Humanitarian Situation Update #233 | 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. The Gaza Humanitarian Response Update is issued every other Tuesday. The next Humanitarian Situation Update will be issued on 31 October.

Key Highlights

• At least seven mass casualty incidents have been reported across Gaza over the past week, including four in North Gaza. 
• The Ministry of Health appeals for immediate deployment of medical teams, ambulances and civil defence vehicles to save lives in North Gaza, as only two doctors remain at the overwhelmed Kamal Adwan Hospital.  
• Children in Gaza are not only dying from bombs, bullets and shells, but also because those who survive are prevented from leaving Gaza to receive life-saving care. According to UNICEF, only 127 children in critical condition have been allowed to leave the Strip since May. 
• Schools, including those sheltering internally displaced persons, continue to be affected by escalating hostilities, including airstrikes, forced evacuations, shelling and arson; between 13 and 26 October, 31 such incidents were documented by the Education Cluster, including 20 in North Gaza.

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. Efforts to deliver life-saving assistance to communities and families in high-risk zones have been hampered. Between 6 and 28 October, 36 coordination requests submitted to the Israeli authorities for critical aid missions targeting Jabalya, Beit Hanoun, and Beit Lahya (all in North Gaza governorate) were denied access, 14 faced impediments, and 23 were facilitated. 
• Between the afternoons of 22 and 29 October, according to the Ministry of Health (MoH) in Gaza, 343 Palestinians were killed and 914 were injured. Between 7 October 2023 and 29 October 2024, at least 43,061 Palestinians were killed and 101,223 were injured, according to MoH in Gaza. The MoH further reported that these figures do not include the mass casualty incident in Beit Lahya on the morning of 29 October, nor the casualties in North Gaza on 25 and 26 October (see below). 
• Between the afternoons of 22 and 29 October, nine Israeli soldiers were reportedly killed in Gaza, according to the Israeli military. Between 7 October 2023 and 29 October 2024, according to the Israeli military and official Israeli sources cited in the media, more than 1,565 Israelis and foreign nationals were killed, the majority on 7 October 2023 and its immediate aftermath. The figure includes 365 soldiers killed in Gaza or along the border in Israel since the beginning of the ground operation. In addition, 2,373 Israeli soldiers were reported injured since the beginning of the ground operation. 
• Over the past three weeks, more than 71,000 people have been displaced from North Gaza governorate to Gaza city and about 100,000 people remain in North Gaza, according to the most recent estimates by the UN and its partners. On 25 October, the Palestinian Civil Defence (PCD) announced that it has been forced to halt operations in North Gaza, rendering the area without life-saving civil defence services, including firefighting, search and rescue, and emergency medical assistance. Several PCD staff members were detained, including two at Kamal Adwan Hospital, three others were injured, and the last firefighting vehicle in North Gaza was hit and destroyed, PCD said. The humanitarian crisis in Jabalya is further exacerbated by severe shortages of food, water, and medical supplies. According to the Food Security Sector, as of 26 October, the two bakeries in North Gaza governorate have remained closed due to escalating hostilities and all eight kitchens that were operational as of the end of September suspended operations or became inaccessible. 
• On 26 October, Ms. Joyce Msuya, UN Acting Under-Secretary-General for Humanitarian Affairs and Emergency Relief Coordinator stated: “What Israeli forces are doing in besieged North Gaza cannot be allowed to continue. Hospitals have been hit and health workers have been detained. Shelters have been emptied and burned down. First responders have been prevented from saving people from under the rubble. Families have been separated and men and boys are being taken away by the truckload. Hundreds of Palestinians have reportedly been killed. Tens of thousands have been forced to flee yet again. The entire population of North Gaza is at risk of dying.” The following day, the UN Secretary-General expressed shock at the “harrowing levels of death, injury and destruction in the north, with civilians trapped under rubble, the sick and wounded going without life-saving health care, and families lacking food and shelter, amid reports of families being separated and many people detained,” warning that “widespread devastation and deprivation … are making the conditions of life untenable for the Palestinian population there.” 
• Between 22 and 29 October, at least seven mass casualty incidents were reported across Gaza, including four in North Gaza governorate. On 24 October, between 150 to 200 people were reportedly killed or injured when a residential block of eleven houses was hit in Jabalya refugee camp. On 24 October, Ash Shuhada school in An Nuseirat refugee camp, in Deir al Balah, was hit and a fire reportedly broke out; according to the Government Media Office (GMO), 17 Palestinians were killed, including nine children, and over 52 others were injured. On 25 October, 25 people were reportedly killed when two houses were hit in Beit Lahya Project area (Mashrou’ Beit Lahya). On 24 and 25 October, MoH reported that a total of 38 Palestinians were killed and tens of others, mostly children and women, were injured when several residential buildings were destroyed during a military operation in Qizan An Najjar and Al Manara areas in Khan Younis, while about 20 people were missing according to PCD. On 26 October, at least 30 people were reportedly killed and dozens injured when a residential block was hit near the eastern junction in Beit Lahya, while some remained under the rubble due to the suspension of PCD services in North Gaza. On 27 October, eleven Palestinians, including one girl and four women, were reportedly killed when Asma UNRWA school designated as IDP shelter in Ash Shati’ (Beach) refugee camp in Gaza city was hit. On 29 October, 93 Palestinians were killed or went missing under the rubble following an Israeli strike on a residential building in Beit Lahya, according to MoH. 
• The following are some additional deadly incidents reported between 21 and 27 October: 
  • On 21 October, at about 12:35, nine Palestinian family members were reportedly killed when a house was hit in Az Zarqa area, northeast of Gaza city. 
  • On 22 October, at about 09:20, eight Palestinians, including at least five males, were reportedly killed and others injured when a group of Palestinians was hit in Az Zeitoun neighbourhood, southeast of Gaza city. 
  • On 23 October, at about 16:30, six Palestinians were reportedly killed when a house hosting IDPs was hit in Jabalya Al Balad, in North Gaza.  
  • On 27 October, at about 1:00, 10 Palestinians were reportedly killed and others injured when a house hosting IDPs was hit in Beit Lahya Project, in North Gaza. 
• The continued targeting of schools is severely hampering the emergency education response throughout Gaza. Between 13 and 26 October, 31 incidents were reported, affecting 22 schools run by the UN and eight managed by the Palestinian Authority, with some schools impacted multiple times. Of these incidents, 20 occurred in the North Gaza governorate. In total, 57 incidents affecting schools were recorded between 1 and 26 October, including airstrikes, forced evacuations, shelling, and arson. These incidents continue to further destroy educational infrastructure, resulting in loss of life and instilling fear among parents and children.  
• Health care conditions remain critical in North Gaza, with “intensive military operations unfolding around and within healthcare facilities and a critical shortage of medical supplies, compounded by severely limited access, depriving people of life saving care,” warned the WHO Director-General, Tedros Adhanom Ghebreyesus, on 26 October. Out of five hospitals that were functional in the North Gaza governorate prior to October 2023, two (Kamal Adwan and Al Awda) remain partially operational at present after the Indonesian hospital was put out of service.  
• On 26 October, MoH informed WHO that the siege at Kamal Adwan Hospital had ended. On 25 October, Israeli soldiers had reportedly entered the hospital where 600 people were present including 195 trauma and non-trauma patients; according to MoH, three nurses and a cleaner were injured while three ambulances, a transport vehicle and the solar panel electricity generation system were destroyed on 25 and 26 October. Of the hospital’s 70-member team, 44 male staff members were detained by the Israeli military, 30 of whom remain currently in custody and others were forced to move southward.  In a press statement on 29 October, MoH described a horrific situation at Kamal Adwan Hospital as the facility had to cope with a new mass casualty influx on the same morning, with only the hospital’s director and one pediatrician struggling to assist 150 injured patients, no surgeons, anesthesia or Intensive Care Unit teams. The MoH appealed for the urgent deployment of medical teams, particularly surgical ones, as well as ambulances and civil defense vehicles to save lives. 
• On 24 October, just hours prior to the raid into Kamal Adwan, WHO, alongside OCHA, UNMAS, CADUS and the Palestine Red Cross Society (PRCS) managed to reach the hospital, delivering 10,000 litres of fuel, 180 blood units, medicines to cover the needs of 5,000 patients as well as trauma surgery and alcohol supplies for 1,600 interventions. The mission also transferred 23 critical patients, alongside 26 caregivers, to Al Shifa Hospital in Gaza governorate, and provided the latter with laboratory supplies and medicines to cover the needs of 6,000 people. Briefing the press in Geneva on the mission, the WHO Representative in the OPT, Dr. Richard Peerperkorn, reported that, at a checkpoint near Kamal Adwan, the team witnessed “thousands of women and children leaving the area, walking, limping with their few belongings towards Salah al Din [road] and Gaza city.” At Kamal Adwan, the mission team saw “mayhem and chaos,” with the emergency ward overflowing with “horrific trauma patients,” hospital staff completely overwhelmed and underequipped to deal with the mass casualty situation, and hundreds of people seeking shelter in every corner of the facility, added Peerperkorn.  
• As for the Indonesian Hospital, WHO observed during its 24 October mission that the facility’s boundary wall had been demolished, and the Health Cluster reported as of 26 October that no food or water were available for patients, medical staff and IDPs, four patients had died between 20 and 26 October, and a WHO-led mission to deliver food, water and medical supplies was denied by the Israeli authorities. Lastly, Al- Awda Hospital is inaccessible due to damaged roads, with 151 people, including 65 employees, 43 patients, 36 companions and seven children remaining in the facility as of 26 October, according to the Health Cluster. The hospital lacks potable water and is mainly relying on untreated well water. Central water pipes have been damaged, limiting water availability to two hours per day.  
• “Escalating violence, intense bombardment, mass displacement orders, and lack of assured humanitarian pauses across most of northern Gaza” have compelled the Polio Technical Committee for Gaza, which comprises the Palestinian Ministry of Health, WHO, UNICEF, UNRWA and partners, to delay the third and final phase of the emergency polio vaccination campaign, aimed at administering the second dose of the novel oral polio vaccine type 2 (nOPV2) to 119,279 children in the northern governorates. In a statement, WHO and UNICEF explained that “current conditions, including ongoing attacks on civilian infrastructure continue to jeopardize people’s safety and movement in northern Gaza, making it impossible for families to safely bring their children for vaccination, and health workers to operate.” Following sustained negotiations, agreement has now been reached with the parties to undertake the vaccination drive between 2 and 4 November in the Gaza governorate. Completing the third phase and ensuring that at least 90 per cent of all children in every community and neighbourhood are vaccinated is critical to stop the polio virus transmission in Gaza and avert the risk of more children being paralysed, warned UNICEF and WHO. 
• Recent attacks on water, sanitation, and hygiene (WASH) personnel and facilities, intermittent access to fuel, and military operations have significantly undermined access to clean water. On 19 October, four  engineers from the Coastal Municipalities Water Utility (CMWU) were reportedly hit while travelling in a clearly marked vehicle during a mission approved by the Israeli authorities the same morning. CMWU subsequently suspended most operations in areas that require coordination with the Israeli authorities. Moreover, according to the WASH Cluster, the strike on Safa well field in Gaza city on 24 October killed two municipal well operators and damaged this critical source of water that has four wells each with a production capacity of 500 cubic metres per hour. While a site assessment is yet to be conducted, the damage is likely to negatively affect water supply in Gaza city, where ground water resources are limited and IDPs from Jabalya continue to move. Intermittent access to fuel has recently forced eight private sector water providers to halt operations in Gaza city and significantly limited production levels of municipal wells. In North Gaza, the lack of fuel deliveries to WASH facilities since 1 October has forced municipal teams to ration or stop water production entirely. Across the Gaza Strip, a recent WASH Cluster assessment revealed alarming water scarcity, with nearly two-thirds of households, or about 1.4 million people, consuming less than the recommended six litres per person per day for drinking and cooking, while nearly half the population lacks the minimum 15 litres per person per day for drinking, cooking, and hygiene.  
• “Children in Gaza are dying, not just from the bombs, bullets and shells that strike them,” but also because, when they survive, “they are then prevented from leaving Gaza to receive the urgent care that would save their lives,” stressed UNICEF Spokesperson, James Elder, on 25 October. Since the Rafah crossing closed on 7 May, only 127 children – many suffering from head trauma, amputations, burns, cancer, and severe malnutrition – have been allowed to medically evacuate outside Gaza. Prior to the closure, between 1 January and 7 May, 296 children were medically evacuated abroad. UNICEF, appalled that “figures have failed to stir those with power to act,” shared the stories of three of the many children trapped in Gaza: a twelve-year-old girl needing urgent bone surgery after severe facial injuries (medical evacuation denied four times); a six-month-old with muscle cancer and severe malnutrition, with a tube inserted in his kidney, awaiting evacuation for two months in a tent; and a four-year-old girl who lost a leg and fingers, sustained fourth-degree burns, and risks further amputations of her hand and the other leg without immediate evacuation. The last case was only approved for medical evacuation at the end of October, with no set date for departure, after her mother, whose medical evacuation had been denied, died of fourth degree burns and severe blood poisoning on 23 October. Overall, WHO estimates that 14,000 patients are in urgent need of medical evacuation outside Gaza, with only 39 per cent of all medical evacuation requests approved by the Israeli authorities since October 2023, and just 33 per cent of patients having physically left the Strip. Since the closure of the Rafah crossing, only 229 patients, along with 316 companions, have been exceptionally evacuated on six occasions, with WHO continuing to appeal for the immediate restoration of medical corridors to the West Bank, including East Jerusalem, as well as to Egypt and Jordan, from where patients could be transferred onwards as needed.  
• 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 3 October 2024, at least 14 aid workers and four health workers have been killed and others injured across the Gaza Strip, including some who were off-duty. These include seven UNRWA staff and seven staff of national and international NGOs. Since October 2023, at least 322 aid workers, including 315 Palestinians and seven foreigners have been killed; this includes 237 UN staff (of whom 233 were UNRWA staff members), 33 PRCS staff and volunteers, and at least 52 other aid workers with national and international NGOs. 
• On 26 October, the Israeli military announced the expansion of the zone in Al Mawasi to which it has been ordering Palestinian to move; the order revokes previous evacuation notices affecting 11 square kilometres in Khan Younis and Deir Al Balah, therefore expanding the zone to 68 square kilometres or about 19 per cent of Gaza’s total area. In total, since October 2023 and as of 29 October, the Israeli military has issued over 65 evacuation orders, including four that were subsequently revoked. Currently, about 80 per cent of Gaza is under active evacuation orders. 
• Between 1 and 28 October, out of 580 planned aid movements across the Gaza Strip requiring coordination with Israeli authorities, 44 per cent (254) were denied, 36 per cent (212) were facilitated, 16 per cent (92) were impeded, and four per cent (22) were cancelled due to logistical and security challenges. This includes 93 coordinated aid movements aimed at providing humanitarian assistance in the North Gaza and Gaza governorates via Al Rashid checkpoint, of which only eight per cent (seven) were facilitated by Israeli authorities. 
• A new joint assessment by the UN Development Programme (UNDP) and the UN Economic and Social Commission for Western Asia (UNESCWA) highlights that, by the end of 2024, the Human Development Index (HDI) in Gaza will drop to 0.408—a level estimated for 1955, erasing over 69 years of progress. For the West Bank, the HDI is expected to decline to 0.676, reflecting a 16-year loss, and could further worsen if military incursions expand, with the overall HDI in the Occupied Palestinian Territory (OPT) estimated to have regressed by 24 years. The poverty rate throughout OPT is projected to rise to 74.3 in 2024, up from 38.8 per cent in 2023, affecting 4.1 million people, including 2.61 million who are newly impoverished. The assessment underscores that the number of people living in multidimensional poverty has more than doubled in 2024 compared with 2017, rising from 24.1 to 55.4 per cent throughout OPT, with the greatest increases in deprivation rates observed across the following Multidimensional Poverty Index (MPI) indicators: freedom of movement, monetary resources, unemployment, access to healthcare and school enrolment. The analysis also shows that Gross Domestic Product (GDP) has contracted by 35.1 per cent this year, compared with a no-war scenario, with unemployment potentially rising to 49.9 per cent. “Projections in this new assessment confirm that amidst the immediate suffering and horrific loss of life, a serious development crisis is also unfolding – one that jeopardizes the future of Palestinians for generations to come,” stressed the UNDP Administrator, Achim Steiner, adding that “even if humanitarian aid is provided each year, the economy may not regain its pre-crisis level for a decade or more,” particularly in the absence of early recovery or under a restricted early recovery scenario.  

Funding 

• As of 29 October, Member States have disbursed about US$2 billion out of the $3.42 billion (60 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, 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.