestinian Territory twice a week. The Gaza Strip is covered on Tuesdays and the West Bank on Thursdays. As of this week, the Gaza Humanitarian Response Update is issued every other Tuesday. The next Humanitarian Situation Update will be issued on 24 October.

Key Highlights

• Israeli strikes have reportedly impacted all three partially functional hospitals in the North Gaza governorate, with injured patients dying at Kamal Adwan Hospital amidst a lack of life-saving medical supplies, fuel and food, while communication challenges hamper efforts to ascertain the situation at the Indonesian and Al-Awda hospitals.
• Between 1 and 21 October, only six per cent (four out of 70) of coordinated aid movements that aimed to provide humanitarian assistance in North Gaza and Gaza governorates via Al Rashid checkpoint were facilitated by Israeli authorities.
• The number of people facing catastrophic levels of food insecurity is projected to increase three-fold between November 2024 and April 2025, and an estimated 60,000 children between six and 59 months are projected to become acutely malnourished over the coming year, the Integrated Food Security Phase Classification global initiative warns.

Humanitarian Developments

• Israeli bombardment from the air, land and sea continues to be reported across the Gaza Strip, resulting in further civilian casualties, displacement, and destruction of civilian infrastructure. In the North Gaza governorate, the Israeli military has been carrying out a ground offensive since 6 October and imposed a tightened siege particularly around the area of Jabalya refugee camp, amid a near total lack of humanitarian aid entering as well as severe communications and internet disruptions. Heavy fighting in and around Jabaliya continues to be reported, so is rocket fire by Palestinian armed groups toward Israel. Meanwhile, the Israeli military continued to issue orders for residents, schools and hospitals to evacuate, including on 17 October when a pause was announced via the Israeli Civil Administration between 08:00 and 16:00 and presented as another chance for Jabalya refugee camp residents to leave.
• In a statement issued on 20 October, the UN Human Rights Office (OHCHR) highlighted its increasing concern “that the manner in which the Israeli military is conducting hostilities in north Gaza, along with unlawful interference with humanitarian assistance and orders that are leading to forced displacement, may be causing the destruction of the Palestinian population in Gaza’s northernmost governorate,” particularly around Jabalya, Beit Lahya and Beit Hanoun. Describing the measures taken by the Israeli military, the statement cited inter alia: the denial of entry into northern Gaza of “all essential supplies between 1 and 14 October,” with only “a token amount of aid” having entered since then; continuous bombing and attacks especially in and around Jabalya refugee camp, which “have made it extremely dangerous for civilians to flee,” with reports received of “Palestinians targeted while fleeing”; reported restrictions and attacks on rescue teams and medics which are “hindering lifesaving operations, including the recovery of Palestinians trapped under rubble”; and reports of tens of Palestinian men detained by the Israeli military.
• Between the afternoons of 15 and 22 October, according to the Ministry of Health (MoH) in Gaza, 374 Palestinians were killed and 1,269 were injured. Between 7 October 2023 and 22 October 2024, at least 42,718 Palestinians were killed and 100,282 were injured, according to MoH in Gaza. Moreover, on 20 October, the Palestinian Civil Defence (PCD) reported that tens of homes have been hit in Jabalya, Beit Lahya and Beit Hanoun, but coordination requests to reach injured and trapped people in inaccessible areas have been unsuccessful. Tens of bodies reportedly remain under the rubble and dozens of bodies remain scattered in the streets of Jabalya, PCD added.
• On 20 October, the MoH published the breakdown of 40,717 out of 42,010 fatalities as of 7 October 2024 for whom full details have been documented by MoH (also available on the Health Cluster’s Unified Dashboard here); according to MoH, these include 13,319 children, 7,216 women, 3,447 elderly, and 16,735 men. Among the child fatalities, 786 children are under one year of age, representing about six per cent of killed children whose full identification details have been documented, MoH further reported. Additionally, as of 7 October 2024, MoH noted that 35,055 children had lost one or both parents over the past year.
• Between the afternoons of 15 and 22 October, three Israeli soldiers were reportedly killed in Gaza, according to the Israeli military. Between 7 October 2023 and 22 October 2024, according to the Israeli military and official Israeli sources cited in the media, more than 1,556 Israelis and foreign nationals were killed, the majority on 7 October 2023 and its immediate aftermath. The figure includes 356 soldiers killed in Gaza or along the border in Israel since the beginning of the ground operation. In addition, 2,362 Israeli soldiers were reported injured since the beginning of the ground operation.
• Between 17 and 19 October, at least three mass casualty incidents took place in North Gaza governorate. On 17 October, at about 14:00, Abu Hussein UNRWA school hosting internally displaced people (IDPs) was reportedly hit in Jabalya refugee camp, resulting in the killing of 28 Palestinians and the injury of 160 others, according to the Government Media Office (GMO). According to UNRWA, this was the third attack on UNRWA facilities in the Gaza Strip in one week. On 19 October, at about 00:05, several houses belonging to three families were simultaneously hit in Jabalya refugee camp, killing 33 Palestinians, including women and children, and injuring dozens, with many reported missing under rubble. On the same day, at about 22:00, a residential block in Beit Lahya Project area, which belongs to five families and where newly displaced families from Jabalya were sheltering, was reportedly hit by the Israeli military, resulting in 87 fatalities and people trapped under rubble and more than 40 people injured, according to MoH.
• The following are some of the other key deadly incidents reported between 14 and 21 October:
  • On 14 October, at about 22:00, 11 Palestinians, including six women, were reportedly killed and others injured when a house was hit in the Al Falouja area of Jabalya refugee camp, in North Gaza.
  • On 14 October, at about 18:45, five Palestinians were reportedly killed and at least 15 were injured when six IDP tents were hit in Al Sumoud camp in the Al Mawasi area, west of Khan Younis.
  • On 15 October, at about 02:30, six Palestinians, including a husband, his wife and their three children, were reportedly killed when a house was hit in the vicinity of the European Gaza Hospital in Al Fukhari town, southeast of Khan Younis.
  • On 17 October, at about 14:45, 13 Palestinians, including four females, were reportedly killed and others injured when a house was hit in Al Maghazi refugee camp, in Deir al Balah. The Director of Emergency Medical Services for central Gaza was reportedly among the fatalities.
  • On 18 October, at about 23:30, 11 Palestinians were reportedly killed when a residential building was hit in Al Maghazi refugee camp, in Deir al Balah.
  • On 19 October, at about 12:10, eight Palestinians, including at least one woman and one girl, were reportedly killed and others injured when UNRWA Asmaa School, which was sheltering IDPs, was hit in As Shati’ (Beach) refugee camp, west of Gaza city.
  • On 21 October, at about 11:00, six Palestinians were reportedly killed and others injured when a group of people filling water tanks was hit at Al Halabi Junction, in North Gaza.
• On 18 and 19 October, Israeli strikes reportedly impacted all three remaining hospitals in the North Gaza governorate – Kamal Adwan, Indonesian and Al-Awda. According to MoH, the top floors and front yard of the Indonesian Hospital, which hosted more than 40 trauma and chronic patients as well as medical staff, were hit and had a total power outage. Two critical patients subsequently died amid lack of electricity and supplies, MoH added. Al-Awda Hospital and the entrance to the laboratory of Kamal Adwan were also hit, resulting in casualties, Al-Awda Health and Community Association and MoH reported. On 21 October, a complex mission led by the World Health Organization (WHO), together with OCHA, the United Nations Mine Action Service (UNMAS) and the Palestine Red Crescent Society (PRCS), managed to evacuate 14 critical patients, alongside 10 caregivers, from Kamal Adwan to Al Shifa Hospital in the Gaza governorate. The mission, which departed from Deir al Balah on 20 October, had to spend the night at the Kamal Adwan Hospital due to intense fighting in the area and was only able to proceed to Al Shifa the following day. Overall, as of 21 October, 100 in-patients remained hospitalized at Kamal Adwan, including seven adults and seven children in the Intensive Care Unit, with a constant influx of new casualties flooding the emergency department; some 200 trauma patients arrived in the space of 24 hours between 20 and 21 October, including 53 already deceased. On 21 October, the Director of Kamal Adwan reported that blood units had been exhausted, medical crews have been working restlessly without food, a number of patients had succumbed to their wounds amid capacity constraints, and other wounded persons were lying in the streets with no possibility to rescue them. Meanwhile, communication challenges caused by internet outages are hampering efforts to ascertain conditions at the Indonesian and Al Awda hospitals, informs the Health Cluster. Moreover, no UNRWA medical points are currently operational in North Gaza.
• For more than two weeks, the UN and its partners estimate that more than 60,000 people have been displaced from North Gaza to Gaza city, including more than 1,000 people, mostly women and children, displaced via Salah ad Din Road to northern and western Gaza city on 19 October. Approximately 4,000 people have also been displaced from Jabalya to Beit Hanoun, in addition to others who have been displaced from an UNRWA school and two other UNRWA shelters in Jabalya to Beit Lahya. Displacement to Deir al Balah and Khan Younis in southern Gaza has been limited, with around 100 people, primarily women and children, crossing via Al Rashid Road. During an inter-cluster mission to schools in Gaza City hosting IDPs on 19 October, UN agencies and partners identified the urgent need to provide shelter solutions to relieve severe overcrowding, with some people living in restrooms due to lack of space. The severe lack of shelter and non-food items (NFIs) is disproportionately affecting women and children, who comprise about 70 per cent of people residing in some IDP sites. Facilities also lack lighting, contributing to increased risks of gender-based violence (GBV). A significant number of family separation cases were reported, and many requests were made by communities for bodies to be collected from under the rubble and in the streets. There are limited mental health and psycho-social support (MHPSS) activities, and efforts are underway to expand the provision of protection services. Elderly people and persons with special needs were identified in all sites and were found to require various types of assistive devices that are unavailable.
• Between 14 and 20 October, according to WHO, the total number of children vaccinated during the second round of the polio vaccination campaign reached 420,100 children, with 339,885 children also receiving vitamin A supplements. This includes 183,556 children under the age of 10 vaccinated in central Gaza as of 17 October and 236,544 vaccinated in southern Gaza since 19 October. On 14 and 15 October, WHO also conducted special missions to deliver polio vaccines and related equipment to areas in central Gaza that are beyond the agreed humanitarian pauses, and eight health facilities in the area continued to administer the vaccines to ensure the greatest possible coverage. To date, 71 per cent of all children to be vaccinated have been reached, and negotiations are still ongoing with the Israeli authorities on how the last phase of the vaccination drive can be implemented in northern Gaza, which was originally scheduled to begin on 23 October.
• According to the latest data by the Health Resources and Services Availability Monitoring System (HeRAMS), covering the period up to 30 September, 76 per cent of still partially functioning hospitals across the Strip have insufficient water supply, 94 per cent struggle with insufficient sanitation facilities, 71 per cent are unable to follow proper hand hygiene practices, 82 per cent have insufficient personal protective equipment (PPE), and all hospitals lack sufficient means to maintain adequate environmental cleaning standards. With regard to waste management, 94 per cent of hospitals are unable to follow proper waste segregation practices and 88 per cent have insufficient means for the safe, final disposal of both sharps and infectious waste. Furthermore, according to UNRWA, at least 56 items in its still functional healthcare centres across the Strip will be exhausted by November. Moreover, due to zero stock of most laboratory supplies and equipment requiring maintenance or replacement, UNRWA laboratories are now able to perform only four tests, compared with nearly 35 tests prior to October 2023. Hospitals are also struggling to operate amid intensified military activity in their surroundings, a continuous flow of casualties, access impediments, and severe shortages of fuel, supplies and specialized medical teams. At present, 14 international Emergency Medical Teams (EMTs) are operational in central and southern Gaza and one national EMT is deployed at Al Shifa Hospital in Gaza governorate. Given the critical state of Gaza’s healthcare system, WHO appeals for all potentially qualified Emergency Medical Teams (EMTs) to be allowed to enter the Strip to support the local healthcare workforce in providing primary services and undertaking specialized surgeries, including rehabilitation and reconstruction surgeries.
• The risk of famine remains high throughout the Gaza Strip and the recent surge in hostilities has heightened concerns that this worst-case scenario may materialize, highlights the fourth analysis published by the Integrated Food Security Phase Classification (IPC) initiative. The analysis, conducted between 30 September and 4 October by over 52 experts from 16 organizations, shows that about 1.84 million people in Gaza, comprising 86 per cent of the total population, are currently facing crisis or worse levels of food insecurity (IPC Phase 3 or above), including 664,000 people facing emergency levels of food insecurity (IPC Phase 4) and nearly 133,000 facing catastrophic levels of food insecurity (IPC Phase 5). The analysis explains that, while a temporary surge in humanitarian assistance and commercial supply between May and August 2024 partly alleviated acute food insecurity, the sharp decline in both commercial and humanitarian goods entering Gaza in September - the lowest volume recorded since March – combined with deterioration in humanitarian access to the north of Gaza since then - is expected to have dramatic consequences in the upcoming winter months. For the period between November 2024 and April 2025, the analysis projects that nearly two million people, or 91 per cent of the population, will be in crisis or worse levels of food insecurity and that there will be a three-fold increase in the number of people facing catastrophic levels of food insecurity (345,000 vs. 133,000), particularly affecting Rafah and the northern governorates. The IPC analysis concludes that “only by ensuring widespread access to adequate food, medical supplies, water, and basic services across the Gaza Strip can the risk of a rapid descent into famine be contained.” This in turn requires an immediate, sustained and unconditional ceasefire, safe and unimpeded humanitarian access, rehabilitation of local food systems and the scaling up of prevention and management of acute malnutrition, adds the report. Commenting on these risks, the Senior Deputy Director of UNRWA Affairs, Sam Rose, stressed: “Whether people are on the verge of famine or in famine, they are in absolutely desperate conditions and this is completely man-made.” The situation can only be reversed with “trucks coming in,” he added, noting that more than three months’ worth of food supplies are still awaiting outside Gaza.
• For the first time, the IPC analysis also covered Acute Malnutrition (AMN), showing that the latter has already reached serious levels (IPC AMN Phase 3) - increasing ten-fold since the escalation of hostilities in October 2023 - and is projected to further worsen across all governorates. An estimated 60,000 children aged six to 59 months are expected to become acutely malnourished in the period between September 2024 and August 2025 - 12,000 of whom (20 per cent) in the most severe form - alongside some 16,500 pregnant and breastfeeding women. The analysis attributes this deterioration to a combination of extreme food deprivation, collapse of health and nutrition services and insufficient access to safe water, sanitation and hygiene facilities in a context characterized by winter temperatures, rains and flooding, which will both exacerbate acute malnutrition and heighten the risk of epidemics in highly congested areas. According to the latest WHO data, communicable disease rates are already alarming across Gaza, with more than 1.1 million cases of acute respiratory infections, 669,000 cases of acute watery diarrhea, 225,000 cases of skin diseases, 132,000 cases of acute jaundice syndrome, as well as 18 cases of acute flaccid paralysis already reported in the Strip. “The latest IPC analysis confirms our worst fears for children in northern Gaza,….nearly one in five children suffer from wasting, the most life-threatening form of malnutrition,” highlighted the UNICEF Deputy Executive Director Ted Chaiban in a statement on 18 October. “This looming disaster could lead to the loss of countless young lives unless immediate and unhindered humanitarian access is granted to deliver life-saving support. The world must act now to prevent this catastrophe from becoming a full-scale famine,” he added.
• To curb acute hunger and malnutrition and restore the availability of fresh food that humanitarian aid cannot provide, the UN Food and Agriculture Organization (FAO) stressed that supporting farmers in reactivating local food production is critical. This can be achieved by delivering critical agricultural aid and commercial food production inputs and protecting some 30,000 sheep and goats remaining alive in the Strip. To-date however, restrictions at crossings and the collapse of public order and safety inside Gaza have severely hampered the entry of agricultural inputs into the Strip, making planting and agricultural activities nearly impossible. As of 29 September, FAO had distributed fodder to over 4,400 livestock holders in Rafah, Khan Younis and Deir al Balah, and veterinary kits to about 2,400 herder families, but the urgent entry of many more supplies to preserve livestock hinges on restoring access, security and mobility conditions, FAO noted.
• In a new report, Juzoor for Health and Social Development, a Palestinian NGO, shed light on the extreme hardships faced by older people in Gaza. For example, the escalation of hostilities has severely hindered access to medication and now only 40 per cent of elderly people with health problems are estimated to be able to obtain the medications they need. As a result, “many are dying prematurely. Their nutrition has declined, they’ve lost weight, and their psychosocial wellbeing is collapsing. They live with a fear of death or of losing their families,” noted Dr. Umaiyeh Khammash, Director of Juzoor. Restrictions by Israeli authorities on the entry of supplies into Gaza have further limited access to essential items, such as assistive devices, increasing the vulnerability of the elderly, according to the report. Furthermore, many elderly people have been unable to flee during the bombings or escape areas affected by the sudden and frequent evacuation orders issued by the Israeli military, primarily due to mobility issues; therefore, they have often remained stranded without sufficient support for basic needs, such as food, water or medical care. In mid-2023, approximately 100,000 elderly people, or about five per cent of the population, lived in the Gaza Strip, according to the Palestinian Central Bureau of Statistics (PCBS), of whom 69 per cent suffered from chronic diseases.
• Humanitarian access across the Gaza Strip remains severely restricted, especially for aid missions seeking to reach more than 400,000 people in North Gaza (175,000) and Gaza (256,000) governorates, amid ongoing hostilities, escalating insecurity, and restrictions at Israeli military-controlled checkpoints. Between 1 and 21 October, out of 448 planned aid movements across the Gaza Strip requiring coordination with the Israeli military, 45 per cent (201) were denied, 36 per cent (162) were facilitated, 15 per cent (67) were impeded, and four per cent (18) were cancelled due to logistical and security challenges. These figures include 70 coordinated aid movements that aimed to provide humanitarian assistance in North Gaza and Gaza governorates via Al Rashid checkpoint, of which only six per cent (four) were facilitated by Israeli authorities. Access conditions have especially worsened following the onset of the Israeli military operation in Jabalya on 6 October; between 6 and 21 October, 29 coordination requests for critical aid missions to Jabalya, Beit Hanoun, and Beit Lahya were denied, six were impeded, and 13 were facilitated. Denied movements included a critical mission to rescue about 40 people trapped under rubble in the Falouja area of Jabalya, which has been repeatedly denied since 18 October, underscoring the severe limitations on lifesaving, humanitarian efforts. Similarly, the transport of critical life-saving supplies including blood, medical supplies such as anaesthesia, food parcels and fuel to Kamal Adwan Hospital was denied on 20 October.
• Aid workers and emergency responders continue to face extreme challenges in assisting people across the Gaza Strip, often with immense risks to their personal safety. Since 10 October 2024, at least 10 humanitarian workers and four health workers have been killed and others injured across the Gaza Strip, including some while at home with their families. These include five UNRWA staff and five staff of national and international NGOs. Moreover, Oxfam reported that on 19 October, four water engineers working with the Coastal Municipalities Water Utility (CMWU) were killed in Khuza’a while en route to repair infrastructure in eastern Khan Younis. On the same day, an ambulance belonging to Al Awda Hospital was reportedly struck in Tal al Zaatar area, east of Jabalya, injuring six people, including a paramedic.

Funding

• As of 22 October, Member States have disbursed about US$2 billion out of the $3.42 billion (59 per cent) requested to meet the most critical needs of 2.3 million* people in Gaza and 800,000 people in the West Bank, including East Jerusalem, between January and December 2024. For funding analysis, please see the Flash Appeal Financial Tracking dashboard. (*2.3 million reflects the projected population of the Gaza Strip upon issuance of the Flash Appeal in April 2024. As of July 2024, the UN estimates that about 2.1 million people remain in the Gaza Strip, and this updated number is now used for programmatic purposes.)
• The oPt humanitarian Fund (oPt HF) is currently managing 87 ongoing projects, totalling $77.5 million. These projects aim to address urgent needs in the Gaza Strip (90 per cent) and the West Bank (10 per cent). They are strategically focused on education, food security, health, protection, emergency shelter and non-food items, water, sanitation, and hygiene (WASH), coordination and support services, multi-purpose cash assistance and nutrition. Of these projects, 48 projects are being implemented by international non-governmental organizations, 27 by national NGOs and 12 by UN agencies. Notably, 31 out of the 60 projects implemented by INGOs or the UN are being implemented in collaboration with national NGOs. Moreover, in addition to the four other reserve allocations for 2024, the oPt HF is finalizing its critical and time sensitive First Standard Allocation of US$30 million, aligned with the 2024 oPt Flash Appeal, aiming to rapidly scale up relief efforts to meet the immediate needs of affected people in the Gaza Strip and the West Bank. The allocation includes 16 fast-tracked projects, prioritizing critical winterization preparedness and addressing urgent shelter, WASH, and other emergency needs of IDPs and other vulnerable groups in Gaza. Monthly updates, annual reports, and a list of all funded projects per year, are available on the oPt Humanitarian Fund webpage, under the financing section.